Prostate Cancer

Prostate cancer, also known as prostate carcinoma, is a form of cancer that develops in the prostate, a small gland in the male reproductive system. The main function of the prostate is to produce the fluid for the sperm cells.

At just under 22%, prostate cancer is the most common cancer in men and is easily treatable if detected early. It occurs when cells in the prostate grow and divide uncontrollably. This excessive cell growth can lead to a malignant tumour that can expand and squeeze the structures in the urinary tract. In addition, prostate cancer can also metastasise to distant tissues and affect the entire body.

Prostate cancer mainly occurs at an older age, from 50 onwards. While statistically, only one in 4800 men under the age of 35 is diagnosed with prostate cancer, this figure rises to one in fifteen among 75-year-olds. Regular screening should therefore take place with increasing age.

Nevertheless, even at a young age, if symptoms are present, a check-up should be carried out to rule out an aggressively growing tumour.

Prostate cancer can often be asymptomatic in the early stages. However, if symptoms do occur, the following physical reactions may become noticeable:

Frequent urge to urinate: sufferers may experience an increased urge to urinate, which manifests itself particularly at night.

Difficulty urinating: Problems starting or stopping urination, weak urine stream or the feeling of not being able to empty the bladder completely.

Blood in the urine or ejaculate: The presence of blood in the urine (haematuria) or ejaculate may indicate prostate cancer.

Pain: Pain or discomfort in the pelvic area, lower back or thighs may occur.

Erection problems: Difficulty maintaining an erection can be a symptom of prostate cancer.

It is important to note that these symptoms can also indicate other diseases of the prostate or urogenital tract. You should definitely consult an experienced doctor for a more precise clarification.

Metastases in prostate cancer mean that the cancer has spread from the prostate to other parts of the body. The most common areas of the body to which prostate cancer can spread (metastasise) are the bones, particularly the spine, pelvic bones and thigh bones. However, other organs such as the lungs, liver or lymph nodes can also be affected by metastases from prostate cancer.

Metastasis usually occurs at a late stage. Therefore, it is very important to recognise the cancer early and remove the prostate. Once it has spread, it is almost impossible to cure it completely and the treatment is associated with significantly greater side effects.

When diagnosing prostate cancer, there are various methods that can ultimately support the diagnosis of prostate cancer. The digital rectal examination, determination of the PSA value, special blood values, ultrasound diagnostics and biopsy, are all part of the diagnostic measures for suspected prostate cancer.

The digital rectal examination is a manual examination technique in which the prostate and rectum are palpated by the examiner in order to detect possible changes and hardening. If the urologist has the appropriate experience, the examination is reliable and therefore part of regular screening in old age.

The PSA test analyses the prostate-specific antigen, which is produced by the prostate and can be elevated in the event of pathological changes to the prostate. We go into more detail about the PSA value below.

The PSA value has been the golden standard in prostate examinations for years and provides information about changes in the prostate. The PSA value is elevated in cases of hyperplasia, inflammation and cancer and can support a suspected diagnosis in combination with other examination techniques.
In addition to the PSA value, alkaline phosphatase and LDH (lactate dehydrogenase) can be determined in the blood in order to recognise metastases in the bone.

Ultrasound is a frequently used imaging method in the diagnosis and monitoring of prostate cancer. There are different types of ultrasound examinations that are used for prostate cancer:

Transrectal ultrasound (TRUS): this is a commonly performed method of examining the prostate. The doctor inserts a narrow ultrasound probe into the rectum. As the prostate lies directly in front of the rectum, the TRUS enables detailed visualisation of the prostate structure. The doctor can identify suspicious areas and, if necessary, take specific tissue samples (biopsies).

Transabdominal ultrasound: This method is performed through the abdominal wall (transabdominal) and allows a rough view of the prostate. It is less commonly used for the diagnosis of prostate cancer, but can be useful in certain situations such as monitoring the size of the prostate.

Doppler ultrasound: This special ultrasound mode measures the blood flow in the blood vessels. Doppler ultrasound can help to distinguish malignant tumours from benign ones, as cancerous tumours often have increased blood flow.

Biopsy plays a crucial role in the diagnosis of prostate cancer. Other diagnostic procedures, such as the PSA test (prostate-specific antigen), digital rectal examination (DRE) and imaging procedures can only provide a tentative diagnosis. However, only a biopsy can provide a definitive diagnosis.

