A New Method for Prostate Cancer Diagnosis
In men with high PSA (Prostate-Specific Antigen) levels and/or abnormal findings in a digital rectal examination, the standard method for diagnosing prostate cancer involves taking needle biopsies from 10 or 12 different points of the prostate under ultrasound guidance. With this method, prostate cancer can be detected in approximately 40% of cases. In men with persistent suspicion of prostate cancer, repeated biopsies may be necessary, increasing the risk of complications such as infection, bleeding, and pain. Furthermore, ultrasound-guided prostate biopsy has certain limitations, including the inadequate detection of clinically significant prostate cancer (Gleason score > 7) and the overdiagnosis of clinically insignificant prostate cancer.
As a result, men with undetected clinically significant prostate cancer may miss out on necessary treatment, while those diagnosed with clinically insignificant cancer may undergo excessive treatment, facing serious complications.
In recent years, advancements in imaging techniques have led to the widespread use of multiparametric MRI in prostate cancer diagnosis. In addition to conventional imaging, dynamic contrast-enhanced and diffusion-weighted imaging allow for the identification of areas within the prostate that are highly suspicious for cancer.
The most significant advantage of prostate MRI is its ability to evaluate the entire prostate gland comprehensively. Multiparametric prostate MRI plays a crucial role in guiding prostate biopsies. By using specialized equipment and software, MRI images are fused with ultrasound images, creating a three-dimensional visualization and mapping of the prostate. This fusion technique is more successful in diagnosing clinically significant prostate cancer compared to traditional ultrasound-guided biopsy.
Laser Prostate Surgery – HoLEP Method
Holmium Laser Enucleation of the Prostate (HoLEP) is a type of minimally invasive surgical procedure used to treat urinary obstruction caused by benign prostatic hyperplasia (BPH).
HoLEP surgery is one of the closed (endoscopic) prostate surgery methods, utilizing high-energy laser technology.
In men with benign prostatic hyperplasia, there is no cancer in the prostate gland, but the gland itself is enlarged. An enlarged prostate can lead to several urinary symptoms, such as frequent urination, difficulty urinating, urinary retention, or impaired bladder control.
Patients experiencing urinary complaints are initially treated with medication. If the symptoms persist despite medical treatment, surgical intervention is considered for patients with benign prostatic hyperplasia.
The choice of surgical method depends on the severity of the patient’s symptoms, prostate volume, the presence of other medical conditions, the medications the patient is using, and their ability to tolerate anesthesia.
HoLEP surgery is considered a highly effective treatment method based on the principle of separating the adenomatous portion of the prostate that obstructs the urinary tract from the surrounding prostate capsule using laser technology. The inner prostate tissue, known as the adenoma, is dissected from the capsule with a laser and pushed into the bladder. The adenomatous tissue is then fragmented and removed using a device called a morcellator.
The advantages of this surgery include a shorter operative and hospitalization time, particularly in patients with large prostate glands (>80 grams). Postoperatively, the urinary catheter is removed in a shorter period. Additionally, since the sphincter muscle responsible for urinary continence is separated from the prostate tissue at the beginning of the surgery, the risk of urinary incontinence is significantly reduced. As the entire prostate adenoma tissue is removed, the likelihood of recurrence is nearly nonexistent. Furthermore, HoLEP can be successfully performed on patients using blood-thinning medications.
Prof. Dr. Ender Özden
Assoc. Prof. Dr. Mehmet Necmettin Mercimek
Urology Specialists
