prostate cancer

Prostate cancer, technically known as prostate carcinoma, is a malignant tumor of the male prostate gland, the prostate. In Germany, it is the most common type of cancer in men and accounts for about a quarter of all cancers diagnosed each year.

In almost all cases, the carcinoma originates from the prostate gland tissue. Doctors speak of an adenocarcinoma in such a case. In most patients, in about 66% of cases, the malignant tumor arises in the outer part of the prostate. Since this area is further away from the urethra, the symptoms of the disease often only become noticeable at a later stage, namely usually only when the urethra is narrowed by the tumor growth. One of the first signs of cancer is difficulty urinating. By the time it does, however, the prostate cancer is generally larger and has spread locally.

Like many other forms of cancer, prostate cancer tends to eventually rupture the capsule of the prostate and spread to other organs of the body via the blood and lymphatic system. However, if it is possible to diagnose the cancer early, it is often still locally limited to the prostate. In this case, the disease can be easily treated and even cured, for example through surgery or radiation therapy.

However, without timely diagnosis and treatment, prostate cancer can metastasize to the lymph nodes, bones and other body organs. At such a stage, the cancer can no longer be cured, but even then there are still good treatment options: For example, there are drugs that can stop prostate carcinoma.

Many forms of prostate cancer are not very aggressive and the tumor grows slowly. Prostate cancer does not have to be fatal, and many men have a high chance of survival despite being diagnosed with it.

In the ICD-10, the international index of diseases, prostate carcinoma can be found in the chapter "Malignant neoplasms of the male genital organs" under the number C.61.

Anatomy and functioning of the prostate

The prostate (prostate gland) is part of the internal male sex organs and is one of the male reproductive organs.

Some of the seminal fluid is produced in the prostate, the rest is produced by the two seminal vesicles that lie on the outside of the prostate gland. The semen is of great importance for the mobility of the male sperm and thus for the ability to fertilize. During an ejaculation (ejaculation), the prostate muscles contract and force the semen into the urethra. At the same time, the sperm from the testicles and the secretion of the seminal vesicles are also fed into the urethra. The seminal and urinary tracts converge in the prostate area.

The majority of the male sex hormone testosterone is produced in the testicles (testes): This hormone controls both growth and the function of the prostate. Without this sex hormone, the prostate gland would remain underdeveloped and would not be able to secrete.

The male prostate gland also produces the prostate-specific antigen PSA: This enzyme is added to the ejaculation and thus liquefies the ejaculate.

In women and men, a distinction is made between the external and internal sex organs:

• The external sex organs of men are the penis, the scrotum with testicles and the epididymis.
• The vas deferens, seminal vesicles and prostate form the internal male sex organs.

The prostate is a gland about the size of a walnut. In a young man around 20 years old, the prostate weighs around 20 grams. Anatomically, it is located in front of the rectum and below the bladder. This prostate gland encases the urethra, which carries urine through the penis to the man's glans. This also explains why many men with prostate problems also experience pain when urinating.

The prostate can be divided into five different zones:

• In the front prostate zone there is almost only muscle and connective tissue.

There are hardly any glands here.

• Surroundings of the urethra: In this zone there is mainly musculature, only a little tissue.

• Transition Zone: This area is quite small and is also known as the Transition Zone. This zone is located in front of and to the side of the beginning of the urethra.

• Central prostate zone: This area makes up about a quarter of the prostate. It is specifically about the areas - behind and above - around the spray canals.

• Peripheral Zone: Also known as the outer zone, this area of ​​the prostate is the largest part of the prostate gland. It makes up almost 75% of the prostate. Prostate carcinoma most commonly develops in the peripheral zone.

Since the prostate gland is located in front of the rectum (part of the rectum), it can be palpated through the intestinal wall by a doctor. Regular prostate examinations are a key part of early prostate cancer detection.

Symptoms: what indicates prostate cancer?

