I have prostate cancer

Prostate cancer - what to do if it is suspected?

The illness

Prostate cancer is now diagnosed in every sixth man over the age of 50. However, 4 out of 5 of the men affected do not die from it, because prostate cancer often has a favorable course. However, there are different types of prostate cancer cells. Some reproduce very quickly and aggressively, while others grow slowly.

The treatment options are correspondingly different. Several examinations are important to find the right treatment for you. The aim is to assess the risk your cancer is likely to pose. How prostate cancer will develop in you cannot, however, be predicted with one hundred percent.

Recommended examinations

  • PSA determination
    The prostatasspecific A.ntigen (in short: PPE) is only produced by prostate cells, especially prostate cancer cells. The higher the PSA value, the less favorable the course of the disease is likely to be.

  • Palpation examination
    From the intestine, the doctor feels the prostate with his finger. In this way, the size and location of the tumor and thus the tumor category can be determined. A tumor category of 1c or 2a is favorable. Then the cancer has not grown into other tissue and is confined to one half of the prostate.

  • Tissue sample
    The doctor takes samples from the prostate at 10 to 12 fixed points with a thin hollow needle. If you have had an MRI scan beforehand, any abnormal areas should be examined in a targeted manner.

  • Histological examinationSpecialists examine the tissue samples under a microscope. You notice how aggressive the cancer cells are. They do this with the help of a certain classification - that Gleason score. This ranges from 6 to 10. A low score of 6 indicates that the cancer is not growing or is growing slowly.

The risk groups

The doctor uses the results of the examinations to determine the risk group. Low risk is characterized by:

  • PSA value of 10 or less

  • Tumor category of 1c or 2a

  • Gleason score of 6

Such prostate cancer is likely to have a very favorable course. High-risk cancer is usually aggressive and should be treated soon.

decisions

Do not decide on further treatment until you have understood all the results of the examinations. Seek advice from partners, confidants, and friends if this is helpful. Let the doctor's office explain all treatment options with their advantages and disadvantages. You can also use other reliable information, for example the patient guideline: "Prostate Cancer I - Localized Prostate Cancer" (see "Explained in detail" below). You usually have several months to make a decision. Unless the cancer is growing particularly aggressively.

The treatment

If the cancer is to be cured, it is important to remove or destroy the cancer cells as completely as possible. Serve:

  • The surgery: the prostate is surgically removed (radical prostatectomy).

  • The Irradiation: irradiation takes place either from the outside through the skin or directly in the prostate.

After 10 years, 7 out of 10 treated men are cured. Both procedures are equally effective for low and medium risk. If the risk is high, you don't know exactly. There is a lack of good studies. Both procedures have side effects and risks. The most common include erectile dysfunction (impotence) and bladder weakness (Incontinence). If your cancer belongs to the low-risk group, it can therefore make sense not to undergo an operation at first. There are different wait-and-see approaches:

  • The active monitoring is an option for physically fit men, including younger ones. At the time of diagnosis, curative intervention is not necessary because the cancer is not aggressive. The doctor will check regularly to see if the cancer is getting worse. Then surgery or radiation is carried out. Active monitoring is about as safe as surgery or radiation for over 10 years. It saves those affected from their consequences - at least temporarily.

  • The long-term observation is a procedure for men who generally want to forego an intervention. For example, because they are older or frail. Then the doctor will check your state of health. Nothing is done about cancer. If complaints arise, these are treated specifically. Many men live with their cancer for a long time.

There is also the option of hormone withdrawal treatment. The testosterone level is lowered surgically or through medication, which is supposed to slow the progression of the disease.

What you can do yourself

  • Many questions can be answered in a conversation. However, if you repeatedly feel that you are not being properly advised or pressured to seek treatment, seek a second opinion.

  • Exchange ideas with other people affected. The Federal Association for Prostate Cancer Self-Help can help here.

  • You can support treatment with a healthy lifestyle.

June 2018, published by the German Medical Association and the National Association of Statutory Health Insurance Physicians