Synonyms in the broadest sense
Therapy prostate cancer, prostate CA, prostate tumor
Introduction
The type of treatment is determined not only by the tumor stage and the degree of malignancy of the tissue (differentiation), but also by the general condition and age of the affected patient. In the case of a localized prostate carcinoma, treatment is usually also local, i.e. surgery or radiation therapy is performed. An advanced stage requires systemic (affecting the whole body) treatment, such as hormonal (anti-androgenic) therapy (see below).
Controlled waiting
If it is a very small, well-differentiated tumor (T1; G1=low malignancy) in a very old, symptom-free patient whose life expectancy has already been significantly reduced by other pre-existing conditions, therapy can be dispensed with, since the affected patients will most likely die not from the consequences of prostate cancer but from other pre-existing conditions (e.g. heart failure, coronary heart disease, etc.). In addition, treatment with all possible side effects would possibly further reduce life expectancy with prostate cancer.
Radical removal of the prostate (prostatectomy)
The complete removal of the prostate, including its capsule and the adjacent seminal vesicles, is the therapeutic gold standard in Germany for localized and well differentiated prostate cancer. However, it should only be performed if no distant or lymph node metastases are present and the tumor is still restricted to the prostate. Surgical access is performed above the pubic bone or directly at the pelvis.
A “keyhole technique” procedure (laparoscopy) is also being tested in studies. There are two major risks associated with this operation. The first is urinary incontinence, i.e. the inability to “hold water”.
Temporary urinary incontinence is common immediately after the operation. The regression of this symptom is possible later. In the worst case, however, the incontinence may persist.
The second is erectile dysfunction, i.e. the inability to achieve an erection. Libido (sensation of pleasure) and the ability to orgasm are not affected. Although ejaculation is lost, it is the stiffening of the limbs that is most frequently affected (in 50% of cases). Nerve-sparing surgical procedures try to avoid this and maintain potency. Less frequent complications are post-bleeding, stricture (scarring) or inflammation of the epididymis.