Prostate cancer

introduction

Prostate cancer is one malignant tumorthat develops from the tissue of the prostate. It puts the most common type of cancer in men and performs as third most common cancer-related cause of death in men. The incidence of this disease increases with the Age continuously. This is characteristic of prostate cancer slow growth, which is associated with good chances of recovery with early therapy. In the late stages of the disease, the tumor forms Metastases in bone and Lymph nodes out.

Up to 90% of all prostate cancers arise in the outer portions of the gland and can therefore be used in the routine examination, i.e. the digital rectal exam (DRU) are mostly felt by the examiner.

One distinguishes different shapes of prostate cancer. When the tumor in the routine examination groped or by means of a imaging procedures seen and means of a biopsy secured one speaks of a overt or clinical prostate cancer.

Is a tumor availablethat during his lifetime, however not known is, it is a latent prostate cancer. This is usually determined during autopsy examinations, i.e. after death.

Studies have shown that the Number of latent Prostate cancer very much much higher is than that of the manifest. In the group of over 80 years for example, the incidence of prostate cancer is around 60%.

There is still that incidental prostate cancerwhich is discovered by chance during other investigations. An example of this would be the removal of tissue from the prostate due to a benign prostate enlargement, in which the pathologist then determines a carcinoma.

From occult prostate cancer one speaks if already Metastases in other parts of the body occur without the actual tumor being found using standard examinations.

causes

The exact origin of prostate cancer is not finally clarified. However, there is evidence that various factors can play a role in the development of the disease. For one thing, it seems genetic factors that favor the occurrence of prostate cancer. The fact that in different population groups the frequency distribution different is. Colored Americans, for example, are significantly more likely than Asians. There is also Familysin which the Prostate cancer occurs frequently. If a first-degree relative is sick, the individual risk increases by up to twice as much.

There is further evidence that too hormonal influences can promote the development of prostate cancer. They play male sex hormones, so Androgens, a crucial role. It could be observed that men after a castration a clearly lower risk have for this condition. It is also shrinking prostate and often the tumor if there is a lack of these hormones, which is also often used in therapy.

Last but not least seem various environmental influences to influence the development of prostate cancer. Whether that too nutrition has had an impact on it so far controversial.

Symptoms

There are almost no early warning signs in prostate cancer. Relevant and specific symptoms usually only appear at an advanced stage, which is why regular participation in routine examinations is very important.

If the tumor is still limited to the prostate and presses against the urethra, urination problems can occur. These include, for example, a weakened urine stream, increased nocturnal urination and urination. However, these symptoms can also be caused by benign prostate enlargement.

If the tumor continues to grow, blood can be found in the urine and urinary retention can occur. This can back up to the kidneys and lead to further kidney complications. If the prostate carcinoma breaks through the organ capsule, pain usually occurs in this area. If the tumor is large enough, stool irregularities such as constipation (Constipation) or blood in the stool.

The appearance or rapid worsening of erectile dysfunction (erectile dysfunction) should be further clarified in men over 45 years of age. Prostate cancer can sometimes cause the nerves responsible for it to become pinched.

In the advanced stage with metastases, the symptoms mostly depend on the affected organ system. Lymph node metastases can impede the flow of lymph, which can lead to accumulations of lymph, for example in the legs. Bone metastases mainly cause pain in the back, hip, pelvic and thigh area. But they can also lead to fractures without the need for excessive force.

General symptoms of advanced prostate cancer are tiredness, fatigue, loss of appetite, fever, unwanted weight loss, and increased night sweats.

Please also read our article on this What is the terminal stage of prostate cancer?

early detection

Since prostate cancer does not cause specific symptoms until very late, it is important to attend preventive examinations at regular intervals.

One of these is the digital rectal examination (DRU, Prostate examination), in which the examiner tries to feel abnormalities on the prostate with his finger through the patient's anus. Since prostate cancer often develops from the outer parts of the gland, the palpation examination is also successful in many cases.

There is also the transrectal ultrasound (TRUS), in which a probe is inserted through the anus to better assess the condition of the prostate.

And last but not least, the so-called PSA value (tumor marker) can be determined from the blood, which can provide information about a possible prostate disease.

Read more on this topic at: Prostate cancer screening: when? For whom? Procedure!

diagnosis

In order to finally confirm the diagnosis of prostate cancer, a biopsy is required, i.e. a sample taken from the prostate, which is examined microscopically for degenerate cells. This is carried out if the tactile findings in the DRE were abnormal, the PSA value exceeds 4ng / ml or a rapid increase in the PSA value can be observed. During the biopsy, 10 to 12 tissue samples are taken from the prostate under TRUS control. The whole thing happens painlessly for the patient.

The removed material is then processed and examined for cancer cells by a pathologist. It then ultimately determines the type of tumor and the degree of malignancy or else malignancy, the so-called grading according to the Gleason Score.

You might also be interested in: PSA value

Grading / Gleason score

At the Grading it is about the Malignancy Assessment the tumor cells. The pathologist assesses the Deviations of the tumor cells from healthy cells the prostate and assigns it to one scale to, the so-called Gleason score.

A distinction is made between highly differentiated cellsthat are relatively differ little from healthy tissue and low differentiated cells, the one high degree of degeneration exhibit.