After ultrasound-guided tissue sampling, the sample is sent to the laboratory and histologically analysed. Based on the exact visualisation of the cell types, a definitive diagnosis can be made in the laboratory.

PSA, also known as prostate-specific antigen, is an antigen produced by the prostate. If the prostate becomes enlarged, inflamed or cancerous, the production of the antigen increases and the increased concentrations can be detected in the blood.

Especially in asymptomatic cases, the PSA status provides indications of possible diseases and is therefore an excellent basic screening tool.

Depending on age, there are different threshold values that can indicate a change. In addition, recurring determinations allow changes and their dynamics to be analysed very quickly so that treatment can be initiated at an early stage.

In addition, both free and bound PSA can be determined and the ratio of the two can provide information about the type of disease.

If the value is elevated, this is an indication for a biopsy to confirm the diagnosis.

The exact causes of prostate cancer are not fully understood, but there are some factors that are associated with an increased risk of developing prostate cancer. It is important to note that the presence of these risk factors does not necessarily mean that a person will develop prostate cancer, and many men with prostate cancer have no obvious risk factors.

Conventional risk factors for prostate cancer include:

Age:
The risk of prostate cancer increases with age. The disease is more common in men over the age of 50, and the risk increases further with age.

Family predisposition:
Men who have had close relatives with prostate cancer may have an increased risk. A genetic link plays a role in this.

Ethnicity:
African-American men have a higher risk of prostate cancer than men of other ethnic groups.

Genetic changes:
Certain genetic changes or mutations can increase the risk of prostate cancer. However, this only affects a small number of cases.

Smoking:
Smoking is an additional factor that can increase the development of prostate cancer. In addition, the malignancy of prostate cancer is increased in people who smoke.

Increased toxin exposure:
Increased toxin exposure to various heavy metals, pesticides, herbicides and endocrine disruptors are suspected to be a possible cause of prostate cancer.

Depending on the stage and individual variations, there is a wide range of treatment options. The aim is to surgically remove the affected areas or the entire prostate or to destroy the cancer cells by radiotherapy before the cancer has spread.

If metastases have already developed, the aim is to slow down growth and contain further spread, as well as to ensure quality of life for as long as possible.

Brachytherapy is a form of radiotherapy in which the radiation source is introduced rectally in order to destroy degenerated tissue as precisely as possible.

This significantly reduces unwanted mutations in the surrounding healthy tissue.

Surgery with a Da-Vinci surgical robot enables a minimally invasive, precise surgical result without large incisions and blood loss. The prostate, parts of the urethra and nearby lymph nodes are removed via small incisions in the abdominal wall, while particular attention is paid to the innervation of the sphincter muscle.

Cyberknife is a form of radiotherapy in which the radiation source is introduced into the body and can act precisely. Healthy tissue in the surrounding area can be spared in this way.

Chemotherapy is mainly used for advanced, metastasised tumours. It does not act locally, but systemically, which means that the side effects are much more severe.

The administration of antiandrogens can block male sex hormones and inhibit the growth of prostate cancer.

Complementary medical treatments can support conventional therapies or represent an alternative if, after consultation with the oncologist, they are better suited to the individual case.

Measures such as hyperthermia or fever therapy can be used in prostate cancer and accelerate recovery.

Hyperthermia in the treatment of prostate cancer

Combined hyperthermia and radiotherapy for prostate cancer: a systematic review

Intensity-Modulated Radiotherapy with Regional Hyperthermia for High-Risk Localized Prostate Carcinoma

Hyperthermia and Radiotherapy in the Management of Prostate Cancer

Current Role and Future Perspectives of Hyperthermia for Prostate Cancer Treatment

Mistletoe therapy is also promising for prostate cancer.

Das Prostatakarzinom und seine Behandlung mit Iscucin® Populi – Einführung und klinische Fälle aus der Praxis

Antiproliferative activity of an aqueous mistletoe extract in human tumor cell lines and xenografts in vitro

Boie D (1977). The additional Helixor therapy in stage D prostate carcinoma. Report. Rosenfeld, Association for Leukaemia and Cancer Therapy.

The chances of a cure for prostate cancer are very good, especially if it is detected early. Nevertheless, there are many factors that significantly influence the success of the treatment.
These include the aggressiveness of the tumour, the stage or progression of the disease and possible metastases. Furthermore, the chance of recovery is significantly influenced by the general state of health and the chosen treatment method.

