Prostate Cancer

Prostate cancer may not have symptoms for years, which makes prevention so important.

What is it?

Prostate cancer is the most common male cancer but also a cancer with a relatively good prognosis, especially if diagnosed early. As it is usually asymptomatic, periodic examinations are very important to the diagnosis. These tests are PSA, prostate ultrasound and DRE. These tests do not necessarily make the diagnosis but show if there is a need for prostate biopsy, as the diagnosis is only made upon biopsy.


There are no clear causes for prostate cancer. We can only mention risk factors that will motivate men to make a prostate check-up after a certain age. These factors are heredity, genetic background and various gene mutations.

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Prostate cancer may not have symptoms for years, which makes prevention so important. When symptoms occur, the disease has usually already spread and is very difficult to treat.

Typical symptoms may be:

  • difficulty in starting or stopping urination
  • nocturia
  • burning when urinating
  • erectile dysfunction
  • presence of blood in the urine or sperm

The problem is that while sometimes we have a strong suspicion of prostate cancer, the biopsy fails to detect it. This is because either there is no cancer (the examinations raise suspicions but not certainty) or it is difficult for the cancer to be detected on biopsy. This is because the biopsy is performed via transrectal ultrasound, but very often the cancer is equivalent to the rest of the parenchyma and is therefore indistinguishable, i.e. practically invisible. For this reason, we take several samples at each biopsy, thus scanning the areas where cancer usually occurs

In order to reduce the possibility of “error” in the initial indication (i.e. during tests, such as PSA, etc, which create the suspicion of cancer while it does not exist), and to avoid unnecessary biopsies, we now have additional tests available. PCA3 is a molecular test performed on a urine sample and aims to solve this very problem: if a negative biopsy to a man with suspected PSA was wrong and there is actually cancer. It is a simple test that can save many men from unnecessary biopsies.

At the same time, for better detection of a cancerous outbreak in the prostate, we now have a special MRI of the prostate called multiparametric. It is a special MRI which requires good training and experience on the part of the radiologist and helps to identify cancer foci inside the prostate gland.

Very recently, the technique of biopsy has evolved, which can now be done with the fusion technique: that is, while the corrective ultrasound remains as a way of imaging during the biopsy, modern machines “read” the MRI and project to the ultrasound’s image the findings of the MRI so that the physician can direct the biopsy accurately to the suspicious areas.


To diagnose prostate cancer, some tests are performed to pinpoint cancer cells or subcutaneous nodules.

The DRE is a rapid method of diagnosing prostate cancer, giving the andrologist a clear image of the gland through palpation. The next test is the measurement of the PSA antigen, with a simple blood test. Usually the high levels are worrying.

The imaging methods i.e. plain ultrasound or MRI are also important.


Prostate cancer treatment remains mainly surgical. Alternatives exist depending on the age, stage and general condition of the body. Thus a patient can undergo radiation, hormone therapy or combinations of the above, as the case might be.

Radical prostatectomy is the removal of the prostate, the seminal vesicles and –if necessary- the lymph nodes, which is the best solution. Robotic radical prostatectomy is an evolution of laparoscopic radical prostatectomy with several benefits: less blood loss and possibly better rates of self-restraint and maintenance of erectile function.

An important condition for a good postoperative erectile function is the maintenance of vascular neurotransmitters. In Androclinic, the surgical treatment of prostate cancer, either through the classic radical prostatectomy or using Robotics, is performed with special respect to the preservation of angioedema, so that our patients have the best possible conditions for a good erection and a good sex life after surgery.

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Vasilis Protogerou

Dimitrios Mporousas

Konstantinos Makarounis