Using the Gleason score, the Degree of degeneration quantified. For the individual tumor cell, the pathologist can do a one For very slightly deviating cells up to one five For very degenerate cells forgive. this happens for two differently severely affected tissue samples from the prostate and the individual values ​​are added together. Of the lowest value for the Gleason score is therefore a 2 (1 + 1), the highest accordingly a 10 (5 + 5). This classification is of crucial importance for further therapy.

Staging / TNM classification

Staging means determining the extent of the tumor. This is classified using the TNM system. The "T" stands for the size of the actual tumor, "N" for the involvement of lymph nodes (engl. Nodes) and "M" for any metastases.

T0 formally stands for a non-existent tumor, T1 for a prostate carcinoma that is clinically undetectable, T2 for a prostate carcinoma that is confined to the prostate, T3 for a prostate carcinoma that has already broken through the organ capsule and T4 for a prostate carcinoma that is already adjacent Has affected organs.

In the case of lymph node involvement, a distinction is only made between no involvement (N0) and an involvement of the local lymph nodes in the pelvic area (N1).

The metastases are classified analogously with M0 for no metastases and M1 for existing metastases.

An X after the respective letter means that this parameter could not be assessed in more detail.

There are also other sub-categories, but this rough division is sufficient for an initial orientation.

This classification is also of crucial importance for the further treatment of prostate cancer.

Also read: What are the chances of a cure for prostate cancer?

Staging

Once the grading and staging have taken place and the PSA value determined, prostate carcinomas can be further summarized in different stages with a similar prognosis.

A frequently used classification is that according to UICC (Union Internationale contre le cancer). Stage I comprises prostate cancers that are limited to the prostate, have no lymph node involvement or metastases, and have a rather low Gleason score (up to 6) and PSA value (below 10 ng / ml).

Stage II includes prostate carcinomas that are limited to the prostate, have no lymph node involvement and no metastases, but have a significantly higher Gleason score and PSA value.

Prostate carcinomas that have broken through the organ capsule are considered stage III and tumors that have already affected neighboring organs or lymph nodes or have metastasized as stage IV.

With the stage, the risk of dying of prostate cancer within a few years ultimately increases, but the choice of treatment method usually depends on the tumor stage.

Read on below: What are the stages in prostate cancer?

Guideline

The Working group of the scientific medical societies (short: AWMF) is an organization called Guidelines publishes for the most diverse clinical pictures. This is supposed to attending physicians in making decisions regarding the therapy of your patients help. The guidelines are based on the current state of research and should for more safety in medicine and care for patients. There are also current guidelines for prostate cancer. A basic distinction is made here between non-metastatic prostate cancer that has appeared for the first time and relapse or metastatic prostate cancer.

For patients with a non-metastatic carcinoma come curative, so healing therapy options in question. On the one hand, these are the OP (radical prostatectomy), radiotherapy and the Active surveillance (Active surveillance).

requirements for the choice of this therapy option, active monitoring, are a PSA level below 10 ng / ml, a Gleason score below 6 or a Tumor stage T1 or T2a. In these patients will then The PSA level is checked again every three to six months and a DRU carried out.

In the elderly one can also refer to the therapy concept of long-term observation (Watchful waiting) skip. This only intervenes in the course of the disease if symptoms arise.

The locally limited Prostate cancer can persist operational or with a Radiation treatment be treated. Both procedures are roughly equivalent and should be checked carefully in each individual case.

For patients with locally advanced, ie. metastatic Prostate cancer come in both one surgical as well as radiation therapy in question. Here, too, the patient should be informed about both procedures in each individual case and, taking into account the respective advantages and disadvantages, make the decision on further treatment options together with the specialist.

Is curative treatment is no longer possible, come according to the guideline palliative therapy options in question. On the one hand, these are the hormone-ablative therapy and the Watchful waitingwhere only symptom dependent and intervention is made with palliative intent. With hormone-ablative therapy, the time interval is lengthened without further deterioration, but the data on overall survival are still unclear. In any case, the patient must be informed about both options.

OP

In the operative therapy option it is about the radical prostatectomy (RPE).

The Prostate gland (prostate) completely cut out (Ectomy), mostly too both seminal vesicles and possibly also infected Lymph nodes in the immediate vicinity (regional lymph nodes).

There are different surgical procedures. The procedure can be both through the stomach (retropubic RPE) as well as from the dam (perineal RPE) can be made. In addition, between the open and the laparoscopic or minimally invasive OP differentiated. The minimally invasive Procedure has the advantage that less cutting area and therefore fewer wound edges. The great disadvantage compared to the open procedure, however, is that only lymph nodes in close proximity can be.

With the prostate, however, will also cut out a part of the urethra. This is sutured again, but often leads first Incontinence. How long this lasts depends on the one hand on the operation itself, but also on factors that the patient brings with him. In some cases it disappears completely immediately or within a few weeks, but it is also possible that this lifelong persists.

Another complication that can result from surgery is that injury of those annoythat for the erection are responsible. After that, in the worst case, there is one Erection no longer possiblehowever, the ability to have a climax remains unaffected. The operation on the nerves hangs very much on the skill of the surgeon and the technology used. In recent years, the process of "nerve-sparing technology“Enforced, which may have better results in this regard.

A cosmetic side effect The operation can also be done in a Shortening the outer limb end, which some sufferers do too mentally after the operation Problems prepares.

Despite all the complications, however, the radical prostatectomy the Method of choice to be able to cure a localized carcinoma. However, the decision should always be made on a case-by-case basis and with supportive advice.