Brief overview
- What is prostate cancer? A malignant growth in the prostate gland and one of the most common cancers in men.
- Symptoms: often no symptoms at first, later unspecific symptoms such as pain when urinating and ejaculating, blood in the urine and/or seminal fluid, erection problems
- Causes: not exactly known; possible risk factors are mainly older age and genetic predisposition
- Treatment: In early stages, possibly only “active surveillance.” Otherwise surgery, chemotherapy, radiotherapy and/or hormone therapy.
- Responsible specialist: Urologist.
- Prognosis: With early diagnosis and treatment, good chances of cure. If the cancer has already spread, life expectancy decreases considerably.
Prostate cancer: Description
Prostate cancer must not be confused with benign prostatic hyperplasia, which also usually occurs after the age of 50, and more frequently with increasing age: two out of ten men between 50 and 59 are affected, and seven out of ten men over 70.
Anatomy and function of the prostate
The prostate is one of the male reproductive organs. Its main task is to produce a secretion that is added to the seminal fluid during ejaculation. One component of this secretion is the so-called prostate-specific antigen, or PSA for short. This enzyme makes the seminal fluid thinner. PSA is produced exclusively by the prostate gland. Its determination is used for the diagnosis and progression of prostate cancer.
Prostate cancer: symptoms
- Problems emptying the bladder, e.g. pain during urination, weak or interrupted urine stream, urinary retention (= inability to empty the bladder spontaneously)
- Pain during ejaculation, reduced ejaculation
- Erection problems (reduced erection or impotence)
- Blood in the urine or seminal fluid
- Pain in the prostate area
- Problems with bowel movements
- Pain in the lower back, pelvis, hips, or thighs
If you suffer from some of the above-mentioned complaints, you should therefore not immediately assume a prostate carcinoma. However, it is definitely advisable to be examined by a urologist. He can tell you whether you actually have prostate cancer or not. If so, he will initiate treatment immediately so that you can get well as soon as possible.
Prostate cancer: causes and risk factors
Age
An older age is the most important risk factor for prostate cancer. Before the age of 50, the malignant prostate tumor almost never occurs. In the 45-year-old age group, for example, one in 270 men will develop prostate cancer in the next ten years. In the 75-year-old group, this already happens to one in 17 men.
Genetic predisposition
Overall, however, such familial prostate cancer is rare – 90 to 95 percent of all prostate cancers probably arise “spontaneously” (without heritable risk genes).
Ethnic factors
The reasons for this probably lie in different dietary habits (e.g. preference for a high-fat, animal-based diet in the USA vs. a diet rich in cereals and vegetables with lots of soy in Asia) and socioeconomic factors. Genetic factors may also play a role.
Diet, testosterone, sex, smoking, alcohol, inflammation?
It used to be thought that the male sex hormone testosterone increased the risk of prostate cancer. Today, this view is considered outdated. However, it is correct that the malignant tumor grows in a testosterone-dependent manner. This means that testosterone promotes the growth of an already existing prostate carcinoma – but it does not trigger the cancer.
The assumption that sexual intercourse influences the risk of prostate cancer is also considered to be refuted: regardless of whether a man has no, little or a lot of sex – according to current research, this has no influence on the risk of disease.
According to studies, there could be at least a weak connection between prostate cancer and tobacco consumption. However, this needs to be researched further. There also seems to be a link with alcohol consumption (at least with high alcohol consumption).
Prostate cancer: examinations and diagnosis
Prostate cancer screening
The first step is an interview: the doctor asks about general health complaints (problems with urination, constipation, high blood pressure, erection problems, etc.) as well as about any previous illnesses and the use of medication. He also asks whether there are any known cases of prostate cancer in the man’s family.
This means that the digital-rectal examination can provide indications of major changes in the prostate gland. These changes may be due to an already advanced prostate carcinoma (in the early stages, changes are not yet palpable) or may have a more harmless cause. This can only be clarified by further examinations.
Prostate cancer diagnosis
Anyone who discovers possible symptoms of prostate cancer in themselves should definitely go to the doctor. The right contact person for suspected prostate cancer is the urology specialist. He will first talk to the patient to obtain his medical history (anamnesis). To do this, the doctor may ask, for example:
- Are there any cases of prostate cancer or breast cancer in your family?
- Do you have problems urinating?
- Do you have erection problems?
- Have you lost weight unintentionally lately?
- Have you had a fever or night sweats lately?
- How is your general physical performance?
- Do you have any problems with digestion?
- Have you noticed blood in your urine or stool?
- Do you feel pain in your lower back (“sciatic pain”)?
This is followed by digital rectal palpation (see above: prostate cancer screening).
