Prostate cancer is one of the most common cancers in men. Every year, more than 60,000 men in Germany are diagnosed with prostate cancer. More than 80 percent of the men affected are older than 60 at the time of diagnosis. The average age of onset is 69 years.
For every 100 men, around three die of prostate cancer every year. That is about 10 percent of all cancer deaths. This makes prostate cancer the third most common fatal cancer after lung cancer and bowel cancer.
It is mainly men over 60 who develop prostate cancer © Sergii Mostovyi / AdobeStock
The earlier prostate cancer is detected, the better it can be treated.
Prostate cancer does not cause any symptoms at an early stage. This is why early prostate cancer screening tests are of the utmost importance. Men aged 45 and over can have them once a year free of charge.
Various examinations are available for the early detection and diagnosis of prostate cancer, including
If prostate cancer is detected early, the chances of recovery are very good. The surgeon can then remove the tumor completely, for example by performing a prostate cancer operation. If the prostate cancer is at an advanced stage, it can, for example
- Difficulties urinating,
- blood in the urine and
- pain during ejaculation or
- bone pain
bone pain.
Radical prostate cancer surgery is the best choice for localized prostate cancer.
Other therapeutic options are
The prostate is also known as the prostate gland. It is about four centimetres in size and has a walnut-like shape. The organ is located directly below the bladder and surrounds the urethra, which drains urine from the bladder to the outside.
The location of the prostate © Henrie / Fotolia
The two seminal vesicles are located to the left and right above the prostate. They are also part of the internal male sex organs. The prostate and seminal vesicles produce fluids that are important for sperm motility.
During ejaculation (ejaculation), the fluids are expelled as seminal fluid together with the sperm formed in the testicles.
The testicles and adrenal glands produce the male sex hormone testosterone. It regulates the growth and function of the prostate.
The reasons why prostate cancer develops are largely unknown. However, risk factors have been identified that increase the development of prostate cancer. These risk factors include
- age and
- a genetic predisposition.
In addition, there are other factors that may increase the risk of developing prostate cancer. These include, for example
- hormones and
- vitamin D deficiency.
Age as a risk factor for prostate cancer
The most important factor in the development of prostate cancer is age:
- Prostate cancer practically never occurs under the age of 40.
- Over 80 percent of men are older than 60 when they are diagnosed with prostate cancer.
- Between the ages of 50 and 85, the probability of developing prostate cancer increases 40-fold.
Many men develop silent (latent) prostate cancer. This is a precursor to prostate cancer. Only in some of these men does it develop into a prostate carcinoma requiring treatment. According to studies of deceased men
- around 30 percent of all men over the age of 50 and
- about 60 percent of all 60-year-olds
have latent prostate cancer.
Genetic predisposition and the development of prostate cancer
Prostate cancer occurs more frequently in some families. Doctors therefore assume that prostate cancer is at least partly due to a genetic predisposition.
Men from families in which there are no cases of prostate cancer have a risk of developing the disease of around 13 percent. Men whose father or brother suffers from prostate cancer, on the other hand, have a twofold higher risk of developing the disease themselves.
The risk of developing the disease can even rise to over 50 percent if other relatives suffer from prostate cancer.
Influence of hormones on the development of prostate cancer
The hormone testosterone is involved in the growth of prostate cells and the function of the prostate. Without testosterone, prostate cancer cannot develop.
Men who lose their testicles at a young age very rarely develop prostate cancer. This shows that testosterone promotes the growth of prostate cancer cells.
A high testosterone level promotes the development of prostate cancer © jarun011 / AdobeStock
Vitamin D deficiency as a risk factor for prostate cancer
Doctors attribute growth-inhibiting properties to vitamin D in cancer. Vitamin D levels could play a role in the development of prostate cancer.
However, further research is required to confirm this assumption.
Other possible risk factors
There are different study results on the influence of
- diet,
- lifestyle and
- occupational factors
are available. Therefore, no conclusions can be drawn regarding the risk of prostate cancer. According to the latest findings, however, the following factors do not appear to have any influence on the risk of prostate cancer:
- Sexual behavior
- viral infection
- benign enlargement of the prostate gland(prostatic hyperplasia)
- Socio-economic factors
- Sterilization after vasectomy (cutting of the spermatic cords).
Unfortunately, there are no typical complaints or early symptoms. Those affected therefore initially notice nothing of the growing tumor in the prostate.
Only when the disease progresses does prostate cancer cause symptoms. Many of these symptoms can be traced back to a constricted urethra or blockage of the urine outflow. This is the result of the enlarged prostate, which then presses on the urethra. These micturition disorders (problems urinating) include
- Delayed onset of micturition (urination),
- prolonged micturition with a weak stream,
- dribbling,
- interruption of the urine stream,
- residual urine in the bladder and
- urinary retention (inability to urinate).
