Prostate cancer treatment is an emergency
Urology: University Clinic for Urology - Navigation
Prostate carcinoma is the most common carcinoma in men, the incidence being highly age-dependent. Prostate carcinomas are very different in terms of their aggressiveness and therefore, also considering the patient's age, not every prostate carcinoma needs (immediately) treatment. Diagnosis is based on rectal palpation of the prostate and determination of prostate-specific antigen (PSA). The determination of the PSA in the blood is controversial. The PSA is only produced by prostate cells. Elevated values are found in prostate cancer, but also in benign prostatic hyperplasia and prostatitis. The antigen is therefore not cancer-specific and has only limited informative value. Nevertheless, the urological societies recommend a PSA determination in well-informed men with appropriate therapeutic consequences. If abnormal findings are found during PSA or digital scanning of the prostate, a specific MRI of the prostate is followed by a prostate biopsy, which is performed with the aid of the MRI images (see article on stereotactic prostate punch biopsy).
If the biopsy is negative (no evidence of carcinoma), the regular preventive examinations with further rectal examinations and PSA checks follow. In the case of a positive biopsy (with evidence of carcinoma), depending on the biopsy result, computer tomography and skeletal scintigraphy are used to determine whether metastases are already present or not. Based on the results of the examination, the need for active therapy is assessed and discussed with the patient. If no immediate active therapy is necessary, the prostate cancer is monitored and monitored as part of an "active surveillance". The close-knit check-ups are intended to ensure that progression of the tumor is detected at an early stage and that appropriate treatment is initiated.
If active therapy is necessary, there are the following options in addition to possible radiation:
Radical prostatectomy: The removal of the prostate, seminal vesicles and regional lymph nodes is the recognized surgical treatment for localized prostate cancer. There are basically two technical options for the operation: the conventional open operation and the minimally invasive (DaVinci robot-assisted or laparoscopic) operation. The results of the two techniques are comparable, with slightly faster convalescence and less blood loss with robot-assisted surgery. The functional results in terms of incontinence are good; severe postoperative incontinence is rare regardless of the surgical method. Postoperative erectile dysfunction, however, is far more common, but it can be addressed with appropriate drug therapy.
Focal Therapy: In very selected cases, prostate carcinomas with a low risk profile can be treated focally. This means that only the region of the prostate that showed carcinoma in the biopsy is treated, the rest of the prostate is left without treatment. One of the possibilities here is the HIFU (Highly Intensive Focused Ultrasound), here the tissue is focally “boiled over” by ultrasound.
Medical therapy: Treatment is indicated in patients with metastatic or locally very advanced symptomatic carcinoma, but radical prostatectomy in most cases does not make sense. The basis of the therapy here includes the suppression of testosterone, which is a decisive driving force in the growth of prostate cancer. This can be done either surgically, by removing the testicular tissue, or medically with various preparations that cause the body to inhibit testosterone production. Patients who suffer a relapse after an operation can be given hormone therapy in the further course. There are also other drug therapy options such as second-line hormone therapy or chemotherapy.
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