Prostate Cancer – Information and Specialists in the Treatment of Prostate Cancer

Prostate cancer, also known as prostate carcinoma, is a malignant tumor of the prostate, the male gland located below the bladder. It is one of the most common cancers in men. The tumor in the prostate develops from abnormal cells that multiply uncontrollably and displace healthy tissue. In this form of cancer, malignant tumors typically form; these initially grow locally but can eventually spread to other organs via the lymph nodes or the bloodstream.

In its early stages, prostate cancer usually causes no symptoms. Only when the tumor grows larger or spreads beyond the gland do initial symptoms such as difficulty urinating, pain during ejaculation, or blood in the urine begin to appear. These nonspecific signs can also occur in benign conditions such as benign prostatic hyperplasia, which is why a medical evaluation by a urologist is always necessary.

In most cases, the disease develops slowly—sometimes over many years. This explains why prostate cancer is often not detected until later in life. Most men who develop prostate cancer are over 60 years old. However, the disease can also affect younger men, especially if there is a family history of the condition.

If prostate cancer is diagnosed at an early stage, the chances of a cure are very good. The goal of treatment is the complete removal or destruction of the malignant tumor and the restoration of a good quality of life. Treatment for prostate cancer depends on the stage of the disease, the patient’s risk profile, and his individual preferences.

Prostate cancer primarily affects men over the age of 60 © Sergii Mostovyi / AdobeStock

Prostate cancer is one of the most common cancers in men. In Germany, more than 60,000 men are newly diagnosed with prostate cancer each year, which accounts for about a quarter of all malignant tumors in men. This makes prostate cancer the most common cancer among men—even more common than lung and colorectal cancer. According to current estimates, the lifetime risk of developing prostate cancer is about 13 percent.

The risk of developing the disease increases significantly with age. While men under 50 are rarely affected, the number of new cases rises sharply starting at age 60. The average age of diagnosis is about 69. Prostate cancer is common among men aged 70 and older, and many men live for years with a slow-growing tumor that causes few symptoms.

According to estimates, more than 300,000 men in Germany are currently living with a diagnosis of prostate cancer. The number of new cases continues to rise due to increasing life expectancy and improved early detection of prostate cancer. International studies show that over the next ten years, more and more men worldwide will be diagnosed with prostate cancer, especially in industrialized nations with high life expectancy and accessible medical care.

Despite the high number of diagnoses, prostate cancer mortality has declined slightly in recent years. Thanks to modern diagnostic procedures and personalized treatment for prostate cancer, the disease can often be detected early and treated successfully. The earlier prostate cancer is detected, the better the chances of recovery.

The prostate, also known as the prostate gland, is an organ about four centimeters in size that is part of the male reproductive system. It is located directly below the bladder and surrounds the urethra—through which urine leaves the body—in a ring-like manner. Anatomically, the gland borders the rectum at the back and the seminal vesicles at the top. This location explains why changes in the prostate—for example, a tumor in the prostate—often lead to problems with urination.

The prostate tissue consists of numerous small glandular lobules surrounded by a capsule of connective tissue. These lobules produce a milky secretion that is expelled with the seminal fluid during ejaculation. This secretion contains, among other things, enzymes, zinc, and what is known as prostate-specific antigen (PSA)—a protein that liquefies the seminal fluid and improves sperm motility. The antigen also plays an important role in the early detection of prostate cancer, as elevated PSA levels in the blood may indicate pathological changes in the prostate.

The function of the prostate is closely linked to male hormone metabolism. The male sex hormone testosterone, which is produced in the testicles, controls the growth, function, and secretion of the gland. Without testosterone, prostate cancer cannot develop—the hormone is therefore considered a key factor in the development of prostate cancer.

In addition to its role in reproduction, the prostate also influences urinary continence. Its muscles help control the flow of urine. If the organ is partially or completely removed during surgery, the sphincter mechanism must be specifically trained to prevent involuntary urination.

The location of the prostate © Henrie / Fotolia

The causes of prostate cancer are not yet fully understood. What is certain, however, is that several risk factors can contribute to the development of prostate cancer. Among the most important are age, genetic predisposition, hormonal influences such as testosterone, and certain environmental and lifestyle factors. These potential causes often interact and influence a man’s individual risk of developing prostate cancer over the course of his life.

