Prostate Cancer

What Is Prostate Cancer?

Prostate cancer (also: prostate carcinoma, PCA) is the most common malignant tumor disease in men. Almost 3% of men in Germany die of prostate cancer. After lung cancer and colon cancer, prostate cancer is the third deadliest tumor disease in the western world. Due to the further increasing life expectancy, the number of men who have prostate cancer is also increasing.

Prostate carcinoma is a tumor of the older man, in men under 40, it is practically non-existent. 80% of the over-70s have a clinically not yet noticeable prostate carcinoma without dying of it.

The tumor cells in this type of cancer originate from the glandular tissue of the prostate gland. The cause of the disease is still only vaguely known. However, an active genetic component is clearly to be pointed out. For example, men whose fathers have been diagnosed with prostate carcinoma have about twice the average risk of developing the disease.

Symptoms of Prostate Cancer

In the beginning, prostate carcinoma shows no signs, which is why the tumor is often discovered in an advanced stage. In the later stages of cancer, the patient may complain about problems urinating. Nerve lesions can lead to erectile dysfunction.

It is also possible that tumor disease is only recognized by symptoms of metastases (tumor spread). In this case, tumors mainly occur in the bones (primarily the spine and pelvis). These can cause pain or spontaneous fractures (pathological fracture).

Metastases in the lymph nodes can lead to congestion of lymph fluid, which accumulates in the legs or scrotum. In advanced stages of the disease, most patients lose a lot of weight unintentionally and suffer from anemia.

How Is Prostate Cancer Diagnosed?

The non-invasive form of digital-rectal examination by an experienced examiner is an excellent way of detecting prostate cancer at an early stage. The prostate cancer shows a very typical palpation finding. A more precise determination of size and location is possible in a transrectal ultrasound. A special ultrasound probe is inserted rectally, and tumors with a diameter of 20 millimeters or more can be reliably detected.

A more sophisticated form of examination is the possibility of magnetic resonance imaging (nuclear spin). In the field of nuclear medicine, positron emission tomography (PET) is now available. In this procedure, cancer cells are radioactively marked and can then be reliably defined from healthy or inflamed prostate tissue in a computer tomogram.

Among others, the prostate-specific antigen (PSA) can be verified in the blood. PSA is only found in prostate tissue but is not specific for a tumor disease. The PSA level can also be elevated in an enlarged prostate gland (prostate) or inflammation of the prostate (prostatitis). PSA is, however, a good indicator as progression parameter over the years of prostate observation and an important laboratory value in tumor aftercare (a renewed increase in PSA is a sign of tumor relapse.

The tumor prognosis depends mainly on the degree of tumor cell aggressiveness, the PSA value, the lymph node metastases, and distant metastases. As long as the tumor has not spread, there is a good chance of healing prostate cancer.

Unfortunately, tumors are often only diagnosed after metastasis has formed due to the lack of early symptoms. For this reason, regular cancer screening by a urologist is essential for men over 50. The digital-rectal examination can already detect early stages of prostate carcinoma, and the probability of recovery is many times higher.

Therapy: How Is Prostate Cancer Treated?

The treatment options for prostate cancer are very versatile. Since the patients are usually older men who often do not experience or will not survive a burdensome late stage of the tumor, an increasingly common treatment method is "watchful waiting," where the tumor is actively observed, and invasive therapy is only initiated if necessary.

The therapy is always carried out by a multidisciplinary team of urologists, radiologists, pathologists, internists, and oncologists.

General therapy approaches include surgical removal of the prostate tissue (prostatectomy), radiation therapy, hormone therapy, or chemotherapy. Complete surgical removal of the prostate is possible if the tumor stage is not too advanced. The prostatectomy can be carried out in different ways, depending on the access possibilities, among others, robot-assisted ( Da Vinci® surgical system ). Each surgical technique has its advantages and disadvantages, and the most suitable therapeutic approach must be worked out individually for each patient.

Alternative Treatment Methods for Prostate Cancer

Newer methods, such as therapeutic hyperthermia, e.g., in the form of HIFU, are currently undergoing clinical trials. The highly intensive focused ultrasound has been used in Germany for about ten years. The therapeutic results achieved with this technique to date are very satisfactory, but in the treatment guidelines (status 2011), HIFU therapy is still considered an experimental procedure.

PSMA therapy also represents a new procedure in prostate cancer therapy for patients in whom chemotherapy and hormone therapy are no longer sufficient. PSMA stands for prostate-specific antigen and is a targeted form of treatment using radioactive substances that only act on the tumor cells. As a result, the tumor is irradiated from the inside, and, in many cases where there no treatment options in the past, there is a reduction in tumor mass and thus, an improvement in symptoms.

Prognosis: What Are the Healing Chances for Prostate Cancer

The prognosis for prostate cancer is relatively good. If the tumor has spread only to the prostate, life expectancy is hardly reduced.

The overall mortality rate in patients with prostate cancer is estimated at 20%. 5 years after the diagnosis of a tumor limited to the organ, 80-99% of patients are still alive. With metastatic prostate cancer, 31% are still alive after five years. The chances of recovery (complete removal of the tumor cells) are only possible if the tumor is limited to the prostate.

Early Detection of Prostate Carcinoma

Since prostate carcinoma can be easily cured when diagnosed early, the guidelines for the therapy contain the following:

All men over the age of 40 should have an annual digital-rectal examination of the prostate and an annual PSA measurement. So, do not forget to go to your preventive medical checkups early and regularly!

Which Doctors And Special Clinics Are Specialists in Prostate Cancer?

Anyone who has been diagnosed with prostate cancer wants the best medical care. Therefore, the patient is wondering where to find a prostate cancer specialist or the best clinic for prostate cancer?

Since this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on the experience of a doctor and certification by independent bodies. The more prostate cancer cases a doctor treats, the more experienced he becomes in his specialty.

Prostate cancer specialists are urologists who work in a certified prostate cancer center. Due to their experience and many years of work, they are the right contact person for the diagnosis and determination of the treatment plan.

Sources:

• S3-Leitlinie: Prostatakarzinom; Früherkennung, Diagnose und Therapie der verschiedenen Stadien
• de.wikipedia.org/wiki/Prostatakrebs
• www.krebsinformationsdienst.de/tumorarten/prostatakrebs/