Treatment of prostate cancer

In the case of less aggressive tumours detected at an early stage, direct treatment may be deferred initially. Instead, the condition is monitored closely. The aim is to avoid the side effects of treatment as long as the tumour shows no signs of progressing.

Active surveillance is particularly suitable for so-called low-risk tumours. Regular check-ups (PSA level, digital rectal examination, MRI and repeat biopsies) are crucial in this approach. Only when there are signs of progression is active treatment initiated. Studies show that the chances of survival in these cases are comparable to those with immediate surgery or radiotherapy.

Surgical removal of the prostate is one of the most important curative treatment methods. It is primarily considered when the tumour is still confined to the prostate. During the procedure, adjacent structures such as the seminal vesicles are removed along with the prostate.

There are various surgical procedures, such as open surgery, minimally invasive (laparoscopic) techniques or robot-assisted procedures. Both the method and the surgeon’s experience are crucial to the success of the operation. After removal, the urethra is reconnected to the bladder. A catheter is often required temporarily until the connection has healed securely.

Side effects of prostatectomy

One potential issue is incontinence, which is usually temporary. Therefore, rehabilitation exercises may be beneficial after surgery to help the muscles regain their function. Depending on the individual case, it may take a few days or longer before the patient can fully control their bladder again – after twelve months, 95% of those affected are continent once more. In some cases, erectile function may also be impaired. Depending on age and the tumour, sexual function can be preserved in up to 80% of those affected.

Thanks to new, nerve-sparing surgical techniques and individual adaptation to the tumour findings, continence and erectile function can often be preserved.

Radiotherapy is an alternative to surgery and is equally effective for locally confined prostate cancer. It can also be used as an adjunct to surgery if risk factors are present.

In the case of ‘watchful waiting’ – in contrast to active monitoring – curative treatment is deliberately avoided. This strategy is used primarily in older patients or in cases of severe comorbidities.

The focus here is on quality of life. Treatment is only initiated when symptoms arise, and is then primarily aimed at providing relief.

In advanced prostate cancer, particularly where metastases are present, hormone therapy plays a key role. It aims to suppress the effects of the male hormone testosterone, as this promotes the growth of cancer cells.

Treatment can be carried out using medication or surgery. The aim is not necessarily a cure, but rather to control the disease and alleviate symptoms.

Side effects are often similar to those experienced during the menopause, such as hot flushes, tiredness or mood swings.

If the disease continues to progress or no longer responds to hormone therapy, chemotherapy may be used. This involves administering drugs that destroy rapidly growing cells.

Treatment is usually carried out in cycles, with breaks in between to allow the body to recover. Side effects may include nausea, hair loss or a weakened immune system. However, modern supportive medications can often significantly reduce these effects.