Age as a Major Risk Factor

The risk of prostate cancer increases significantly with age. Men under 40 are almost never affected, while over 80 percent of those diagnosed are older than 60. Between the ages of 50 and 80, the likelihood of developing prostate cancer increases 40-fold. Thus, advancing age is considered the most important risk factor for prostate cancer.

Genetic Predisposition

In about 10 to 15 percent of cases, prostate cancer runs in families. If a father or brother has had prostate cancer, the individual’s risk of developing prostate cancer is increased. If there are multiple cases in the family, the risk of developing the disease can even rise to over 50 percent. These findings suggest that certain genetic mutations promote the development of prostate cancer.

Hormonal Influences

The male sex hormone testosterone plays a crucial role in the growth of prostate cells. It not only promotes normal cell function but also the growth of cancer cells in the prostate gland. Without testosterone, prostate cancer cannot develop. Men with consistently high testosterone levels therefore appear to have an increased risk of developing prostate cancer.

High testosterone levels promote the development of prostate cancer © jarun011 / AdobeStock

• Vitamin D Deficiency and Environmental Factors

  Another factor associated with the development of prostate cancer is vitamin D deficiency. Vitamin D inhibits the growth of cancer cells in many tissues. Low levels may therefore increase the risk of prostate cancer. In addition, there is ongoing debate as to whether diet, lack of exercise, occupational stress, or chemical substances also play a role. However, the scientific evidence for these possible causes remains inconclusive.

  Summary

  The causes of prostate cancer are complex and result from an interplay of age, genetic, hormonal, and environmental factors. While some risk factors—such as age or genetic predisposition—cannot be influenced, personal risk may be reduced through a healthy lifestyle, sufficient exercise, and avoiding nicotine and excessive alcohol consumption.

The typical symptoms of prostate cancer usually do not appear until the later stages. In the early stages, prostate cancer causes few or no symptoms, so the disease is often discovered by chance—for example, during a screening exam or when PSA levels in the blood rise.

As the disease progresses, prostate cancer causes symptoms resulting from the tumor in the prostate and pressure on the surrounding urethra. The most common urinary symptoms include a weak urine stream, difficulty urinating, or the feeling of not being able to completely empty the bladder. Some patients also report a frequent urge to urinate at night, a burning sensation when urinating, or dribbling of urine.

In more advanced stages of the disease, the tumor in the prostate can spread to surrounding tissue and lymph nodes. This leads to additional symptoms such as pain in the pelvic or back area. Some patients experience pain during ejaculation, blood in the urine or semen, and erectile dysfunction. While these symptoms are not specific to prostate cancer, they should always be evaluated by a doctor.

In advanced prostate cancer or when metastases form, other general symptoms may occur: fatigue, weight loss, loss of appetite, and bone pain. Metastases in the bones often manifest as dull back pain or spontaneous bone fractures. In cases of metastatic prostate cancer, neurological deficits may also occur if the spinal cord is affected.

The absence of early symptoms is what makes early detection of prostate cancer so important. Anyone who notices changes in urination or ejaculation should definitely see a urologist. The earlier the cancer is detected and treated, the better the chances of a cure and the prospects for a good quality of life.

Men who notice symptoms characteristic of prostate cancer should be examined by a urologist © New Africa / AdobeStock

Early detection of prostate cancer is crucial for identifying the disease at a treatable stage. Since prostate cancer usually causes no symptoms in its early stages, regular screening is particularly important for men aged 45 and older. In Germany, public health insurance plans cover the annual urological examination for early detection.

The foundation of screening is the digital rectal exam (DRE). During this exam, the urologist feels the prostate through the rectum to check whether it is hardened or enlarged. This method is simple to perform and painless, but it is not sufficient on its own to reliably detect prostate cancer.

A key component of screening is the so-called PSA test. This test measures the level of PSA (prostate-specific antigen) in the blood—a protein produced by prostate cells. An elevated PSA level may indicate inflammation, benign prostate enlargement, or prostate cancer. Therefore, the test does not serve as definitive proof but rather as an indication of suspected prostate cancer.

The benefits of the PSA test remain a subject of debate in the medical community, as it can yield both false-positive and false-negative results. Nevertheless, studies show that the PSA test leads to more frequent detection of prostate cancer in its early stages—thereby significantly increasing the chances of a cure.

If prostate cancer is suspected following the screening exam, the urologist will initiate further diagnostic steps. These include imaging tests and a tissue sample (biopsy) to confirm the diagnosis of prostate cancer.