The following symptoms can also occur with prostate cancer:
- Increased urge to urinate, especially at night,
- difficult urination,
- frequent leakage of small amounts of urine,
- pain when urinating,
- painful ejaculation and
- reduced ejaculation.
If the tumor continues to grow outside the prostate, those affected experience pain in the genital area. Erectile dysfunction is possible with nerve damage. In rare cases of advanced prostate cancer, there may also be visible blood in the urine or seminal fluid. As with any cancer, there may also be general symptoms such as
- fever,
- night sweats,
- fatigue,
- poor performance,
- anemia and
- unwanted weight loss
can occur. However, symptoms may also be due to metastases. Depending on the location of the metastases, the following symptoms may occur, for example:
- Pain in the spine and pelvis in the case of bone metastases
- spontaneous bone fractures in the case of bone metastases
- neurological deficits due to spinal cord injury in the case of metastases in the spinal cord or spinal column
- lymphoedema of the legs or scrotum in the case of metastases in the lymph nodes
Men who notice symptoms characteristic of prostate cancer should be examined by a urologist © New Africa / AdobeStock
The current German guidelines recommend the following screening tests to prevent prostate cancer:
- digital rectal examination
- PSA test
The statutory health insurance companies pay for these screening tests for men of a certain age.
Palpation of the prostate
The doctor feels the prostate with a finger via the anus. With this palpation examination, the doctor can only detect superficial and larger prostate carcinomas.
The digital rectal examination of the prostate is not sufficient as the sole early detection test for prostate cancer screening.
Determination of the PSA value
The PSA test is a blood test that detects the so-called prostate-specific antigen (PSA) in the blood. In the case of cancer, elevated PSA levels are usually found in the blood. The PSA test can therefore provide an early indication of tumor growth.
However, the benefits of comprehensive PSA screening are still controversial. The test can also
- false positives (i.e. the PSA value is high even though there is no prostate cancer) and
- false negatives (i.e. the PSA value is low even though prostate cancer is present).
results. However, according to a recent long-term study, PSA screening appears to reduce the risk of death.
Determination of the PSA value © jarun011 / AdobeStock
Screening examinations or existing symptoms can lead to a suspicion of prostate cancer. The doctor will then initiate further examinations. These can confirm the suspicion and provide information about the malignancy and extent of the prostate cancer.
The following methods are used to diagnose prostate cancer:
- Transrectal ultrasound examination(TRUS). The doctor inserts an ultrasound probe into the rectum via the anus. This allows him to examine the prostate and the surrounding tissue. The TRUS provides initial indications as to whether a tumor is present and whether it has already extended beyond the prostate. It is painless.
- Prostate biopsy: Using a thin needle, the doctor takes tissue samples from the prostate under ultrasound guidance. If cancer cells are found in the microscopic examination, it is certain that prostate cancer is present.
- Ultrasound examination of the kidneys: to determine whether the prostate cancer is already obstructing the outflow of urine from the kidneys.
- Magnetic resonance imaging(MRI): Good visualization of the tumour. An MRI provides more precise information on the location and extent of the prostate or tumor. In addition, the doctor can also assess whether and to what extent prostate cancer surgery is advisable.
- Excretory urography (X-ray examination with contrast medium): The doctor examines the urinary tract. The aim of excretory urography is to determine whether the ureters, urinary bladder or urethra are affected.
- Skeletal scintigraphy(bone scintigraphy): Used to examine the bones or the entire skeletal system for metastases. To do this, the doctor injects a radioactively labeled substance into the bloodstream, which accumulates in the metastases. The metastases can then be visualized using a special camera.
- Chest X-ray: In advanced prostate cancer, metastases in the lungs can be detected in this way.
Transrectal ultrasound © bilderzwerg / Fotolia
Various treatment options are available for the treatment of prostate cancer. Specialists can combine them and tailor them to the individual needs of the patient. Which treatment has the best chances of recovery depends primarily on the stage of the tumor.
Surgical treatment methods include radical prostatectomy. This involves the complete surgical removal of the prostate.
Non-surgical therapies include
are available.
Conservative prostate cancer treatment: radiotherapy
Radiotherapy is an alternative to surgery for early-stage prostate cancer. Targeted radioactive radiation damages the tumor cells to such an extent that they can no longer divide.
If the radiation is administered externally, doctors refer to this as percutaneous radiotherapy. If the radiation source is introduced into the body, this is called brachytherapy.
With modern radiation techniques, the neighboring organs are largely spared. Nevertheless, temporary symptoms such as inflammation of the bladder and bowel can occur. In addition, 30 to 40 percent of men experience impotence.
Conservative prostate cancer treatment: hormone therapy
Hormone therapy is often used in addition to prostate cancer surgery or radiotherapy for advanced prostate cancer.
