Prevents castration prostate cancer

Prostate cancer

Information about prostate cancer (malignant tumor of the prostate)

The diagnosis of prostate cancer (malignant disease of the
Prostate gland) is a major turning point in the life of a man and his loved ones.

Unfortunately, prostate cancer is a frequently made diagnosis with over 60,000 new cases per year in Germany. In many cases, however, prostate cancer is curable. However, the therapy options are varied and often confusing for the patient and his relatives. In particular, the decision which form of therapy is best for the patient in his or her individual life situation is a challenge.

Since prostate cancer is usually a slowly growing tumor, you have plenty of time to make a decision.

We will do all we can to support them in their decision-making. The following information is intended to give you an overview.
In addition, you will be given web addresses that provide more detail
have outgoing information ready for you.
Of course, this information is only supplementary and in no way replaces a confidential discussion with your treating urologist.

1. Location and function of the prostate

The prostate, also called the prostate gland, is usually the shape and size of a chestnut. It is located directly below the urinary bladder and surrounds the upper part of the urethra like a ring.

The prostate secretion, which forms the largest part of the seminal fluid, ensures the supply of nutrients and the ability of the sperm to move on their way to the egg cell. The prostate closes the neck of the bladder during orgasm so that the sperm flows forward. Due to its location at the transition between the urinary bladder and urethra, the prostate also supports the secure "closure" of the urinary bladder.

With age, the prostate gland enlarges, sometimes it grows to the size of a peach. The larger it becomes, the more it can narrow the urethra. Almost every second man over 60 has problems urinating as a result. What causes benign glandular tissue or prostate carcinomas to grow has not yet been precisely clarified, despite intensive research.

2. Numbers and facts about prostate cancer

Prostate cancer is the most common tumor in men.
The earlier the disease is recognized, the greater the chances of recovery.
The incidence of the disease increases with age. The mean age of onset is around 69 years. In Germany about 63,000 men fall ill every year,
around 12,500 men die of prostate cancer every year.
The type of treatment depends largely on how aggressively the cancer is growing and how far it has progressed.

Prevention and the use of PSA (Prostate Specific Antigen) increases the proportion of prostate cancers that are detected at an early stage. Men whose brothers and / or fathers have prostate cancer have a two-fold increased risk of developing prostate cancer during their lifetime.

Even at an advanced stage, prostate cancer can usually be successfully kept in check for many years.

3. Prostate cancer

As a rule, prostate cancer develops in the outer part of the prostate gland, where it can be detected during a palpation examination. Since the cancer often forms daughter tumors (metastases) in lymph nodes or bones without treatment, targeted therapy should be started as soon as possible.
The problem with prostate cancer is that in the early stages it usually does not cause any symptoms at all. If you have problems with urination, blood in the urine or bone pain, this can be an indication that the cancer has already progressed.

The earlier prostate cancer is discovered, the better the chances of recovery. Regular preventive care is therefore important. From the age of 45 (men with first-degree relatives, e.g. brothers who have prostate cancer from the age of 40), men should have an annual screening examination.

3.1 Diagnosis

During the screening examination, the doctor carries out a palpation examination. Because the prostate gland is scanned through the rectum with a finger, this procedure is also known as a digital rectal examination (DRE). Above all, benign enlargements, but also suspicious lumps and indurations, can be easily felt, provided that they are in a location that is accessible to the doctor. Since the prostate, which is located in a ring around the urethra, can grow in all directions and many tumors are hardly enlarged at an early stage of the disease or produce an inconspicuous palpation, the DRU does not offer a 100% reliable early detection.

The so-called PSA test can be a useful addition to the palpation examination. PSA (Prostate Specific Antigen) is a protein that is also produced by "normal" prostate cells. However, if the PSA value exceeds a certain limit, this can be a sign of prostate cancer.
A blood sample is taken to determine the PSA value. In healthy men, the limit value - depending on age and depending on various other factors - is below 4 ng / ml. A higher value does not necessarily mean cancer, but the risk of developing a prostate tumor is significantly higher.
The rate of increase of the PSA over the course must also be taken into account.
The early detection examination with the PSA test should definitely be carried out by an experienced doctor you trust. He can also inform you about the benefit, the risk and any further examinations that may be necessary.
If a PSA value higher than 4 ng / ml is measured and / or if a suspicious palpation examination of the prostate is found, follow-up examinations are necessary to confirm the diagnosis. As part of an ultrasound examination of the prostate via the rectum (transrectal ultrasound ultrasound, TRUS), tissue samples (biopsy) are taken from the prostate in our practice under local anesthesia.
After the diagnosis of prostate cancer, further examinations may be useful. B. a bone examination.

