Prostate cancer occurs when cells in the prostate begin to divide uncontrollably. This can happen if the genome of the cells is changed. Usually, the body’s immune system keeps such cells in check. Cancer occurs when too many mutated cells multiply and grow into a tumor.
The diagnosis of prostate cancer is a shock for most men and their loved ones. However, the reassuring news is that prostate cancer is among the diseases with the most excellent chance of recovery. Because he often grows very slowly and can therefore usually treat well.
Prostate cancer usually does not trigger discomfort until it is more advanced. Then it can lead to problems such as increased urinary urgency or a weaker urinary stream. Most issues with urination are caused not by cancer, but by a benign enlargement of the prostate. It is very common in men over 50.
Rarely, blood in the urine or semen can also indicate prostate cancer. If the tumor is very advanced, it can spread through the lymph channels or the bloodstream to other parts of the body, such as the bones. This can trigger symptoms like bone pain.
Causes and risk factors
The exact causes of prostate cancer are unknown. However, there are certain factors known to increase cancer risk. The most important are:
Age: The risk of prostate cancer increases with age.
The pedigree: Men with black skin are a little more affected by prostate cancer than men with different skin color.
First degree relatives: Anyone with a father or brother who has prostate cancer has a slightly higher risk of their own. If the father and several brothers get sick, the risk is higher.
High Doses of Vitamin E: Dietary supplements rich in vitamin E have been shown to increase the risk of developing prostate cancer when taken for years.
Often certain foods such as red meat or tomatoes are associated with cancer – sometimes as a cause and sometimes as a preventive measure. However, the fact that men can reduce their prostate cancer risk from a particular diet is not supported by essential studies.
The number of prostate cancer diagnoses has increased significantly in recent decades but is now declining slightly again. One reason for the increase was the increase in life expectancy because of the risk of contracting prostate cancer increases with age. In men under 50, prostate cancer is sporadic.
The second reason is that more men are taking part in screening for prostate cancer. In these investigations, small cancerous nodules are increasingly found today that were not discovered in the past, because they do not cause any symptoms in many men all their lives. The early detection thus increases the number of diagnoses.
The following tables show how likely it is that a man of a certain age will be diagnosed with prostate cancer over the next decade of his life and whether he will die from it. These are average values. The individual risk of a man also depends on whether and which risk factors he has.
Prostate cancer can be different. Most men with this diagnosis have good chances of recovery. Because often prostate cancer is local (local) limited and has not formed any metastases (metastases). Over 90% of men diagnosed with prostate cancer still alive five years later. Considering only men with localized prostate cancer, it is even 99%.
In recent decades, several studies have shown that many men have small cancerous nodules in the prostate that cause no discomfort. In these studies, men who died of other causes were examined. In other words, they did not kill, but with prostate cancer. Such nodules are also referred to as latent tumors and are relatively common in men over 50: it is estimated that 30 to 70% of them have potential prostate cancer.
However, there are also aggressive forms of cancer that can grow fast and shorten the lifetime. When cancer is detected, it is not possible to predict with certainty how it will develop in the future. However, a tissue sample and other tests can be used to assess whether a tumor is more aggressive (high-risk cancer) or only very slowly (low-risk cancer). This is important for the treatment decision, among other factors such as the age of the man.
If there is a suspicion of prostate cancer, the doctor will first ask for any symptoms that may be present to roughly classify the symptoms and to provide information on possible causes (anamnesis). After that, various investigations are possible:
Palpation: By palpation of the prostate via the rectum with a finger, the size, firmness, and surface of the prostate can be assessed. This examination is called digital-rectal examination (from the Latin “digitus” = finger). Some men find the test uncomfortable, but usually, it is not painful.
PSA test: The PSA test is a blood test for a specific protein. PSA stands for “Prostate Specific Antigen,” a protein that is produced in the prostate and small amounts into the blood. An elevated PSA level may or may not be indicative of prostate cancer. The value may also be increased for other reasons.
Transrectal ultrasound examination (TRUS): With an ultrasound device, the shape and size of the prostate can be assessed. For this purpose, an approximately finger-thick ultrasound probe is inserted into the rectum.