In summary: Men who undergo regular screenings have a significantly higher chance of detecting prostate cancer early and receiving successful treatment.

PSA Level Measurement © jarun011 / AdobeStock

The diagnosis of prostate cancer is a step-by-step process aimed at detecting the disease as early and reliably as possible. If prostate cancer is suspected following a screening or an abnormal PSA level, further tests are conducted to detect the tumor in the prostate and determine its stage.

The most important diagnostic methods include:

• Transrectal ultrasound (TRUS): Using a small ultrasound probe inserted into the rectum, the urologist can examine the prostate and surrounding tissue. This allows the urologist to determine whether there is a suspicious lump or enlargement.

Transrectal ultrasound © bilderzwerg / Fotolia

• Prostate biopsy: This is the crucial step in confirming a diagnosis of prostate cancer. During the procedure, the doctor uses a thin needle to remove several tissue samples from different areas of the prostate. These samples are examined under a microscope to determine whether cancer cells are present and how aggressively they are growing.
• MRI or CT: Imaging techniques help detect the spread of the tumor and any possible metastases. This makes it possible to determine whether the prostate cancer is locally confined or has already metastasized.
• Bone scan: This test is used to detect bone metastases, as prostate cancer often spreads to the skeletal system first.

The removed tissue is examined histologically. During this process, the pathologist assesses the structure of the cancer cells and determines the so-called Gleason score, which provides information about the aggressiveness of the malignant tumor. The higher the score, the more the cancer cells differ from healthy tissue, and the poorer the prognosis.

Based on the results of the tissue examination and imaging studies, the stage of prostate cancer is determined according to the TNM classification. Here, T describes the extent of the tumor within the prostate, N describes lymph node involvement, and M describes the presence of metastases in other organs.

An accurate diagnosis of prostate cancer is crucial for selecting the appropriate treatment. It forms the basis for distinguishing between localized prostate cancer, locally advanced prostate cancer, and metastatic prostate cancer, and for developing an individualized treatment strategy.

The treatment of prostate cancer depends on the stage, tumor type, and the patient’s overall health. The goal is the complete removal of the malignant tumor or the control of its growth.

Key Forms of Treatment

Combinations of multiple treatments (e.g., radiation and hormone therapy) are common and increase effectiveness. The decision is made by an interdisciplinary team of physicians from urology, oncology, and radiation oncology.

Surgery for prostate cancer, also known as radical prostatectomy, is considered one of the most effective methods for curing locally confined prostate cancer. During the procedure, the malignant tumor in the prostate is completely removed to prevent it from spreading to other organs. This form of prostate cancer treatment is particularly appropriate when there are no metastases and the patient is in generally good health.

Goal and Procedure

The goal of the surgery is to completely remove the tumor while preserving continence and sexual function, provided this is oncologically feasible.
During the procedure, the surgeons remove the prostate, the seminal vesicles, and usually the surrounding lymph nodes as well, in order to detect any cancer cells at an early stage.

There are several surgical procedures:

• Open radical prostatectomy: Access via the lower abdomen.
• Laparoscopic prostatectomy: A minimally invasive procedure performed through small incisions with camera assistance.
• Robot-assisted prostatectomy (da Vinci system): A state-of-the-art, highly precise method with a shorter recovery time.

The surgery is performed under general anesthesia and usually takes two to three hours. After the procedure, a urinary catheter remains in place for a few days to allow the urethra to heal.

Chances of Recovery and Follow-Up Care

When prostate cancer is detected early, the chances of a cure after surgery are very high. Studies show that over 80 percent of patients remain tumor-free in the long term. Regular PSA tests are conducted after surgery to detect a possible recurrence at an early stage.

Structured pelvic floor exercises support the restoration of continence, while specialized rehabilitation programs help maintain sexual function.

Regular prostate exams as part of follow-up care © peterjunaidy / AdobeStock

Possible Complications

As with any surgical procedure, radical prostatectomy also carries risks. The most common include:

• Urinary incontinence: Usually temporary; can be effectively managed with targeted exercises.
• Erectile dysfunction: If nerve structures are affected, sexual function may be impaired.
• Infections or bleeding: Rare, but usually treatable.
• Lymphoceles: Fluid collections following lymph node removal, which are monitored by a doctor.

Despite possible side effects, surgery offers the best chance of cure for many patients with localized prostate cancer.

