• What is prostate cancer

    Brachytherapie Vorsorge Prostatakrebs - Anatomie Prostata

PROSTATE CANCER – THE MOST COMMON CANCER IN MEN

Around 58,000 cases of prostate cancer are diagnosed in Germany every year. This makes prostate cancer the most common malignant tumor in men. According to the American Cancer Society, it is estimated that one in six US citizens will develop prostate cancer in the course of their lives. The exact cause of the disease is still unclear.

The prostate

The prostate, commonly known as the prostate gland, is a gland about the size of a walnut that is located directly below the bladder and in front of the rectum. It has two functions: It produces a secretion which, together with the sperm, forms the seminal fluid and is therefore part of the male reproductive organ. As the prostate surrounds the urethra, it is also known as the internal sphincter muscle and plays a significant role in holding urine (continence). After removal of the prostate, this can lead to the problem of incontinence.

Prostate cancer occurs when malignant cells develop in the prostate. These often form in marginal areas of the organ and usually do not initially cause any symptoms. In such “localized” prostate cancer, the tumour remains within the organ and is curable. If the cancer has already formed metastases in the lymph nodes or bones at the time of diagnosis, this is referred to as a metastatic stage. The chances of recovery are then lower. The earlier the tumor is detected, the greater the likelihood that the patient can be completely cured.
We therefore recommend that all men over the age of 50 (or over the age of 40 if there is a family history of prostate cancer) undergo an annual screening – including the determination of the prostate-specific antigen (PSA) in the blood, an ultrasound examination of the prostate and a rectal palpation.

There are various factors, known as risk factors, that increase the likelihood of developing prostate cancer. In general, a distinction is made between factors that can be influenced, such as smoking, diet and physical activity, and factors that cannot be influenced, such as age, genetic make-up and ethnic origin.

In the case of prostate cancer, the main risk factors are age, a family history and the respective place of residence. If risk factors are present, this does not necessarily mean that the person concerned will develop prostate cancer. However, it is then particularly important to keep to the screening appointments.

The patient’s age is the greatest risk factor for prostate cancer. Across Germany, the disease rarely occurs before the age of 50, but the incidence increases considerably after that. On average, men are diagnosed with the tumor around the age of 69 [source: “Krebs in Deutschland” published by the Robert Koch Institute 2019].

Prostate cancer is particularly common in some families. Men with first-degree relatives who have prostate cancer therefore have an increased risk of developing this tumor themselves. Specifically, the probability of also developing the disease is 5 times higher than in the general population.

Prostate cancer occurs at different regional frequencies around the world. For example, men in the western industrialized nations – including Germany – develop the disease more frequently than men in China, Japan and India. In the USA, there are also differences between the various ethnic groups. There, African-American men fall ill significantly more often than white American men.

The differences may be due to hereditary factors, but dietary factors and a particular lifestyle may also be the cause of the phenomenon.

Diet and body weight obviously also have a decisive influence on prostate cancer. Overweight men (BMI >35) generally have larger and more aggressive tumors at the time of diagnosis than men of normal weight. It is also assumed that a wholesome diet with plenty of fruit and vegetables but low meat consumption has a positive effect on the risk of the disease.

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Prostatakrebs Anatomie der gesunden Prostata
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The urinary bladder is an expandable hollow organ in the area of the small pelvis that serves to store urine. Together with the urethra, it forms the lower urinary tract.

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Urethra

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Prostate capsule. Carcinomas preferentially develop in this area

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Normal sized prostate
The prostate is about the size of a chestnut, weighs around 20 g and has a firm, partly glandular, partly muscular body. The external shape is almost pyramidal, with the base pointing towards the bladder and the apex pointing downwards. The prostate consists of around 30-40 individual tubuloalveolar glands whose ducts (prostatic ducts) open into the prostatic part of the urethra around the seminal colliculus.

Anatomy of the healthy prostate
The prostate is about the size of a chestnut, weighs around 20 g and has a firm, partly glandular, partly muscular body. The external shape is almost pyramidal, with the base pointing towards the bladder and the apex pointing downwards.

