비뇨기질환
What is prostate cancer?
Like prostatic hyperplasia, prostate cancer becomes more common with age. It was originally a disease of Western populations, but the number of patients in Korea is also rising sharply with a Westernized lifestyle and an aging population. Prostate cancer occurs mainly in older men; in examinations of the prostate in patients who died of other conditions, prostate cancer was found in 20% of those aged over 50. Because it is found frequently in Western populations, a high-fat, high-protein Western diet has been suggested as a cause, but no clear causal relationship has yet been established.
Prostate cancer and prostatic hyperplasia arise in different parts of the gland. Prostate cancer develops mainly in the outer (peripheral) zone and prostatic hyperplasia in the inner (transition) zone, so prostatic hyperplasia never develops into prostate cancer. However, the two conditions can occur at the same time, so a man with prostatic hyperplasia may also have prostate cancer. Because they can arise separately, anyone with troubling symptoms should see a urologist promptly and be checked for prostate cancer as well.
Diagnosis of prostate cancer
| Digital rectal examination |
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| It is the most basic and essential test for prostate screening and for detecting prostate cancer. Because prostate cancer mainly arises in the peripheral zone, the digital rectal examination is highly significant. 1) Performed annually for men in their 50s and older with a life expectancy of 10 years or more 2) Performed annually from age 45 for those with a family history of prostate disease |
| Prostate-specific antigen (PSA) |
| PSA is an extremely important test used clinically for the early detection of prostate cancer, for staging before treatment, and for follow-up after prostate cancer treatment. It is present in high concentrations in prostate tissue and semen, but in the blood of healthy adult men its concentration is below 4 ng/ml; when the structure of the prostate is disrupted, the blood level rises. |
| Transrectal prostate ultrasound |
| It must be performed when an abnormality is found on digital rectal examination or PSA is elevated, and it is used for diagnosis, staging and follow-up after treatment. |
| Prostate biopsy |
| If the digital rectal examination is abnormal or PSA is elevated, a prostate biopsy must be performed. |
| CT and MRI |
| After a diagnosis of prostate cancer, radiologic examination is required for accurate staging and to decide whether to operate. |
| PHI test |
| This is the most recently developed test. In patients with a high PSA, it calculates other prostate-related factors to estimate the likelihood of prostate cancer. University hospitals have begun performing the PHI test before biopsy, and its use is expected to expand further. |
Treatment of prostate cancer
Treatment of prostate cancer varies with the stage of the cancer and includes radical prostatectomy, radiotherapy, hormone therapy and chemotherapy. In localized prostate cancer, where the cancer is confined within the prostate, complete cure can be expected with surgical treatment, but prostate cancer at a relatively advanced stage is known to have a lower chance of cure than localized disease.
| Radical prostatectomy |
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| Patients diagnosed with localized prostate cancer can be cured by radical prostatectomy, performed robotically or as open surgery, and the recurrence rate is very low when it is carried out early. Complications such as erectile dysfunction and incontinence may occur after surgery, but they are not permanent. |
| Radiation therapy |
| Radical radiotherapy is used for prostate cancer that has no distant metastasis and is confined to the prostate or the tissue immediately around it. As with surgery, the decision must take the patient's age into account, as well as the various side effects and complications that come with treatment. |
| Hormone therapy |
| This treatment is based on the fact that the prostate grows under the influence of male hormones and that prostate cancer cells, too, slow their growth or die without them. It is generally used in patients with advanced prostate cancer rather than localized disease. It is currently used in combination before or after radiotherapy, and there are reports that this can reduce the radiation field or lower the rate of cancer recurrence after radiotherapy. |
| Expectant management |
| This approach may be considered when a prostate cancer patient's life expectancy is 10 years or less, the stage is low and the cancer is well differentiated. The greatest advantage of watchful waiting is that it avoids the complications that can follow prostatectomy or radiotherapy, so quality of life can be maximized. The disadvantage is that continued progression of the prostate cancer may cause various symptoms and as a result the chance for active treatment may be missed, which can shorten overall survival. |
Post-treatment precautions
- Treatment results and duration may vary depending on individual symptoms.
- Temporary side effects may occur after treatment and vary with each individual's condition.