Many men develop prostate cancer without first consciously noticing any symptoms. Signs of cancer only become noticeable in later stages of the disease, namely above all when the malignant cancer cells have spread to neighboring regions of the body such as the rectum, the urinary bladder or the coccyx spine.

The following symptoms can indicate prostate cancer:

• Problems with urination such as a weak or interrupted stream of urine or what is known as urinary retention, i.e. the inability to empty the bladder spontaneously.
• Decreased ejaculation
• pain when ejaculating (ejaculation)
• Blood in the urine or semen
• Discomfort with bowel movements
• Pain in the prostate area
• Pain in the lower back, hips, thighs and pelvis.

However, these symptoms are not automatically to be seen as an indication of prostate carcinoma, rather other causes can also be behind it. For example, a benign enlargement of the prostate gland can cause problems with urination. Back pain can have many different causes.

So please don't assume the worst if you notice any of the symptoms mentioned above. In any case, it is advisable to arrange an examination appointment with a urologist and to have the exact causes of the symptoms clarified.

History: How dangerous is prostate cancer?

The risk of developing prostate cancer in the course of life is around 13% for men.
However, the risk of dying from this type of cancer is very low at just 3%. Specifically, this means that while prostate cancer is the most common cancer in men, it is not the most common cause of death.

As with almost all forms of cancer, the following also applies in this case: the earlier the cancer is detected, the better the chances of recovery. If a prostate carcinoma is diagnosed at an early stage and treated adequately, it is definitely curable. However, if the tumor has already spread when the diagnosis is made and, for example, metastases (secondary tumors) have formed in the bones (bone metastases), the chances of recovery - and unfortunately also the life expectancy - are significantly lower.

Causes and Risk Factors: Who is Most at Risk of Prostate Cancer?

The exact causes of prostate cancer have not yet been conclusively determined. A significant risk factor, however, is the age of the affected patients. From the age of 50, the risk of cancer increases sharply. Over 80% of affected men are older than 60 years.

Genetic predisposition

It is scientifically proven that the risk of developing prostate cancer can be genetically inherited. If your father or brother already has prostate cancer, the risk of developing it yourself doubles.
Men with such a genetic predisposition can also develop prostate cancer at a younger age. The urgent recommendation for them is therefore to have urological examinations carried out at an early stage.
Approximately 5-10% of all prostate cancer cases are estimated to be hereditary.

ethnic causes

Prostate cancer can occur at different rates in different populations. This cancer is rather rare in Asia. However, it is more common in black than white American men. More prostate cancer cases can also be observed in Northern Europe than in Southern Europe. This, too, may allow conclusions to be drawn about hereditary factors, but other influencing factors such as individual diet or certain environmental influences must also be taken into account.

External factors as a cause of prostate carcinoma

Medical experts also see a connection between the prostate risk and certain environmental influences such as individual diet.

According to scientific studies, so-called phytoestrogens (plant-based estrogens contained in soy, for example) or the secondary plant substance lycopene, which is found primarily in tomatoes, can reduce the risk of cancer. However, the data available to date are not yet sufficient for specific nutritional recommendations as prostate cancer prophylaxis!

The opinion used to be that the male sex hormone testosterone can increase the risk of prostate cancer. Today, this view is considered outdated among experts. However, it is true that the malignant tumor grows in a testosterone-dependent manner. In concrete terms, this means that the hormone testosterone promotes tumor growth in pre-existing prostate cancer, but it does not cause cancer!

Men who suffer from a testosterone deficiency and do not have prostate cancer can easily receive hormone replacement therapy, i.e. the hormone can be administered to the body as a patch or injection, for example. According to the current state of knowledge, this does not increase the risk of developing prostate cancer. In such a case, however, please be sure to speak to a subject matter expert!

In the past, there was also the assumption that sexual intercourse can influence the risk of prostate cancer. Today, this assumption is also considered to be refuted. It doesn't matter at all whether a man has little, a lot or no sexual intercourse at all. According to the current state of knowledge, this has no influence whatsoever on the risk of illness.