Tissue sampling (biopsy): Whether there is cancerous tissue in the prostate can only be reliably determined by taking a tissue sample. As a rule, ten to twelve tissue samples are taken from the prostate and then examined under a microscope for cancer cells. Usually, a punch biopsy is made. For this purpose, as in TRUS, an ultrasound device is introduced into the rectum, into which a fine hollow needle is integrated. The needle is pierced through the wall of the rectum into the prostate to remove the tissue samples. The ultrasound helps guide the needle to the right places. The examination takes place under local anesthesia, in exceptional cases short anesthesia is possible.
Using the tissue samples, the “aggressiveness” of the tumor can be estimated. By that is meant how much the tissue has changed, how likely it is that the cancer is growing, and how fast it is spreading in the body. For this purpose, the so-called Gleason score is determined by a specialist in pathology. In prostate cancer, the Gleason score is between 6 and 10. At a value of 6, the aggressiveness of the tumor is low, starting from an amount of 8 high.
Three of the diagnostic methods described are also available for early detection of prostate cancer: palpation, PSA and transrectal ultrasound.
They are often referred to as careful screening. The term precaution gives the impression that an investigation can prevent cancer from developing. However, that cannot do any of the examinations. Instead, your goal is to discover prostate cancer earlier so it can be treated better.
The palpation examination is as a screening test performance of the statutory health insurance: All men over 45 years have once a year claim to it. A benefit is not proven. For example, there is no evidence that men die less frequently from prostate cancer if they regularly take part in the palpation.
Transrectal ultrasound is not suitable for the early detection of prostate cancer. The statutory health insurance pays the ultrasound examination only in case of complaints or suspicion of a disease of the prostate, for example, in a benign enlargement of the prostate.
The benefit of the PSA test for early detection of prostate cancer has been investigated in extensive studies. The results show that potential benefits also face serious disadvantages such as overdiagnosis. Before making a decision for or against a PSA test, it is worth weighing the pros and cons.
Which treatment is suitable for a man with prostate cancer depends on various factors. This includes:
The extent of cell changes (aggressiveness of the tumor)
The spread (stage) of the cancer
The PSA value
personal aspects such as the age of the man, his other health status and his consideration of the pros and cons
In men with high-risk prostate cancer, the prostate is usually surgically removed or irradiated. There are two ways of irradiation: from the outside (external radiotherapy) or inside (internal radiotherapy, brachytherapy).
The most common side effects of radiation and removal of the prostate are unwanted urinary output (urinary incontinence) and erectile dysfunction. In particular, external radiation can lead to diarrhea, sometimes also to intestinal inflammation, which may be associated with blood in the stool and convulsions.
As long as the cancer is small, limited to the prostate and is not aggressive (low-risk prostate cancer), a man can also choose the following treatment options:
Active surveillance: In this strategy, prostate cancer is initially only observed and not treated directly. It takes into account that low-risk prostate cancer usually grows very slowly or not at all. Often, even years after diagnosis, there is no progression of the disease. Instead of treatment, the prostate is checked at regular intervals. Only when the tumor grows, is it treated as curative. The advantage of this strategy is that the men who do not develop cancer will be spared the side effects of surgery or radiotherapy. The possible downside: Sometimes it is discovered too late that cancer is progressing. He may have already metastasized. Also, it can be psychologically stressful to live with the knowledge that you have the disease in the body.
Watchful waiting: Even with this strategy, prostate cancer is initially only observed. If the tumor grows, however, just the symptoms are treated, not cancer itself (soothing or “palliative” treatment). This strategy is especially useful for older men who may have other illnesses. For them, the risks and burdens of surgery or radiotherapy could outweigh the potential benefits of these treatments.
For men with low-risk prostate cancer, there is no “right” or “wrong” decision. Which treatment strategy a man chooses is, to a large extent, a matter of personal consideration: for some, it is more important to avoid side effects such as impotence or incontinence as much as possible. The other one wants to be as sure as possible that cancer has been removed and takes the risks of the treatment into account.
As prostate cancer progresses, there are several variants of hormone and chemotherapy that are expected to slow its growth.
The GP practice is usually the first port of call when you are ill or need medical advice if you have a health problem. We inform you about how to find the right practice, how to best prepare for the doctor’s visit and what is essential.
Further information on prostate cancer, for example on the criteria, used to assess the aggressiveness of tumors, and treatment options can be found at the Cancer Information Center’s Cancer Information Service.