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Radiotherapy or surgery for prostate cancer? When is the PSA test useful? How is benign enlargement treated? Topics relating to early detection, modern diagnostics and treatment of prostate diseases were the focus of the "13th Prostate Patient Day" on November 3, 2023 in Cologne, which was attended by around 150 patients, relatives and interested parties at the invitation of the West German Prostate Center (WPZ).
"We are delighted that our patient day was so well received again this year. This shows us how high the demand for information on the diagnosis and treatment of prostate diseases is," says Dr. Stephan Neubauer, head urologist at the West German Prostate Center at the KLINIK am RING in Cologne.
Prostate carcinoma is the most common cancer in men and is diagnosed in 69,000 men in Germany every year. Targeted screening can detect early stages of the disease in around 80% of cases and cure those affected with suitable treatment. "However, patients with radical surgery as the only treatment recommendation are often inadequately informed. Today, there are a number of effective and well-proven therapy options for the treatment of organ-confined prostate cancer," Dr. Neubauer explained to the interested audience.
However, in order to choose the best possible treatment, a precise diagnosis must first be made. In addition to PSA tests, ultrasound and palpation examinations, modern imaging techniques such as multiparametric MRI (mpMRI) are now available for this purpose, as urologist Kai P. Schuster from the WPZ explained in his presentation: "If there is a suspicion of prostate cancer, we can use mpMRI to detect tumor foci in the prostate and remove specific tissue for further examination by the pathologist. "The so-called MRI fusion biopsy increases the accuracy of conventional biopsies from 50 percent to 92 percent," says the urologist. At the West German Prostate Center, tissue is usually removed through the patient's perineum (perineal biopsy). This has the advantage over a biopsy through the rectum that, in addition to greater precision, the risk of infection is also significantly reduced.
The precise determination of the size, spread and malignancy of the prostate tumor is crucial for optimal treatment planning. "First of all, it is important to determine whether the tumour is still confined to the prostate (localized prostate carcinoma) or whether it has already spread to lymph nodes or bones, for example," Dr Pedram Derakhshani, head urologist at the WPZ, emphasized afterwards. If it is a localized prostate carcinoma, the tumour is classified based on the parameters of tumour size, Gleason score and PSA value and assigned to one of three risk groups (low, medium or higher risk). The further therapeutic procedure is based on this. "The aim is always to achieve the best possible cure rate with the lowest possible side effects," emphasized Dr. Derakhshani, referring to the Prostate Cancer Result Study Group, an international committee of prostate experts. "With the help of a patient tool developed by the scientists, it is possible to compare the cure rates of all modern forms of therapy depending on the risk profile of the tumor," explained the urologist. This interactive decision-making aid is based on a scientific analysis of all relevant studies on the treatment of localized prostate cancer.
Brachytherapy is particularly important in all three risk groups. "This special form of radiotherapy is a high-precision radiation treatment that destroys the tumor from the inside without damaging surrounding structures such as the bladder, bowel or sphincter," explained Dr. Carsten Weise, head radiotherapist at the WPZ, in his presentation. For this purpose, tiny radiation sources are introduced directly into the prostate, which irradiate the tumor from the inside. With equal or even superior cure rates, brachytherapy has a significant advantage over total surgery: most patients are spared side effects such as impotence and urinary incontinence is extremely rare. As pioneers of brachytherapy in Germany, the interdisciplinary team of experts at the WPZ has carried out a total of over 9,000 treatments and has more than 20 years of follow-up data.
However, not every prostate disease is malignant. Almost every second man over fifty suffers from benign enlargement, known as prostatic hyperplasia (BPH), which is characterized by constant urination, a weak urinary stream and unpleasant dribbling. Here, too, there are several treatment options: from medication in the early stages to surgery. While traditional exfoliation with an electric snare sometimes involves risks, the prostate experts in Cologne use state-of-the-art laser procedures to effectively and gently vaporize or remove excess prostate tissue. "Compared to conventional prostate excision, laser procedures such as holmium laser enucleation (HoLEP) and diode laser therapy are more effective, lead to fewer complications and reduce the likelihood of re-operation," explained Priv.-Doz. Dr. Dr. Holger Gerullis. With the HoLEP procedure, even men with very large prostate volumes can be operated on gently without the need for open surgery.
Once again this year, the presentations were followed by lively discussions. Numerous visitors took the opportunity to address their questions directly to the prostate experts. Whether in person or in writing, every request was answered in detail by the doctors from the West German Prostate Center. "This gave us the opportunity to provide many patients with specific help in their individual case," summarizes Dr. Neubauer.
