Information on prostate cancer
What is prostate cancer?
Prostate cancer (also known as 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 ever-increasing life expectancy, the number of men suffering from prostate cancer is also increasing.
Tumor in the prostateProstate cancer is a tumor of old men; it practically never occurs in men under 40. 80% of people over 70 have prostate cancer that has not yet become clinically noticeable, but does not die from it.
The tumor cells in this cancer originate from the glandular tissue of the prostate. The cause of the disease is still only vaguely known. However, a strong genetic component is clearly evident. Men whose fathers had prostate cancer have a risk of developing the disease that is about twice as high as normal.
Symptoms of prostate cancer
At the beginning, prostate cancer has no symptoms, which is why the tumor is often only discovered in the advanced stages. In later stages of the tumor, the patient may complain of problems urinating. Nerve lesions can lead to erectile dysfunction.
It can also happen that the tumor is only recognized when symptoms of metastases (tumor spread) appear. This mainly involves tumors in the bones (primarily the spine and pelvis). These can cause pain or spontaneous fractures (breaks, pathological fractures).
Metastases in the lymph nodes can lead to a build-up of lymph fluid, which backs up into the legs or scrotum. In the advanced stages of the disease, most patients lose a lot of weight unintentionally and suffer from anemia.
How is prostate cancer diagnosed?
Digital rectal examination
The non-invasive form of examination, the digital rectal examination, is a very good way for experienced examiners to detect prostate cancer at an early stage. Prostate cancer has very typical palpable findings. A more precise size and location determination is possible using transrectal ultrasound. A special ultrasound head is inserted rectally and tumors with a diameter of 20 millimeters or more can be reliably detected.
PSA value determination
The prostate-specific antigen (PSA) can be detected in the blood, among other things. PSA only occurs in prostate tissue, but is not specific to a tumor. The PSA value can also be increased in the case of an enlarged prostate or prostatitis, among other things. However, the PSA is a good indicator as a progression parameter over the years of prostate observation and an important laboratory value in tumor follow-up care.
Prostate MRI
As a newer procedure, the prostate MRI already shows good results in terms of diagnostic reliability. It can be used for prostate prevention, prostate diagnostics and monitoring the progression of prostate cancer.
PSMA PET/CT
In the field of nuclear medicine, PSMA PET CT is now available. Cancer cells are radioactively marked and can then be reliably distinguished from healthy or inflamed prostate tissue in the computer tomography. The advantage of the procedure is that the entire spectrum of tumor disease can be covered in one examination. PET CT is superior to other examination methods, particularly for detecting metastases, as it provides more precise results. For this reason, the examination has become increasingly important in recent years.
Prostate biopsy
In order to definitively determine whether a prostate cancer is present, a prostate biopsy is necessary. Tissue is taken from the suspicious area and then examined by a pathologist. In order to increase the accuracy, increasingly precise procedures are being developed.
Fusion biopsy of the prostate describes the use of images from ultrasound and MRI to examine the prostate. By merging the imaging procedures, a more precise diagnosis can be made and the tumor can be localized within the prostate before tissue samples are taken with a punch. This increases the hit rate of ultrasound-guided punch biopsy.
Unfortunately, due to the lack of early symptoms, tumors are often only diagnosed after metastases have formed. Therefore, regular cancer screening by a urologist is essential for men over the age of 50. Digital rectal examinations can detect early stages of prostate cancer and the probability of a cure is many times higher.
Therapy: How is prostate cancer treated?
There are many different treatment options for prostate cancer. Since the patients are usually older men who often do not experience/survive the difficult late stage of the tumor, an increasingly common treatment method is "watchful waiting". Here, the tumor is actively monitored and invasive therapy is only initiated if necessary.
The therapy is always carried out by a multidisciplinary team including urologists, radiation medicine specialists, pathologists, internists and oncologists.
General treatment approaches are the 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 performed in different ways, depending on the access options and can also be robot-assisted (Da Vinci® surgical system). Each surgical technique has advantages and disadvantages and the most suitable treatment approach must be worked out for each individual 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. High-intensity focused ultrasound has been used in Germany for around 10 years. The treatment results to date with this technique are very satisfactory, but in the treatment guidelines (as of 2011) HIFU therapy is still considered an experimental procedure.
PSMA therapy is also a new method in prostate cancer therapy for patients for whom chemotherapy and hormone therapy are no longer effective. PSMA stands for prostate-specific membrane antigen and is a targeted form of therapy using radioactive substances that only act on the tumor cells. This irradiates the tumor from the inside and in many cases where there were previously no treatment options, the tumor mass shrinks and the symptoms improve.
Prognosis: What are the chances of recovery from prostate cancer?
The diagnosis of prostate cancer does not have to be a death sentence. On the contrary - the prognosis for prostate cancer is relatively good. If the tumor has only spread to the prostate, life expectancy is hardly reduced.
The overall mortality rate of those suffering from prostate cancer is estimated at 20%. 80-99% of those affected are still alive 5 years after the diagnosis of a tumor limited to the organ. In the case of metastatic prostate cancer, 31% are still alive after 5 years. There is only a chance of recovery (complete removal of the tumor cells) if the tumor is limited to the prostate.
Early detection of prostate cancer
Since prostate cancer is easily curable if detected early, the guidelines for the treatment of prostate cancer contain the following:
All men over the age of 40 should have an annual digital rectal examination of the prostate and an annual PSA test. So don't forget to go for your preventive examinations early and regularly!!
Which specialists and specialist clinics are specialists in prostate cancer?
Anyone suffering from prostate cancer wants the best medical care for themselves. That's why the patient asks themselves, where can I find a prostate cancer specialist or the best clinic for prostate cancer?
As this question cannot be answered objectively and a reputable doctor would never claim to be the best doctor, you can only rely on a doctor's experience 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 therefore urologists who work in a certified prostate cancer center. Thanks to their experience and many years of practice, they are the right people to contact for diagnosis and to determine the treatment plan.