PSA value: discussed again and again
The importance of the PSA value and the meaning of comprehensive PSA tests has been the subject of controversial discussions in recent years. The critics argue that many men are unnecessarily frightened by increased PSA values, but that an increased PSA value is by no means synonymous with cancer.
That's right, because healthy prostate tissue also produces PSA, which is why the substance is not actually a "tumor marker" A sharp rise in the PSA value can therefore be an important indicator of a malignant tumor. The earlier the PSA value is determined for the first time and the more regular it is checked, the better the increase can be assessed in individual cases.
Even if the PPE provision has to be paid for out of pocket.

3.2 forecast

The chances of recovery or survival in prostate cancer depend primarily on how far the tumor has progressed at the time of diagnosis. As treating urologists, we can best assess the individual clinical picture.

If the tumor is discovered at an early stage, prostate cancer is now one of the curable diseases. If the prostate cancer is limited to the prostate gland, around 80 percent of patients will survive the next ten years.
In patients whose tumors have already spread to other organs, the 10-year survival rate is significantly lower.
The more intensively you work on treating your disease, the greater your chances.

How advanced is prostate cancer?
Before deciding on a particular therapy, the degree of spread of the tumor must be determined. Various systems are available for this.
The TNM system is one of the most common. Cancer diseases are classified according to the size of the tumor (T), the occurrence of metastases in the lymph nodes (N from Latin nodus = node) and the occurrence of metastases in other organs (M). The TNM system is crucial in the selection of an individual cancer treatment.
Another important factor in assessing treatment prospects is that according to the American doctor Dr. Donald Gleason called the Gleason Sum. It divides the tumor tissue into points according to the degree of its aggressiveness. A value below 7 speaks for a more favorable prognosis, a value above for a worse prognosis.

3.3 Therapy

In principle, prostate cancer can be operated on, irradiated or treated with medication. Close monitoring is also possible in individual cases. The various therapy options are often combined with one another or applied one after the other.
While the methods of treating localized prostate cancer aim to cure, in the advanced stages of the disease the aim is to stop tumor growth, keep the patient pain-free and thereby enable him to enjoy a high quality of life.

3.3.1 Treatment options for local prostate cancer

- surgery (radical prostatectomy)
If the tumor has not yet expanded beyond the prostate and no daughter tumors have formed, surgery is often performed. The prostate, including the seminal vesicles, is completely removed by making an incision below the navel or on the perineum between the scrotum and the anus. Other options for surgery are laparoscopic or robot-assisted procedures.
The nerve cords that are responsible for the erection of the male member and that run along the right and left of the prostate can be preserved under certain conditions so that the potency can be maintained after the operation.
The patients who cannot be operated on to maintain potency usually lose their erectile function.
Nevertheless, patients with aids can still have sexual intercourse after surgery.

Further consequences can be: thrombosis, secondary bleeding and - at least temporarily - urinary incontinence (involuntary loss of urine).

- radiation therapy (radiotherapy)
As an alternative to surgery, the tumor can be irradiated. If the cancer is already locally advanced, the radiation is often carried out in combination with hormone therapy.

External irradiation
The aim of radiation therapy is to destroy the cancer cells. To do this, the region in which the tumor is located - possibly including the lymph nodes in the pelvic area - is irradiated from the outside (percutaneous irradiation). The affected area of ​​the prostate is irradiated several times a week and for a period of at least eight weeks.
Thanks to modern equipment, the radiation can be placed so precisely that healthy tissue is hardly affected. Nevertheless, in some cases this procedure leads to inflammation and discomfort in the rectum and bladder. Here, too, the potency of the patient can suffer.

Irradiation from the inside
Alternatively, the irradiation can also be carried out "from the inside". With permanent "seed" implantation, very small, radioactively charged metal pins are implanted in the prostate. There they emit radiation for several months. They can then remain in the prostate permanently.
The side effects of permanent seed implantation are moderate. Temporary irritation of the bladder with burning sensation and increased urination may occur three to four weeks after implantation. In rare cases, the rectum is also irritated. Erectile dysfunction can occur as a long-term consequence.
Another method of irradiation from the inside is afterloading therapy. Small hollow needles are inserted into the prostate.
The high doses of radiation can in rare cases lead to chronic inflammation of the rectum or bladder as a result of afterloading applications. Erectile dysfunction can occur as a long-term consequence.

Further forms of treatment with radiation
In some patients, radiation therapy is performed as an additional measure after the operation (adjuvant radiation therapy). This is to reduce the risk of recurrence (relapse). In addition, radiation is often used to specifically combat metastases.
If the tumor can no longer be cured, radiation therapy can provide strong pain relief.