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Prostatakrebs – Anatomie der Prostatazonen
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Central zone (inner zone)

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Periurethral and transitional zone

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Peripheral zone (outer zone)

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Anterior zone (front zone)

Zones of the prostate
While benign prostate enlargement usually originates in the zone around the urethra (periurethral or transitional zone), up to 75% of prostate carcinomas originate in the peripheral zone at the edge of the prostate.

  • Diagnosis

    PSA-test-diagnosemöglichkeiten und vorsorgeuntersuchungen bei prostatakrebs

DIAGNOSTIC OPTIONS AND SCREENING

Diagnosing prostate cancer as early as possible is the key to a cure. Men should therefore regularly undergo a blood test to determine the prostate-specific antigen (PSA), a palpation examination and an ultrasound of the prostate. As the risk of developing prostate cancer before the age of 50 is relatively low

prostate cancer, many experts recommend starting these annual screenings from the age of 50. Men with a family history of prostate cancer should have this examination from the age of 40 (see also risk factors).

A palpation examination of the prostate, also known as a digital rectal examination or DRU for short, is a routine examination in which the prostate gland adjacent to the rectum is palpated with a finger. The urologist looks at the size, texture and mucosal displacement of the prostate.

As both benign and malignant diseases can lead to lumps or hardening of the prostate, the procedure is not sufficient as the sole diagnostic method. DRU also only detects prostate carcinomas of a certain size, which limits the examination procedure.

The DRU is recommended once a year from the age of 45 as part of preventive screening.

Prostate-specific antigen, or PSA for short, is a protein that is produced exclusively by the prostate. It serves to liquefy the ejaculate. Without PSA, the ejaculate would clump together and the sperm it contains would no longer be able to move.

PSA is also partially released into the blood and its concentration in the blood can be determined by laboratory test. An elevated PSA level can indicate a possible prostate carcinoma, but also prostate inflammation. Various other factors can also cause the PSA value to rise.

Screening with a PSA test can therefore be used for the early detection of prostate cancer and there are studies that indicate a reduction in mortality with this type of screening. However, this finding is not uncontroversial; studies in the USA in particular do not see any direct correlation in this matter.

An elevated PSA value does not necessarily mean that a tumor is present. Such a finding must therefore always be assessed individually for each patient.
However, the PSA value is not only important for diagnosis, but also for monitoring the progress of prostate cancer treatment.

From the age of 45, PSA determination in conjunction with a DRU (digital rectal examination) is offered at the patient’s request as part of the preventive examination. However, statutory health insurance companies do not cover the costs of the PSA test for early detection.

In medicine, imaging procedures are examination methods that allow us to “look inside the patient”. These include X-ray examinations, computer tomography (CT), magnetic resonance or magnetic resonance imaging (MRI) and ultrasound examinations.

An ultrasound examination is a procedure frequently used by urologists. It is completely painless and harmless.

An ultrasound examination of the prostate can be carried out either via the abdominal wall or transrectally, i.e. from the rectum. In the so-called transrectal ultrasound examination (TRUS), a probe with a diameter of up to 2 cm is inserted rectally in order to examine the neighboring prostate. The close proximity of the rectum and prostate makes it possible to visualize the prostate with very detailed images. This allows urologists to determine the size, consistency, potential malignant changes, as well as abscesses and inflammatory changes in the prostate. In the case of prostate cancer, TRUS, PSA testing and DRU are part of basic diagnostics.

Elastography of the prostate is a special examination technique at our center. Here, the degree of hardness can be measured in various areas of the gland
can be measured and an optical signal can be assigned to this. Prostate carcinomas can be detected more easily with this procedure. Unfortunately, the procedure is not reimbursed by statutory health insurance.

Elastography of the prostate

Computed tomography (CT) uses X-rays to produce images, while magnetic resonance imaging (MRI) uses a magnetic field. The latter is gentler on the patient as no X-rays are used.

MRI and CT can provide important information on prostate volume and the localization of a suspicious area in the prostate. In addition, enlarged lymph nodes can be detected, which could indicate lymph node metastases.

MRI is increasingly being used in the primary diagnosis of prostate cancer.

