Is prostate cancer curable

Advanced prostate cancer

The illness

The chances of a cure in advanced prostate cancer are not as good as in the early stages. However, around every fourth tumor is estimated to be larger before an operation and turns out to be easily curable afterwards. If the cancer has already spread to the lymph nodes, bones or other organs, it can no longer be cured. But its growth can be slowed down for a long time.

Several tests should clarify how aggressive your cancer is and how far it has spread. The right treatment depends on this and your needs and goals. You can find detailed information about the recommended examinations in the patient guideline "Prostate Cancer II. Locally Advanced and Metastatic Prostate Cancer" (see "Explained in detail" below).

The treatment

Advanced prostate cancer:

Here treatments with the aim of healing can come into question. They are designed to completely remove or destroy the cancer. This includes:

  • The surgery: the prostate is surgically removed (radical prostatectomy).

  • The Irradiation: irradiation takes place either from the outside through the skin or directly in the prostate.

Both procedures can have side effects. The most common include erectile dysfunction (impotence) and bladder weakness (Incontinence).

During an operation, the treatment team should also remove the surrounding lymph nodes. This can lead to further complications, for example a build-up of tissue fluid in the legs. It is unclear whether removing the lymph nodes will prolong life. However, it can be important to plan further treatment.

In the case of irradiation, the expert group also recommends a time-limited treatment with medication ("hormone withdrawal": see below). This can extend the life of some of those affected. It is unclear whether additional irradiation of the lymphatic tract has any advantages.

Irradiation "from the inside", the so-called High dose brachytherapy, should always be carried out in conjunction with external radiation. Medicines are also recommended here as well.

Metastatic prostate cancer:

Once the cancer has spread, the aim is to slow down its growth or alleviate symptoms. Prostate cancer grows stronger due to the body's own hormone testosterone. So-called hormone withdrawal treatment can lower testosterone levels. Hormone withdrawal is possible with medication or surgically by stripping the testicles.

If you are physically fit, you can combine it with chemotherapy or another hormone drug (abiraterone: see below). This combination can significantly extend life.

In the course of the treatment, the cancer cells become completely insensitive to the withdrawal of hormones. As long as the cancer does not cause any noticeable symptoms, further treatment with medication usually does not bring any benefit. However, if symptoms arise, medication is available that can delay the progression of the disease:

  • Abiraterone and enzalutamide are part of hormone therapy, but they also work when the cancer has become insensitive to hormone withdrawal. There are milder side effects compared to chemotherapy. Abiraterone has been tested in patients with relatively minor symptoms. Unlike chemotherapy, you take both active ingredients permanently.

  • Docetaxel is a chemotherapy drug that prevents cells from dividing. As cancer cells divide quickly, it is particularly effective here.

  • Radium 223 is a weakly radioactive substance that is only suitable for bone metastases.

Studies show that these active ingredients can extend life by a few months. So far, however, they have not yet been compared directly with one another. If the cancer continues to progress anyway, these and other drugs may be considered again.

But you can also do without doing more about cancer. Because all drugs are associated with risks and side effects, which under certain circumstances put more stress on your body than cancer. Especially for men with a weakened physical condition, it can make sense to have specific complaints such as pain and tiredness treated effectively.

What you can do yourself

  • Cancer changes your life and that of your loved ones. If you feel the need for professional help, you can take advantage of psycho-oncological care. This offer is also open to your relatives.

  • Be patient with yourself. Treatment success is not always immediately noticeable. Tell your healthcare team if you notice any severe side effects.

  • You can support treatment with a healthy lifestyle. This includes a balanced diet and exercise. Physical activity should be tailored to your personal situation and not overwhelm you. It also helps against side effects such as severe fatigue.

  • Exchange ideas with others. You are not alone in your fate. In self-help groups, you will receive support from other sufferers who know from their own experience how prostate cancer can change life.

June 2018, published by the German Medical Association and the National Association of Statutory Health Insurance Physicians