Observe local prostate cancer instead of operating immediately

Early detection is crucial for the treatment of the most common tumor in men. Controlled observation is often more useful than immediate removal.

Prostate cancer is a malicious Cancer of the prostate gland and the most common malignancy in men in Germany. Over 63.000 new cases are registered every year. After lung and colon cancer, prostate cancer is the third most common cause of cancer-related death.

But not everyone affected has to undergo comprehensive Cancer therapy including surgery. Even if the operation to remove the organ is successful, many men are subsequently impotent or incontinent.

The decision to operate requires an assessment of the size and development of the tumor. Often it is not prostate cancer, but a benign enlargement of the prostate gland, known as benign prostatic hyperplasia (BHP). This primarily causes problems with urination, but is always limited to the prostate.

Prostate cancer usually occurs in older age

“Regular participation in early detection examinations is crucial, because in the early stages prostate cancer does not cause any symptoms,” says Dr. Reinhold Lunow, medical director of Praxisklinik Bornheim near Cologne and Bonn"We recommend annual check-ups starting at age 40. This is because the risk of developing prostate cancer increases with age."

Over 80 percent of all men diagnosed with prostate cancer are over 60 years old, and most new cases only occur after the age of 70. Around 60 percent of all 60-year-old men have prostate cancer. In the vast majority of cases, however, these are early forms that do not require treatment.

If the tumor remains confined to the organ, an operation will initially be of no benefit, as it grows relatively slowly. If the decision to treat cancer is made early, the stressful side effects are more likely to outweigh the benefits.

PSA test and Diagnosis Prostate cancer

“But that does not mean that you have to deal with the prevention time and does not go for early detection. On the contrary: only control and observation over a certain period of time allow a reliable diagnosis and timely treatment,” says the expert for preventive medicine and Diagnostics.

This is also due to the inadequate information provided by the PSA test, which is carried out as part of routine preventive examinations. The prostate-specific antigen (PSA) is a protein that is only produced in the prostate and is released into the blood in increased amounts when the organ is diseased. PSA is also a tumor marker for assessing cancer.

The problem: The PSA value can be elevated without a tumor being the cause. Benign tumors also drive the value up and are only discovered in this way. An inflammation of the prostate (prostatitis) can also be the cause, as can mechanical irritation of the organ: sexual intercourse, cycling or a physical examination. Since the prostate borders on the rectum at the back, the Doctor Feel for irregularities and hardenings rectally with the finger.

The PSA value should therefore not only be assessed in relation to the limit value of 4 nanograms per milliliter (ng/ml). The rate of increase between different PSA measurements is also important. Studies have also shown that only one in four men with a higher PSA value of up to 10 ng/ml actually has prostate cancer. Conversely, a value below 4 mg/ml does not completely rule out prostate cancer.

As part of the preventive care, further laboratory tests are carried out and general inflammatory markers such as C-reactive protein (CRP) and leukocytes are determined. The doctor also examines the external genital organs and feels the lymph nodes in the groin.

A family history can also promote the disease, as between 5 and 10 percent of prostate diseases are genetic. Men whose fathers or brothers have had prostate cancer have twice the risk of developing the disease themselves.

If further examinations are necessary, transrectal sonography, a painless and radiation-free ultrasound examination via the rectum, can be considered. If structural changes are suspected, a tissue sample (biopsy) of the prostate gland can be taken.

Prostate cancer does not cause typical symptoms

However, there are no typical symptoms that indicate an aggressive tumor in the prostate at an early stage. Non-specific warning signs can include difficulty urinating, blood in the urine or semen, and erectile dysfunction. Pain during ejaculation, in the back, pelvis, or hips is also possible.

However, if the tumor continues to spread, it breaks through the connective tissue capsule of the prostate and grows into neighboring tissue (e.g. seminal vesicles, urinary bladder, rectum). As the tumor progresses, cancer cells can spread into lymphatic vessels, lymph nodes and bones and form metastases.

Regular screening tests show changes in prostate cancer

However, if prostate cancer is detected early enough that it is still limited to the prostate gland, almost all those affected survive the disease. Those who have a truly aggressive carcinoma and a significantly elevated PSA value of over 10 ng/ml will benefit from surgery. The decision to undergo surgery should therefore be made carefully - after thorough examinations and consultation with the doctor.

"Most men suffer from a less aggressive early form that is limited to the prostate. Nevertheless, a low-risk tumor in a man in his mid-fifties can develop into an aggressive cancer within ten years. Therefore, prostate control over a longer period of time is important. So you should start early with regular preventive examinations start,” recommends Dr. Lunow.