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Specialists in the Field of Prostate cancer
Information About the Field of Prostate cancer
Definition: What is prostate cancer and how common is it?
Prostate cancer (also: carcinoma of the prostate) is the most common malignant tumor disease that affects men. Approximately 3% of men in Germany die from prostate cancer. Following lung and colorectal cancer, prostate cancer is the third deadliest tumor disease in the western world. Due to the consistently increasing life expectancy, the number of men ill with prostate cancer increases as well. Prostate cancer mostly affects older men, as it hardly occurs in men under the age of 40. 80% of men over the age of 70 have clinically undiagnosed prostate carcinoma, but do not die as a result.
The tumor cells are, by this form of glandular cancer, within the prostate gland. The origin of this disease is still only vaguely known. A strong genetic component is however clearly underlined. Men whose fathers were affected by prostate cancer have as high as double the risk of developing the disease than normal.
Symptoms of Prostate Cancer
Initially, prostate cancer does not cause any symptoms, which is why the tumor is often discovered first in an advanced stage. In later tumor stages, the patient can experience difficulties urinating. Due to nerve lesions, erectile dysfunction can result. It is also possible that the tumor is first recognized through symptoms of metastasis. In this case, there are often tumors in the bones (primarily the spine and pelvis). Pain or spontaneous fractures can be a result of this. Through metastases in the lymph nodes, the clogging of lymph fluids can occur, which can lead to a blockage in the legs or the scrotum. In advanced stages of the disease, most patients unintentionally lose excessive weight and suffer from anemia.
Diagnosis of Prostate Cancer?
The non-invasive type of examination, a digital rectal exam, provides a very good chance to identify prostate cancer early, with an experienced examiner. The prostate cancer exhibits a very typical palpable manifestation. To determine the exact size and position of a tumor, it is possible to do so with a transrectal ultrasound. Here, a special ultrasound probe is lead into the rectum and can discover tumors that are 20 millimeters in diameter and larger.
A further possibility is the more complex and elaborate examination form, magnetic resonance tomography (MRT). In the field of nuclear medicine there is the possibility of the positron-emissions-tomography (PET) . Here, the cancer cells are radioactively marked and can be differentiated from healthy or inflamed prostate tissue in the computed tomogram.
In the blood, other prostate specific antigens (PSA) can be identified. PSA is only in prostate tissue, but is not specifically related to a tumor illness. The PSA-value is increased by an enlarged prostate gland or by an infected prostate (prostatitis). The PSA value is however, a good indicator as a follow-up parameter over the years of observing the prostate, or, an important lab value in the tumor follow-up care (a new increase of the PSA is a sign of tumor recurrence).
The tumor prognosis depends, above all, on the level of aggressiveness of the tumor cells, the PSA-level, and whether there is lymph node metastasis and remote metastasis. If there is no metastasis there is a good chance for recovery from prostate cancer. Unfortunately, due to an absence of early symptoms, the tumor diagnosis is often made first after the formation of metastases. A regular cancer screening for men age 50 and above should take place. Through a digital rectal examination, early stages of prostate cancer be discovered and the chances for recovery are significantly higher.
Therapy by Prostate Cancer
The treatment possibilities for prostate carcinoma are very versatile. Since most patients are older men, who frequently cannot survive the painful late stages of the tumor, an increasingly frequently applied treatment method is known as “watchful waiting.” Here, the tumor is actively observed and an invasive therapy is only performed when necessary. General therapies include the surgical removal of the prostate tissue (prostatectomy), radiation therapy, hormone therapy or chemotherapy. The complete surgical removal of the prostate is possible, if the tumor stage is not too advanced. The prostatectomy can take place in different ways, depending on the access point, and among others, with assistance from a robot (Da Vinci®-Surgical System). Each surgical technique has advantages and disadvantages and needs to be adapted to each patient individually, to determine which therapeutic intervention will be most appropriate.
The therapy takes place with a multidisciplinary team of urologists, radiologists, pathologists, internists and oncologists. New methods such as therapeutic hypothermia, for example in the form of HIFU , is currently being tested. The high intensity focused ultrasound has been used in Germany since the past 10 years. The previous therapy results of this technology have been very satisfactory, and in the treatment guides (Stand 2011) the HIFU-therapy is still seen as an experimental method.
Prostate Cancer Prognosis
The prognosis by prostate cancer is relatively good. If a tumor has not spread, the life expectancy is hardly reduced. The general mortality rate of prostate cancer is about 20%. 5 years after the cancer diagnosis, 80-99% of the patients survive. When prostate cancer metastasizes, 31% of patients survive after 5 years. Recovery (the complete removal of tumor cells) only exists when the tumor is limited to the prostate.
Early Detection of Prostate Cancer
Since prostate cancer can be healed if it is detected early, the guidelines for prostate cancer therapy are:
All men 40 years of age and older should have a digital rectal examination of the prostate as well as an annual PSA-level check.
Do not forget to go early and regularly to check-ups!
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