According to scientific studies, there may be a weak link between prostate cancer and nicotine consumption. However, further studies are required here in order to be able to make reliable statements. There also seems to be a slight link in connection with alcohol consumption, at least when alcohol is drunk heavily.

Researchers are also increasingly examining the importance of local inflammatory processes and would like to find out to what extent they could be responsible for the development of prostate carcinoma. Under certain circumstances, sexually transmitted diseases or prostate inflammation can increase the risk of prostate cancer.

Therapy: What helps with prostate cancer?

There are many different treatment options available for treating prostate cancer. Which treatment is the right one in an individual case depends primarily on the stage of the disease, but also on the age of the patient. Ideally, the patient should discuss the best course of treatment with the treating doctor.

Basically, the following treatment options are available:

Controlled waiting and active observation

Controlled waiting, also known as “watchful waiting”, is a treatment strategy in which physicians only actively treat prostate cancer when symptoms appear.

This method is suitable for men who are older or already have comorbidities. Prostate cancer is examined by a doctor about every six months. If necessary, therapy is initiated, for example in the form of hormone replacement therapy. However, healing the cancer of the prostate gland is not the focus of watchful waiting.

Another treatment method is active surveillance. It is suitable for low-risk prostate cancer.

Here, the doctors assume that the type of tumor is not aggressive and may never cause symptoms. However, active surveillance does not mean that nothing is done medically at all. The affected men are closely monitored, just not yet actively treated.

Treatment is only started when certain measured values, such as the PSA value, provide an indication of the progression of the cancer. For example, an operation or radiation treatment can be considered. In such a case, the chances of recovery are still very good!

Operation – prostatectomy

The surgical removal of the prostate is particularly suitable for men in whom the cancer was discovered at an early stage. It is important that the malignant tumor has not yet spread to the surrounding lymph nodes or other body organs.

During a surgical procedure, doctors remove the entire prostate, including the malignant tumor. Such an operation offers the possibility of a complete cure, but such an operation is also associated with certain risks: many men subsequently suffer from erectile dysfunction or incontinence, at least temporarily.

radiotherapy

An alternative to a prostatectomy is radiation treatment: This method is just as effective and achieves comparable therapy results. It is very important to seek advice from a radiotherapist or a urologist about the advantages and disadvantages of individual cancer therapies before making a treatment decision. Some clinics offer an interdisciplinary consultation with specialists for this purpose.

Radiation can be particularly useful for older men or patients with pre-existing conditions for whom surgery could be too much of a burden. In most cases, cardiovascular diseases speak against an operation under general anesthesia.

Certain forms of radiation treatment can also be used when the Gleason score is high, meaning when the prostate cancer is too advanced for surgery.

The therapy can act on the malignant tumor from the outside via the skin (percutaneously). The radiation focuses exactly on the carcinoma and protects the surrounding healthy tissue as much as possible. Such percutaneous radiation treatment takes place in short units that last only a few minutes or even only a few seconds. However, the therapy extends over a period of around two months.

Alternatively, the radiation source can also be placed directly in the tumor. This radiation treatment from the inside out is called brachytherapy in medicine. There are two possible approaches to this form of therapy:

• Low-dose-rate brachytherapy

Here, tiny elements made of a radioactive metal are placed directly into the capsule of the prostate gland. The radiation effect unfolds locally in the prostate carcinoma. After a few weeks, the radiation has dissipated so that these so-called "seeds" can remain in the prostate without any problems.

• High-dose-rate brachytherapy

Metal particles that radiate more strongly are used here, which have an intensive effect for a few minutes and are then removed from the prostate again. It then pauses for a few days before repeating the process again to completely kill any remaining cancer cells.

Despite the local therapy, this type of radiation can damage neighboring body organs such as the urinary bladder or the intestines. This can also lead to bladder infections or urethral irritation. Slight intestinal bleeding or diarrhea symptoms are also among the possible side effects of high-dose rate brachytherapy. Erectile dysfunction or urinary incontinence can also occur as a late consequence of this therapy.