Follow-up Care and Treatment for Recurrence

Follow-up care for prostate cancer is a crucial component of the overall treatment and management of prostate cancer. It begins immediately after treatment is completed and aims to detect and treat potential recurrences or metastases at an early stage.

Goals of Follow-Up Care

• Early detection of recurrences: Regular monitoring of PSA levels serves as the most important indicator.
• Identification of long-term effects: Such as urinary incontinence, erectile dysfunction, or psychological stress.
• Maintaining quality of life: Follow-up care provides patients with both medical and psychological support.

During the first two years, follow-up appointments are usually scheduled every three months; thereafter, they are scheduled every six months or annually—depending on the tumor stage and individual risk.

Examinations During Follow-Up Care

Treatment of a recurrence

If a local recurrence occurs after surgery or radiation therapy, in many cases repeat radiation therapy or adjunctive hormone therapy may be administered.
For metastatic prostate cancer, a wide range of options are available today—including:

• Chemotherapy to combat cancer cells systemically
• Hormone deprivation therapy (e.g., antiandrogens)
• Targeted and immunotherapies that activate the immune system
• Palliative care approaches to relieve pain and extend life expectancy

The goal is to control the tumor, alleviate symptoms, and maintain the highest possible quality of life.

The treatment of prostate cancer requires experience, precision, and close interdisciplinary collaboration among various medical specialties. Since prostate cancer can take many different courses, diagnosis and treatment should always be carried out by proven prostate cancer specialists.

Departments Involved

Certified Prostate Cancer Centers

For optimal care, treatment at certified prostate cancer centers is recommended. These facilities are accredited by the German Cancer Society (DKG) and meet strict quality standards for the treatment and follow-up care of prostate cancer.
Here, physicians from all relevant specialties work closely together to develop an individualized treatment plan for each patient.

The advantages of treatment at a certified center include:

• Proven better treatment outcomes through standardized procedures
• Regular quality controls and participation in clinical trials
• Access to modern therapies and innovative surgical methods
• Interdisciplinary case conferences to ensure optimal treatment decisions

Second opinions and patient involvement

Especially with complex conditions such as prostate cancer, a second medical opinion can help ensure more confident treatment decisions. Many clinics offer structured second-opinion programs.
Patients should also be actively involved in treatment decisions—it has been shown that informed patients make better decisions and benefit more from their chosen treatment.

How is prostate cancer diagnosed?

Prostate cancer is usually suspected based on an elevated PSA level or abnormal findings during a digital rectal exam. The diagnosis is definitively confirmed by a biopsy, in which tissue samples are taken from the prostate. This is the only way to determine whether a malignant tumor is present. Early detection of prostate cancer starting at age 45 helps identify the disease at an early stage and treat it in a timely manner.

What are the causes and risk factors for prostate cancer?

The exact causes of prostate cancer have not yet been fully elucidated. Age is considered the most significant risk factor for prostate cancer. In addition, a genetic predisposition, high testosterone levels, and a vitamin D deficiency can increase the risk of prostate cancer. Certain dietary and lifestyle habits can also contribute to the development of prostate cancer. Regular screening exams are therefore crucial for preventing or detecting prostate cancer as early as possible.

How is prostate cancer treated?

Treatment for prostate cancer depends on the tumor stage, how far it has spread, and the patient’s overall health. In the early stages, surgery (e.g., radical prostatectomy) or radiation therapy is often used. For advanced prostate cancer, hormone therapy or chemotherapy is used as a supplement. Active surveillance is also an option if the tumor is growing slowly and causing no symptoms. Modern treatments for prostate cancer aim to optimize quality of life and chances of recovery.

What are the chances of recovery and life expectancy for prostate cancer?

The chances of recovery for early-stage prostate cancer are very good. If the tumor is detected early and surgically removed, more than 80 percent of patients survive for more than ten years. Even in cases of advanced prostate cancer, the disease can often be kept under control for years through a combination of treatment and follow-up care. Life expectancy for prostate cancer depends primarily on the stage of the tumor and the patient’s response to treatment.

When should you see a doctor if you suspect prostate cancer?

Anyone who notices problems with urination, blood in the urine, or pain in the pelvic area should visit a urologist’s office immediately. The urologist can rule out the possibility of prostate cancer through targeted examinations and, if necessary, initiate appropriate treatment for prostate cancer. Early diagnosis and timely treatment have been shown to improve the chances of recovery.