Prostate Cancer

Info about PCa.

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Diagnosis

Prostate cancer causes only late symptoms – during the early stage it does not show any symptom.

The sooner, the better

That is why the prostate screening is so important. The first medical indication can be the increased level of the prostate specific antigen –shortly PSA – but of course it is just an indication, not a result. An increased PSA level indicates changes in the prostate. This may just be an inflammation, but it can also be prostate cancer. As long as the PSA level is high, the measurement should be repeated and further examinations, such as ultrasound, magnetic resonance imaging (MRI) or biopsy should be applied. In the PZNW we mainly work with the MRI, which is currently the best imaging method, and we combine these images with those of the ultrasound examination or with the histo-scanning. If the MRI scan shows abnormal tissue structures, we take a targeted biopsy (prostate biopsy). The laboratory examination leads to a more precise result as far as the tumor extension and the type of tumor (Gleason score) are concerned.

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Treatment

The whole spectrum of the possibilities: in the PZNW we offer all the approved therapies – from radiotherapy, brachytherapy to the minimally invasive robot-assisted surgery with the da Vinci system:

Robot-assisted prostatectomy

Brachytherapy

External beam radiation therapy

HIFU therapy

Hormone therapy

 

Open total prostatectomy

The gold standard is not so shiny

We do not use this procedure in the PZNW. We mention this form of therapy only for completeness. The open prostatectomy is the classic form of the prostate removal, because earlier only this method allowed the surgeon full view and control of the surgery steps. There are two possible ways to access the prostate: either via an incision in the perineum or via the abdomen. Even though this form of intervention is the best studied, we prefer the robot-assisted method. It has many significant advantages: less blood loss, less risk of infection, rare wound healing difficulties, less stress for the patient, shorter healing process. The prognosis of the patients with minimal invasive surgery seems to be better – presumably the operation is performed by an experienced surgeon, in a center with high number of cases.

 

 

 

Minimal invasive total prostatectomy

Protective, but inaccurate

During laparoscopic, minimal invasive total removal of the prostate the surgeon puts in specific instruments through small incisions – inter alia a camera, with which the surgeon can lead the instruments under video control. Contrary to open surgery, this procedure is more sparing for our patients. However, it requires appropriate education, and in comparison to open surgery the costs are higher, and more effort is needed.  Compared to the da Vinci-system, the three- dimensional imagery and the high level of precision are missing.

 

Brachytherapy

Attack from closeness

During brachytherapy from short distance the tumor is radioactive irradiated directly from the body surface, or in the tissue, or in body cavities. We distinguish 2 forms of the internal radiation- one of them is the so-called afterloading, and the other form is the seed implantation. During afterloading the tumor tissue is first ‘quilted’ by guide tubes, hollow tubes, or needles. Through them source of radiation is led into the tumor, and it remains there until the end of the treatment. Afterloading is not only used for the treatment of the prostate cancer, but it is used for example in cancer of the mouth floor, esophageal-, ENT (ear, nose, throat), breast, – and gynecological cancers. In case of prostate cancer, the afterloading – as well as in cases of other cancers- is often combined with external beam radiation. In contrast, the seed implantation uses low-dose radioactive implants which are implanted into the tumor, and the tumor is destroyed from inside.

 

External beam irradiation

Focusing to the radiation field

During the external, so-called ‘percutaneous planned 3D conformal radiation’ the tumor tissue is irradiated from outside, through the skin. In order to protect the surrounding tissue the radiation field is exactly pre-calculated with the help of computed tomography, and then it is irradiated in single doses for a few seconds or minutes. The external beam radiation is made at a long-standing cooperation partner. The irradiation affects the general condition of the patient, and it especially affects the surrounding tissues of the tumor. In case of the prostate the irradiation can lead to the irritation of the rectum, bladder, and the erection vessel bundle.

 

HIFU therapy

With sound against the tumor

HIFU means ‘High-Intensity Focused Ultrasound’. With this minimal invasive treatment method we collect ultrasound waves, and we use this 80-100 °C temperature to destroy the tissues which are affected by the tumor. After millimeter precision computerized planning, under anesthesia an ultrasonic probe is inserted through the rectum. Due to the intensive, but precise irradiation, HIFU therapy is especially appropriate for locally limited prostate cancer. It is also applicable in case of recidiv prostate cancer or in case of advanced tumors. We combine the HIFU therapy with the transurethral resection of the prostate (TUR) to make sure that every diseased tissue is destroyed. In the PZNW we have been applying the HIFU therapy for more than 5 years- but we only apply it in studies, because the guidelines classify the HIFU therapy only as an experimental procedure.

 

Hormontherapy

No healing, but slower growth

The cell division of the prostate tumor usually depends on the hormones – especially on testosterone. The therapeutic use is briefly called ‘hormontherapy’ which consists of hormone withdrawal and the use of counter hormones. They affect in different places, but their goal is common: the slow-down of the tumor growth. Even the complaints alleviate which are caused by the tumor. Nevertheless complete recovery is not possible with the hormone therapy. That is why we use hormone therapy in case of the treatment of advanced prostate cancer, or when other therapeutic options are cannot be used. We treat with tablets or with injections- with its help we place medicament depots under the skin, which have a longtime effect and the intervals of injections are extended. Hormone therapy is not a risky therapy. The typical side effects are hot flashes, sexual disinterest, and infertility. These symptoms can be counteracted by sport.  During a fertility treatment unfortunately for men with prostate cancer this is not a possible tumor therapy method.

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Living with the disease

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