- Active surveillance
In some patients with a low tumor burden, a wait-and-see approach is also possible.
The patients must be monitored closely. Therapy is only initiated when the progression of the prostate cancer can be recognized.

3.3.2 Treatment options for advanced prostate cancer

- Hormone therapy

If lymph node or bone metastases have already formed when the prostate carcinoma is diagnosed, local treatment with surgery or radiation therapy is no longer sufficient. Instead, forms of treatment are used that are effective throughout the body (systemic therapy).
In hormone therapy, the fact that around 80 percent of prostate cancers shrink when testosterone is withdrawn is used for treatment.
More than 90 percent of the male sex hormone testosterone is produced in the testes. Since it not only promotes the growth of normal but also prostate cancer cells in the prostate, the removal of testosterone-producing tissue in the testes (surgical castration) or the drug-based suppression of testosterone production (chemical castration) are among the most important hormonal processes Therapy methods for prostate cancer.

Castration by surgery
For many doctors, the goal of hormone therapy today is a testosterone level of below 20 ng / dl. This value corresponds to the testosterone level of patients from whom the hormone-producing testicular tissue was surgically removed.
The advantage of the operation, which is carried out on an outpatient basis in our practice, is that it is immediately effective and only needs to be carried out once.

Medicinal castration
The formation or effect of the body's own testosterone can also be suppressed by drugs (chemical or medicinal castration).
LHRH analogs
So-called LHRH (luteinizing hormone-releasing hormone) analogues are usually used in chemical castration. They intervene in the hormone control loop in such a way that testosterone is no longer produced and tumor growth is stopped.
The drug is usually injected into the patient's subcutaneous tissue every three or six months. The effect of the LHRH analogues is identical to that of surgical testicular tissue removal.

Another variant of hormone therapy is the administration of anti-androgens. They suppress the effect of testosterone by preventing it from entering the tumor cell. Anti-androgens can also be used in addition to hormone therapy to completely shield prostate cancer from growth-stimulating hormones.

Testosterone levels can also be lowered by taking female sex hormones (estrogens). However, estrogen treatment has considerable side effects (such as painful swelling of the mammary glands) and therefore no longer corresponds to the current medical standard as the sole form of therapy.

Cardiovascular complaints, thromboses, embolisms and depressive moods can occur during hormone treatment. Hot flashes and sweats also occur. In addition, those treated have to reckon with reduced sexual drive and impotence

- chemotherapy

Chemotherapy is usually only used for prostate cancer when the possibilities of other therapies such as surgery, radiation or hormone therapy have been exhausted.
For treatment, drugs (cytostatics) are administered that prevent cell growth and thus tumor growth. Since the cells of the skin, hair, mucous membranes and bone marrow also divide, they too are attacked by chemotherapy. This can lead to side effects such as hair loss; other organs can also be affected.
Other side effects such as nausea and diarrhea can usually be controlled with the help of medication.
Chemotherapy does not cure the disease, but it can delay the disease and relieve pain.

3.4 Which therapy is right for me?

Every therapy decision is an individual case. As your treating urologists, we examined you and on this basis suggested a treatment to you. And educated you about the advantages and disadvantages of the various therapy options available.

What happens now is ultimately up to you.
Find out all about it and talk to us about it. It is important that you are convinced of the correctness of the step you are now taking.

3.5 During and after therapy: prostate cancer and partnership

All forms of treatment for prostate cancer have more or less strong effects on your sexual interest and potency.
As a result of surgical removal of the prostate, sometimes also in the course of radiation therapy, erectile function is often impaired. If the tumor is treated with hormone therapy, not only the fertility but also the desire for sex can - at least temporarily - wane.
Go on the offensive! Save yourself false expectations and unnecessary disappointments for your partner. An open conversation can significantly contribute to a more intensive and successful handling of your illness and open up new paths to a loving and sexually satisfying partnership.

3.6 Regular follow-up examinations

In order for us to keep control over the course and success of the therapy - and to be able to take countermeasures quickly if the prostate cancer progresses - it is important that you absolutely keep to the agreed follow-up appointments.
Check-ups usually take place every three months, later at intervals of six or twelve months. The mandatory program includes regular physical exams, an ultrasound examination of the urinary tract and a mostly quarterly blood test to determine the PSA value.

More information:

German Cancer-research center

Urological Oncology Working Group in the German Cancer Society (AUO)

Bruno-Hermann-Weg 5 office
18299 Hohen Sprenz
Tel .: (03 84 54) 3 24 04
Fax: (03 84 54) 3 24 05

Patient information from the German Society for Urology        


Federal Association for Prostate Cancer Self-Help e.V. (BPS)

[email protected]

toll-free advice hotline 0800-7080123