Tailor-made treatment for prostate cancer

9th Uro-oncological Update Symposium in Cologne

Prostate cancer is sometimes treated, although it would never have caused problems for life. On the other hand, many patients whose tumors are already advanced do not receive appropriate therapy. Experts from the West German Prostate Center recently discussed ways out of the dilemma between over- and undertherapy at the 9th Uro-oncological Update Symposium in Cologne.

Prostate cancer is the most common malignant tumour in men: Every year, more than 58,000 men in Germany fall ill and 11,000 die as a result of the disease. Thanks to improved early detection methods, we are now able to detect tumors in the prostate at an ever earlier stage,"said Dr. Pedram Derakhshani on the occasion of the 9th uro-oncological update symposium in Cologne. However, it is often not possible to say with certainty whether a diagnosed tumour actually leads to death if it is not treated. According to Derakhshani, it makes sense to decouple the diagnosis from therapy in order to avoid the danger of overthera-pie. The urologist emphasized that "We have to better identify risk patients in advance. New test procedures from laboratory and imaging diagnostics such as the PCA3 gene test and ultrasound-based elastography are already a valuable supplement to the conventional PSA test. 

The danger of an over-therapy should always be included in the therapy considerations,"especially since prostate cancer patients have to accept serious side effects, especially after radical surgery," said Dr. Stephan Neubauer, also a urologist at the West German Prostate Center. The surgical removal of the prostate gland, which is still the most common procedure in Germany, is often accompanied by a high incontinence and impotence rate. Thus, every 10th patient can no longer hold the urine after surgery, almost two thirds suffer from erectile dysfunction. According to Neubauer, the focus in the treatment of prostate cancer patients must therefore be increasingly on achieving optimal healing rates with minimal side effects.

If prostate cancer is diagnosed at an early stage, the cure rate is 80 to 90 percent, regardless of whether internal radiation therapy (brachytherapy), radical prostatectomy or external radiation therapy is performed. However, as soon as the tumour has grown into the surrounding prostate capsule or lymph nodes are already affected, the likelihood of healing decreases dramatically,"said Neubauer. However, the differentiation between the different tumor stages is not always clear. After a prostate removal, it can be shown that the tumor has already infected the capsule. 

If the tumour has a higher risk of breaking the capsule or of metastasis, radical removal of the prostate is no longer recommended as the therapy of choice, according to the tenor at the symposium. Radiation therapy methods perform better here,"explained Dr. Gregor Spira, radiation therapist at the West German Prostate Center. In contrast to surgical treatment, where a single incision separates healthy from malignant tissue, radiotherapy always includes a safety margin around the tumour, which also records possible settlements that cannot be detected in diagnostics. The radiation dose gradually decreases from the tumour centre to the risk organs bladder, rectum and urethra.

More safety through radiation therapy

Brachytherapy has proven to be particularly effective and gentle. During seed implantation, up to 80 very small beam sources (seeds) are inserted into the prostate under constant ultrasound control. The seeds remain in the patient's body and have a radiation effect on prostate cancer for months,"explained Dr. Carsten Weise, a radiotherapist at the West German Prostate Center. The tumor tissue is destroyed from the inside by the high-dose, targeted radiation. While seed implantation is used for early diagnosis of a tumor, HDR afterloading is the most effective and meaningful treatment for advanced or aggressive prostate cancer. Special hollow needles are inserted into the prostate gland through which a highly active radiation source travels, which irradiates the tumour directly on site "The afterloading procedure is usually combined with external irradiation. This ensures that the peripheral areas of the prostate, where tumour cells can settle, are also irradiated,"said Spira. 

The advantage of "internal radiation" is that patients have to accept significantly lower side effects for treatment. Another advantage of seed implantation and HDR afterloading: Patients are able to resume professional and private activities after only a few days.

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