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Today, a diagnosis of prostate cancer is no longer a death sentence. If the disease is detected in time by means of a PSA test, ultrasound and palpation, it can be cured in many cases. Although prostate cancer is particularly widespread in older age, men regularly fall off the screening grid when they reach the age of 70. The decision as to whether or not the patient receives therapy is also often made too strongly on the basis of the patient's age, "Wrongly," says Dr. Stephan Neubauer, urologist at the West German Prostate Center. The general recommendations are that the blood test to determine the prostate-specific antigen(PSA) should only be performed in patients over seventy if there are symptoms that indicate a tumor. The reason given is that prostate cancer is a slow-growing cancer and therefore most older men do not experience the final stage anyway due to age or health. "A fatal error," Neubauer complains. "Nowadays, seniors are still in the midst of life beyond seventy, are physically active, have a wide range of interests and enjoy good health." The Cologne urologist attests to an average life expectancy of at least 10-15 years for the majority of his patients over 70. So why should early detection and, if necessary, effective therapy be dispensed with here?
Older patients often receive only hormones or no treatment at all A recent study1 has now shown that older prostate cancer patients actually receive curative (curative) therapy such as radiation, brachytherapy or surgery less frequently than their younger counterparts. Instead, men of older age are more frequently treated with hormone therapy or controlled waiting (active surveillance). "At the same time, more aggressive forms of the tumor are not diagnosed as rarely as previously thought in men over 70," Neubauer explains. These are tumors that grow very quickly, form daughter tumors (metastases) and can lead to death if detected too late. However, when very old men who have a more aggressive high-risk tumor are treated with established therapies, the mortality rate decreases by almost half, as recently published in the prestigious British Journal of Urology.2
"We can't just base our decision on the age of the patient; we have to include other factors in our considerations, such as general health, physical and mental agility," Neubauer sums up. Once the decision for a therapy has been made, the focus should rather be on gentle therapy methods. Internal radiation, or brachytherapy, is particularly suitable for this purpose. Under constant ultrasound control, up to 80 tiny radiation sources (seeds) are inserted into the prostate. "The seeds remain in the patient's body and develop their radiation effect on the prostate carcinoma over months," Neubauer said. The tumor tissue is destroyed from the inside with pinpoint accuracy by the high-dose radiation. Neighboring organs such as the intestine, bladder and ureter are spared. This is noticeable in the quality of life and satisfaction of the patients, emphasizes the Cologne urologist. His conclusion: "Under no circumstances should advanced age be a compelling reason not to treat prostate cancer."