A biopsy, i.e. the removal of a tissue sample from the prostate, is also often necessary. The doctor takes tissue from a suspicious region of the organ and sends it to the pathologist for further examination. Using high-resolution microscopes and various staining methods, the pathologist can analyze the tissue sample and make a diagnosis.

In the case of malignant tumors, the biopsy and examination of the tissue sample usually confirm the suspected diagnosis or rule out a tumor. Once the primary diagnosis has been completed, a biopsy is almost always necessary to confirm the diagnosis if a prostate carcinoma is suspected.

The prostate biopsy is carried out as part of a minor operation under local anesthetic and usually takes 20 – 30 minutes. Tissue samples are taken from the prostate using a small, thin needle via an ultrasound probe inserted rectally. The needle is inserted via the rectum and leaves no scars. The biopsy is generally painless and without complications. Side effects such as fever or bleeding only occur in extremely rare cases. The procedure is performed on an outpatient basis in our practice.

A special form of biopsy is the fusion biopsy. Here, we combine the MRI images of the prostate with the ultrasound images of the prostate (TRUS) in real time in order to precisely target only the suspicious areas in the prostate during the biopsy. We offer this procedure in our urology department.

Cancer can spread throughout the body via the blood or lymphatic system and form metastases. We use special imaging techniques to diagnose these. One of these is positron emission computed tomography, or PET-CT for short. PET-CT can be used to visualize metastases that have spread throughout the body as “glowing dots”.

Another method that is particularly important for prostate cancer is skeletal scintigraphy. This is because bone metastases can form in advanced stages of prostate cancer. The associated remodeling processes in the bone can be visualized by skeletal scintigraphy. If such metastases are detected during the primary diagnosis of prostate cancer, the chances of recovery are unfortunately limited.

  • Different treatment methods for prostate cancer

    Spezialisten für Brachytherapie Dr. med. J. Andreas, Dr. med. S. Carl, Dr. med. M. Meilinger

Treatment options

In early stages of prostate cancer, all methods achieve comparably good results. For more advanced tumors, radiotherapeutic procedures are superior to surgery. Several interesting procedures are currently being tested in the curative treatment of localized prostate cancer.

However, due to the lack of evidence of their long-term efficacy, these procedures are not yet recommended as standard therapy and are therefore not used at our center.

Brachytherapy is the implantation of low-level radioactive titanium pins (seeds), about the size of a grain of rice, into the prostate. A pre-calculated dose of radiation is administered directly to the cancer cells. The risk of damaging surrounding tissue is reduced due to the millimeter-precise placement of the seeds in the prostate. The seeds remain in the prostate, while the radiation decreases over time and fades after a year. Brachytherapy is carried out as monotherapy or in combination with hormone therapy and/or external radiation therapy. The side effects of the treatment are manageable, with a few patients experiencing temporary discomfort when urinating after implantation (a few days to a few months).

Radical prostatectomy describes the complete surgical removal of the prostate and its appendages. It is performed via an abdominal incision or keyhole surgery. The patient remains in hospital for several days after the operation, unlike brachytherapy, which can also be performed on an outpatient basis. The two most common side effects of radical prostatectomy are the loss of bladder control (incontinence) and the inability to maintain limb stiffness (impotence). Sexual intercourse is then no longer possible.

Radiotherapy uses high-energy X-rays that are administered externally to the prostate. The outpatient treatment takes place over a period of 6-8 weeks. Side effects can include problems urinating, impotence and radiation damage to the intestines.

In the case of early-stage tumors with less aggressive characteristics, immediate treatment of the prostate carcinoma can be dispensed with. Close monitoring is then carried out without active therapy. During this time, the development and growth of the tumor is monitored very carefully. However, the guidelines of the urological societies recommend a new biopsy of the prostate at regular intervals in these cases.

WE ARE HAPPY TO ADVISE YOU

For a personal consultation, you are welcome to make an appointment at the brachytherapy consultation hours using the telephone number provided.

UROLOGIE EMMENDINGEN
Urological group practice
& Urology Inpatient Department

Dr. med. Stefan Carl
Dr. med. Michael Meilinger
Dr. med. Johannes Andreas

Phone.: +49 76 41 / 63 64
E-mail:

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