PSA value
Today, in addition to the palpation examination, a specific value is often determined in the blood: the PSA value. The PSA (prostate-specific antigen) is a protein that is formed almost exclusively by the prostate cells and normally only passes into the blood in small quantities. Elevated blood levels therefore indicate increased activity of the prostate tissue – such as in prostate cancer.
The PSA value is undisputedly useful as a control parameter for assessing the course of prostate cancer after treatment. However, its usefulness in early detection is controversially discussed. The reason for this is that the PSA value also detects cell changes in the prostate that would otherwise probably never have become apparent and would not have led to prostate cancer. The test result therefore means an unnecessary psychological burden and unnecessary treatment for the men concerned.
Transrectal ultrasound (TRUS)
In addition to the rectal palpation and the determination of the PSA value, further examinations are usually necessary to make the diagnosis of prostate cancer. These include transrectal ultrasound (TRUS). Here, the prostate is examined by means of an ultrasound examination through the rectum. This allows the doctor to assess the size and shape of the prostate gland more precisely.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) is sometimes used as an imaging procedure in the clarification of suspected prostate cancer. It provides much more detailed images than transrectal ultrasound (TRUS).
Tissue sampling from the prostate
If the preceding examinations (rectal examination, PSA measurement, ultrasound) reveal indications of prostate cancer, the next step is to remove a tissue sample from the prostate and examine it in detail in the laboratory (prostate biopsy). Only then can it be said with certainty whether or not prostate cancer is actually present.
There is no risk of cancer cells being scattered in the surrounding tissue as a result of the tissue removal. However, the procedure could trigger local inflammation. Therefore, the patient receives antibiotics as a preventive measure on the day of the procedure and possibly for a few more days.
Examination of the tissue samples
The tissue samples from the prostate are examined by a pathologist under the microscope for cancer cells (histopathological examination). This also reveals the extent to which the cancer cells have changed (degenerated) compared to normal prostate tissue.
Another option for tumor classification is the TNM system.
Prostate cancer: staging
If the histopathological examination of the tissue samples confirms the suspicion of prostate cancer, the spread of the tumor in the body must be examined. In this way it can be determined in which stage the prostate cancer is located (staging). The individual therapy planning depends on this.
- Magnetic resonance imaging (MRI): It can visualize enlarged lymph nodes in the pelvis – a possible indication of cancer cell infestation – as well as more distant daughter colonizations. An alternative to MRI is computed tomography (CT).
- Skeletal scintigraphy (bone scintigraphy): With this nuclear medicine examination, the type can find out whether the prostate cancer has already metastasized to the bones.
- Ultrasound examination of the abdomen: This is used, for example, to detect possible prostate cancer metastases in the liver. A possible urinary stasis due to pressure of the tumor on the urethra can also be detected in the ultrasound.
Prostate cancer: Classification
- Thus, T1 stands for a small prostate carcinoma that causes no discomfort and is neither palpable nor visible on imaging, but was only detected by biopsy. At the other end of the scale, T4 represents an advanced tumor that has grown into the tissue surrounding the prostate (e.g., the rectum).
- Two expressions are possible for the N value: N0 stands for “no lymph nodes affected” and N1 for “regional lymph nodes contain cancer cells”.
Prostate Cancer: Treatment
What prostate cancer treatment looks like in individual cases depends on several factors. Decisive are above all the stage of the cancer and the age of the patient. The doctor will also take into account other factors such as any concomitant diseases and the patient’s treatment wishes (for example, refusal of chemotherapy) as far as possible.
If the tumor does not grow or grows only very slowly, if it does not cause any symptoms and if the patient is already at an advanced age, treatment can be dispensed with for the time being and the tumor can simply be checked regularly by a doctor.
You can read about which therapy makes sense when and what side effects the individual forms of treatment can have in the article Prostate Cancer – Treatment.
Prostate cancer: Aftercare
- Detect recurrence of prostate cancer (recurrence) as early as possible. A physical examination and blood tests (such as the determination of the PSA value) help in this.
Follow-up should begin no later than twelve weeks after ABcompletion of prostate cancer treatment. In the first two years, follow-up should be quarterly, and in the 3rd and 4th years, biannually. From the 5th year onwards, once-yearly prostate cancer follow-up is recommended. If possible, the examinations should be performed by a urologist who has experience in the care of cancer patients (oncology focus practice).
Prostate cancer often grows slowly and can be treated well, which is why the prognosis is generally favorable. However, there are also cases in which the tumor spreads very quickly and aggressively. Then the chances of recovery are worse.
According to statistics, five years after diagnosis, 89 percent of patients are still alive, while the remaining eleven percent have died from the malignant tumor in the prostate (relative 5-year survival rate). Thus, life expectancy in prostate cancer is quite good compared to other types of cancer.