Prostate cancer

Symptoms

There are no definitive symptoms that indicate prostate disease. In general, the signs and associated symptoms of the disease only become noticeable when the cancer has already reached a very advanced stage. There is a variety of potential symptoms:

• frequent urination/frequent urge to urinate
• weakening of the urine stream
• pain when passing urine
• problems passing urine
• blood in urine
• erectile dysfunction
• incontinence

The earlier the tumour is detected, the higher the patient’s chances of recovery. For this reason, it is recommended that men aged 45 and over have regular urological check-ups.

Diagnosis

As part of the screening procedure, the external genital organs are checked by means of a tactile examination. The prostate is then scanned through the rectum in a procedure known as a DRE or digital rectal exam, which is a quick, easy and pain-free examination method. However, this examination is only able to detect larger tumours on the surface of the prostate.

A further step in the diagnosis is the determination of the PSA value. PSA stands for prostate-specific antigen, a protein produced in the prostate. Cancer cells produce much more PSA than healthy prostate cells. A high PSA value is therefore a further indication of prostate cancer. However, the level of PSA can be influenced by various other factors. These factors include other illnesses, sporting activities or medication. It is therefore important that all these factors are taken into account when evaluating the PSA value.

The only way to make a clear diagnosis is to take a tissue sample (biopsy). MRI (magnetic resonance imaging) is used to provide more accurate information about the area of the prostate under question. The MRI scans and the biopsy are used to determine the aggressiveness of the tumour, i.e. the Gleason score, after which the appropriate course of treatment can be established.

Treatment

There are two very different categories of prostate cancer: localised and locally advanced cancer, and metastatic cancer, which has already spread to the cells of other organs. While localised cancer is curable, advanced cancer is treatable but it tends to be resistant to treatment in the long term. Thanks to preventive check-ups, most newly diagnosed cancers are now detected at an early stage and can therefore be cured.

Hormone therapy and chemotherapy are used for certain cases of prostate cancer or metastases.

Conservative, non-surgical treatment

Active monitoring

If the tumour is less aggressive, non-palpable and has a low PSA value, then the first step is active tumour monitoring. Treatment is delayed until the tumour reaches a size whereby it requires further treatment. During active monitoring, the patient receives intensive medical care, and prostate biopsies are performed at regular intervals to evaluate the status of the tumour.

Radiotherapy

The aim of radiotherapy is to damage the tumour cells, thereby preventing the cancer cells from spreading and, ideally, completely destroying them. Radiotherapy can take the form of both internal and external radiation.

Cyberknife

External radiation is carried out through the skin using a linear accelerator, which irradiates the prostate cancer from various directions. This procedure is performed on an outpatient basis. Thanks to the CyberKnife system, tumours can be treated with extreme precision.

Brachytherapy

In brachytherapy, a radioactive chemical element or ‘radionuclide’ is injected into the prostate using a needle. The procedure is performed under spinal anaesthesia and can be done either on an outpatient basis or as part of a short stay in hospital.

High-intensity focused ultrasound ( HiFU for short)

Small and less aggressive tumours are treated using an high-intensity focused ultrasound. Ultrasound waves are directed at the diseased part of the prostate to remove the affected tissue without surgery. HiFU treatment is performed in addition to ‘active monitoring’. This makes it possible to determine precisely how effective the treatment is.

Surgical treatment

Radical prostatectomy

In medicine, the term ‘radical prostatectomy’ refers to the complete removal of the prostate. This is a routine surgical procedure with the aim of extracting the entire prostate cancer. It is performed using the daVinci® surgical robot. In addition to the prostate capsule and the seminal bladder, the lymph nodes are also removed in the course of this operation.

Aftercare

Follow-up treatment includes regular medical examinations designed to ensure that any relapses are detected in good time. 30% of all men treated develop a new tumour or metastasis forms in another part of the body in subsequent years.

Aftercare usually begins immediately after completion of treatment, but at the latest after three months. PSA tests are carried out at regular intervals. If there is an increase in the PSA value, the same tests are carried out as a follow-up as were performed during the initial check-up.