The success of the treatment can be determined by regular PSA value checks.

Hormone therapy

In most sick men, the malignant tumor grows in a hormone-dependent manner. This means that the male hormone testosterone promotes cancer growth.

Hormone treatment is now aimed at stopping this tumor growth in a targeted manner. The level of testosterone in the body is reduced and as a result, the growth of malignant tumor cells also slows down.

Such a treatment method is primarily considered when the prostate carcinoma has spread and there are metastases in the bones, in neighboring body organs or in the lymph nodes. Hormone therapy alone cannot cure the carcinoma, but this procedure makes sense in combination with other treatment methods such as radiation treatment.

The aim is to delay further progression of prostate cancer and to effectively alleviate existing symptoms.

Hormone treatment does not have a permanent effect. In concrete terms, this means that the tumor cells grow again after around one and a half to two years even without the influence of the hormone testosterone. There are different forms of hormone therapy in medicine. They all have a common goal, which is to inhibit cancer growth! Some treatments block testosterone production in the testicles, while others block testosterone's effect on tumor cells.

Hormone therapy can lead to side effects of varying severity, such as erection problems, loss of libido, hot flashes, listlessness or mental impairment. It can also sometimes lead to a reduction in beard growth or painful swelling of the breasts.

chemotherapy

With this therapy method, tumor cells are destroyed throughout the body. Chemotherapy is mainly used for prostate cancer in which metastases have already formed.

The sick patients are treated either with cytostatic infusions or cytostatic injections: These are intended to prevent cancer cell growth and cancer cell division. Unfortunately, the strong cell toxin of the drugs also damages healthy cells.

Typical side effects of chemotherapy are hair loss, vomiting, skin problems and changes in the blood count.

Other treatment methods for prostate carcinoma

In addition to the methods mentioned, there are other procedures that are not yet regarded as standard therapies from a medical point of view, since their effectiveness has not yet been sufficiently proven in many cases. These therapy methods are therefore currently still considered experimental.

These methods include, for example:

• Cryotherapy: Here, the cancer cells are fought with cold.
• In hyperthermia treatment, the tumor cells are tackled with heat.
• HIFU therapy (high-intensity focused ultrasound) can also be used: special ultrasound waves are directed against the malignant tumor.
• Doctors are also trying to eliminate the malignant tumor using laser treatment.

What you can do if you have prostate cancer

There is no reliable prostate cancer prophylaxis. However, with some behavioral measures, the risk of such cancer or a recurrence of prostate cancer after recovering from the disease can be reduced.

• Make sure you have enough physical activity in everyday life!
• Pay attention to healthy weight management: Eat a healthy, varied and nutritious diet and avoid being overweight. In particular, grab fresh fruit and vegetables and eat only a little animal fat.
• Avoid alcohol and nicotine consumption as much as possible.
• Conscientiously make use of regular check-ups for early cancer detection.

Although early detection examinations cannot really prevent prostate cancer, they do help with timely diagnosis and thus increase the chances of recovery. Such examinations for the early detection of prostate cancer make it possible to detect diseases before the first symptoms of the disease become noticeable.
In Germany, every man over the age of 45 is entitled to an annual examination of the external genitalia and the prostate, including a rectal examination.

Sources

https://deximed.de/home/klinische-themen/maennergesundheit/patienteninformation/prostata/prostatakrebs-prostatakrebs
https://www.prostata-hilfe-deutschland.de/prostata-news/prostatakrebs-prostatakrebs
https://www.krebsgesellschaft.de/onko-internetportal/basis-information-krebs/krebsarten/prostatakrebs.html
https://www.krebshilfe.de/informieren/ueber-krebs/krebsarten/prostatakrebs/
https://flexikon.doccheck.com/de/Prostatakrebs
https://www.msdmanuals.com/de-de/heim/nieren-und-urinwegsopathies/krebs-der-renen-und-des-urogenitaltrakts/prostatakrebs
https://www.krebsinformationsdienst.de/tumorarten/prostatakrebs/treatment.php
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