Diagnosis: prostate cancer – in Germany, so many carcinomas of the prostate gland are now detected each year that this form of cancer has relegated lung cancer in men to second place as the most common cause of cancer. About one third of patients still die of prostate cancer each year. This need not be the case. That’s because prostate cancer is one of the slow-growing cancers, and if detected early enough, the chances of cure are 80 percent.
Preventive care: important for men over 45
The cancer statistics are frightening, but they are causing education and screening to be taken more and more seriously. This is because prostate cancer is one of the slow-growing cancers, meaning that if detected early, the chances of cure are 80 percent. The group of 50 to 75 year olds is predominantly affected. People who die of prostate cancer in Germany live to an average age of 77.6 years. That is a good three years more than the statistical male age at death. Unfortunately, prostate cancer can grow entirely without symptoms. That’s why screening is so important for men 45 and older.
Benign enlargement or cancer?
The prostate is an organ about the size of a chestnut that lies just below the urinary bladder and surrounds the urethra like a ring. It has an important job: producing the fluid that is responsible for the motility of the sperm filaments (sperm) and thus their ability to fertilize. The production of the secretion is triggered by male hormones, including testosterone, which is produced in the testicles (testes). During ejaculation, the discharge of semen, the secretion produced by the prostate is added to the seminal fluid. This occurs in the area of the urethra enclosed by the prostate. The size of a healthy prostate remains roughly constant until the age of 45. The enlargement of the prostate that then begins in most men is a normal part of the aging process and can cause discomfort during urination. This benign enlargement of the prostate gland is called BPH – benign prostatic hyperplasia.
Enlargement of the prostate gland due to a tumor.
In malignant prostate tumor (also: malignant prostate carcinoma), individual cells first degenerate, divide, grow until they finally penetrate the various layers of the prostate. Here the tumor spreads and destroys further tissue. The patient first notices symptoms when the urethra is constricted by the tumor and he or she experiences problems urinating. At an even more advanced stage, daughter tumors (metastases) settle in the bones, usually in the area of the lumbar spine.
Screening and examination methods
Because of its location to the rectum, the prostate can be easily palpated with a finger and felt for pathological changes. From the age of 45, health insurance companies reimburse this digital rectal examination (DRU). However, a blood test called a PSA test is considered more reliable by physicians because a prostate-specific antigen, a protein produced by the prostate, can be detected in the blood. A value of four nanograms per milliliter (4 ng/ml) is considered normal; higher values may (but need not) indicate prostate cancer. Health insurance companies reimburse the costs (about 15 euros) for the PSA test as part of cancer screening only in exceptional cases. Ultrasound is another method of detecting changes in the prostate gland. An ultrasound probe is pushed through the rectum to above the prostate and scanned with sound. A tissue sample, called a biopsy, is taken by the doctor only if there is a reasonable suspicion of cancer.
How is prostate cancer treated?
When treating prostate cancer, there are several options and combinations of therapies that can be highly individualized to the patient. Sometimes the entire prostate is surgically taken out to remove the tumor entirely. An alternative is radiation, in which the tumor tissue is specifically destroyed. Some patients receive only hormone therapy. This is intended to stop the production of testosterone in the testicles – testosterone plays a decisive role in the development of prostate cancer. Doctors warn against false hopes in the case of a herbal preparation called PC-SPES, a dietary supplement that is freely available in America.Despite some (also scientifically) proven positive results, such as lowering of PSA levels, the drug is not approved in Germany, because new side effects are repeatedly reported, such as thrombosis.
Ultrasound as a treatment method
At the Heidelberg Clinic for Prostate Therapy, there is now good experience with high-intensity focused ultrasound: a precisely focused ultrasound field is directed at the prostate through a probe inserted into the rectum. The strong focus of the sound field generates temperatures of up to 95 °C, which precisely induce destruction of the diseased tissue.
Conclusion: screening promotes healing
All doctors agree that if all men over 45, and not just about one in six Germans, took advantage of preventive examinations, the mortality rate would be much lower. As a slow-growing cancer, prostate cancer is very treatable, especially in its early stages.