The doctors cause an artificial testosterone deficiency. This can bring tumor growth to a standstill.
The testosterone deficiency can be treated by
- suppression of testosterone production (e.g. by removing the testicles or administering medication) or
- the administration of anti-androgens
can be caused.
Conservative prostate cancer treatment: chemotherapy
In chemotherapy, the patient is given drugs that are intended to damage the cancer cells. Ideally, they can then no longer divide and cancer growth is stopped.
Controlled waiting
Prostate cancer usually grows slowly. It therefore does not always have to develop into a life-threatening cancer. In older patients with slow-growing tumors in the early stages, prostate cancer specialists can therefore also take a wait-and-see approach.
Treatment is then limited to active monitoring of the tumor. The doctors monitor the growth of the prostate carcinoma through regular diagnostic examinations. Active treatment is only started if the tumor begins to grow faster.
Surgery is a very effective therapy if the cancer is confined to the prostate.
The prostate cancer therapy of choice is then radical prostatectomy. Surgeons remove the prostate together with the prostate capsule
- prostate capsule,
- seminal vesicles and
- and the ends of the vas deferens.
The chances of recovery and survival are then greatest.
Prostate cancer surgery procedure
In principle, the following open or minimally invasive surgical techniques can be used to remove the prostate:
- Radical retropubic prostatectomy (RRP ) is an open prostate cancer operation. The approach is performed with the patient in a reclined position. The surgeon removes the prostate via an incision between the pubic symphysis and the navel.
- Radical perineal prostatectomy (RPP ) is also an open operation. Access is also via the back. The patient's legs are bent at about 90 degrees at the hip joint. The surgeon can remove the prostate through an incision between the scrotum and anus (perineum).
- Laparoscopic (transperitoneal) radical prostatectomy (LRPE ) is a minimally invasive prostate cancer operation. The patient is in the supine position. Access is via the abdominal wall through the peritoneum.
- Endoscopic extraperitoneal radical prostatectomy (EERPE) is a minimally invasive surgical method. Access is also gained through the abdominal wall with the patient lying on their back. However, the surgeon does not pass through the peritoneum as in LRPE. Instead, a cavity is created outside the peritoneum by blowing in carbon dioxide, through which the surgeon reaches the prostate.
- The state-of-the-art, minimally invasive robot-assisted radical prostatectomy (RARP) is a further development of conventional laparoscopic methods. It combines the advantages of laparoscopic prostatectomy with those of open retropubic prostatectomy. The so-called Da Vinci robot supports the surgeon during prostate cancer surgery with orientation and movement in the body.
Goals of prostate cancer surgery
All techniques pursue three goals:
- complete removal of the tumor
- Preservation of continence
- Preservation of potency
The first two goals are paramount.
Preserving potency only makes sense if the man is still potent before the operation. When preserving potency, the potency nerves running close to the prostate are spared. However, if the prostate carcinoma has already broken through the capsule of the prostate, nerve preservation is no longer possible.
Complications of radical prostate cancer surgery
Despite advances in surgical techniques, complications cannot always be avoided during a radical prostatectomy. Possible complications include
However, only around 1 to 10 percent of men who have undergone surgery experience permanent urinary incontinence.
Potency is retained in half to two thirds of men after prostate cancer surgery. This also depends on the age of the patient and the extent of the tumor.
The aim of follow-up care is the early detection of treatable relapses and the consequences of treatment.
In the first two years, follow-up examinations are carried out every three months. In the case of advanced prostate cancer, every six months thereafter, and annually in the case of prostate cancer treated with curative intent.
The most important examinations are PSA determination and palpation of the rectum.
Regular prostate examinations for follow-up care © peterjunaidy / AdobeStock
In some cases, the cancer comes back even after successful treatment with surgery or radiotherapy. This so-called recurrence can also spread and form metastases.
Treatment is then carried out in the same way as for advanced prostate cancer. In this situation, the focus is on maintaining or restoring quality of life, including effective pain therapy.
In the event of a local relapse after surgical removal of the prostate, a cure can still be achieved with radiotherapy.
If diagnosed and treated at an early stage, over 80 percent of patients survive for 10 years or more. Most can be considered cured.
But even in advanced stages, it is sometimes possible to bring the disease under control for years. Although a cure is then not possible, the progression of the disease is delayed.
Specialists from various medical fields are usually involved in the diagnosis and treatment of prostate cancer.
Prostate cancer specialists are usually specialists in urology and oncology. But also
are often involved in the care of prostate cancer patients.
Certified prostate cancer centers are best suited for optimal care in all phases of the disease. These are medical facilities certified by the German Cancer Society (DKG) that specialize in prostate cancer. Here, specialists from various fields work together on an interdisciplinary basis.
The prostate cancer specialists working there have proven extensive specialist expertise.