If the cancer is diagnosed in the early stages, the 5-year survival rate is around 90%.

It is important to note that home remedies alone are not enough to treat prostate cancer. Prostate cancer requires professional medical care and appropriate treatment.

However, there are lifestyle factors that can help promote overall wellness and reduce the risk of prostate cancer. For example, a healthy diet rich in antioxidants and high-quality fats forms an important basis. Avoiding smoking and regular exercise are also basic requirements.

Many studies suggest that the active ingredient lycopene, which is found in tomatoes and hawthorns, for example, can slow down the growth of prostate cancer. Lycopene can also be taken in the form of a high-quality dietary supplement. Clarification and constant monitoring by an experienced doctor are highly recommended.

Lycopene exerts anti-inflammatory effect to inhibit prostate cancer progression

The Potential Role of Lycopene for the Prevention and Therapy of Prostate Cancer: From Molecular Mechanisms to Clinical Evidence

Lycopene Extracts from Different Tomato-Based Food Products Induce Apoptosis in Cultured Human Primary Prostate Cancer Cells and Regulate TP53, Bax and Bcl-2 Transcript Expression

Lycopene inhibits the growth of human androgen-independent prostate cancer cells in vitro and in BALB/c nude mice

Drinking green tea is also recommended for prostate cancer and various studies confirm its supportive effect. Here too, a doctor should always be consulted in order to initiate and monitor the correct therapy.

Anti-Cancer Effects of Green Tea Polyphenols Against Prostate Cancer

Effects of Green Tea Catechins on Prostate Cancer Chemoprevention: The Role of the Gut Microbiome

Green tea polyphenols for prostate cancer chemoprevention: A translational perspective

Green tea extract for prevention of prostate cancer progression in patients on active surveillance

Studies have also shown that pomegranates can have a supportive effect on prostate cancer. A targeted intake should also be clarified by a doctor in order to avoid imbalances, intestinal complaints or intolerances.

A review of pomegranate in prostate cancer

Pomegranate and its components as alternative treatment for prostate cancer

The aim of prostate cancer screening is to detect the cancer at an early stage so that it can be treated as effectively as possible and its development prevented.

This includes a digital rectal examination and PSA determination, a sensible risk assessment in the presence of risk factors, a healthy diet and an active lifestyle.

If risk factors such as a family history are known, it is advisable to talk to your GP to clarify individualised prevention options.

Even though a large proportion of developing cancers are due to genetic causes, it is important to understand how our lifestyle influences diseases and even our epigenetics. Therefore, leading a healthy lifestyle and minimising known risk factors should always be a top priority.

As already mentioned, life expectancy with prostate cancer is very high. The 5-year survival rate for treatment in the early stages is 90% and even with advanced metastasis, life expectancy can still be years. However, this is only possible with appropriate treatment and compliance on the part of the patient.

It is not only the pure life expectancy that is important, but also the quality of the remaining life. As requirements and wishes are very individual, treatment must always be customised accordingly.
For example, chemotherapy can be the right approach for many patients, while others do not want to accept the associated side effects and consciously decide against it.

Psychotherapy can also help to make the remaining time of life more pleasant. If you need help, you should communicate this openly with your doctor so that support can be organised promptly.

As with all cancers, regular screening is an important part of aftercare. In 30% of those treated, tumours recur and need to be treated again.

You should also be aware of the possible side effects of removal. Unfortunately, impotence and incontinence are difficult to avoid, as a central nerve plexus is attached to the prostate and can be damaged during the operation.

Even with modern surgical techniques, it is not always possible to avoid damaging the sensitive nerve plexus. Impotence occurs in 20 – 80% of cases (statistics vary widely), which can severely impair quality of life.
If you have any worries or concerns, you should talk to your doctor about possible solutions.

In some cases, the problem improves after several months; in others, medication or implantation of prostheses can provide relief.

For many patients, the risk of incontinence in particular is a major obstacle to deciding in favour of surgery. The symptoms usually improve within a few months. However, possible incontinence after prostate surgery can also persist in the long term and thus lead to a high level of suffering for those affected.

It is also important to be aware of changes in the ejaculate before the operation. Most men are unable to conceive after radical prostatectomy. Sperm freezing is a possible option.

The topic of prostate cancer and prevention raises many questions for affected patients. The most frequently asked questions are answered below.

If you have any further questions, please do not hesitate to consult your doctor.

The information listed contains relevant topics and serves to improve understanding.