Introduction
Prostate cancer is the most common cancer in men and is the second leading cause of cancer death in men. If the cancer is in a later stage at the time of diagnosis, metastases may already have formed. Metastases are cancer cells that leave the tumor and settle elsewhere in the body. In prostate cancer, the most common site for metastases is the bone. The presence of metastases in prostate cancer automatically means that the tumor is classified as stage IV and only palliative treatment options are considered.
Where do metastases occur and why?
Metastases are the metastasis of tumor cells in other organs. They develop when the tumor spreads beyond its original organ and through its growth gets in contact with the bloodstream and the lymphatic system. The tumor cells now have the opportunity to spread to other organs via the bloodstream or lymph, to settle and multiply there.
A distinction is made between hematogenic (via the bloodstream) and lymphogenic (via the lymph drainage system) metastasis. Metastases in the immediate vicinity of the original tumor are called local or regional metastases. Here, mostly lymph nodes close to the tumor are affected. If the tumor cells settle in tissues or organs further away, they are called distant metastases. The most common sites for metastases in prostate cancer are Lymph nodes Bones, especially the spine Liver Lung Brain
- Lymph nodes
- Bones, especially spinal column
- Liver
- Lung
- Brain
How is life expectancy influenced by metastases?
In general, life expectancy is significantly shortened by the occurrence of metastases. The median survival time for the diagnosis of a bone metastasis is 12 to 18 months. The five-year survival rate in the presence of metastases is only 31%.
Once metastases are detected in prostate cancer, the tumor is assigned to stage IV. In stage IV, curative (curative) therapy is no longer possible and palliative (palliative) therapy is sought. The goals of this therapy are to extend the life span, improve the quality of life, slow down further growth of the tumor and alleviate the symptoms caused by the tumor itself or metastases.
The palliative therapy for prostate cancer consists of different pillars. The first is hormone deprivation therapy. The tumor cells of prostate cancer grow dependent on the male sex hormone testosterone.
In hormone withdrawal therapy, drugs are administered which inhibit testosterone production. This causes the tumor cells to lose their greatest growth stimulus. In addition, chemotherapy can be administered if the patient is in sufficiently good general condition.
If the patient responds to hormone therapy, life expectancy can be extended to several years. The further pillars of therapy are described in the sub-topics of the individual metastases. In general, however, therapy should only be initiated if an impact on quality of life or life expectancy can be expected from these measures.
If this is not the case, the concept of “watchful waiting” can be applied. This means that patients undergo regular examinations and the tumor and metastases are initially only observed. One advantage of this concept is that undesirable side effects of the therapy are avoided.
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