Possible symptoms of advanced, metastatic prostate cancer include:
- Performance kink
Possible therapies for prostate cancer:
- Long-term observation
- Active monitoring
- Surgery: Radical prostatectomy
- Radiation therapy/radiation (also brachytherapy)
- Hormone therapy
- Other treatment methods
Surgery for localized prostate cancer (prostate cancer)
RPE is a possibility for the primary treatment of clinically (i.e. detected by examinations) localized prostate cancer (cT1-2 N0 M0) in patients of all risk groups (for these groups, see treatment planning). In one study, the effectiveness of RPE was shown compared to watchful waiting: in patients without metastases (T1b-T2 N0 M0), with a PSA value of less than 50 ng/ml and with a life expectancy of at least 10 years, it reduces the frequency of disease progression, the risk of distant metastases, mortality from prostate cancer and mortality overall. The patient must be informed about this by the treating urologist, as well as about the possibility and limits of a potency-preserving surgical technique.Patients with a high risk of disease progression and the desire for RPE should be informed that the risk of positive (tumour-affected) cutting edges, of the "recurrence" of the disease (recurrence), and any necessary measures (e.g. radiotherapy, hormone therapy) are higher than for low or medium risk.
Surgery for locally advanced prostate cancer (prostate cancer)
RPE is a primary treatment for clinically advanced prostate cancer (cT3-4 N0 M0). Patients with this tumour stage must be informed in advance about the advantages and disadvantages of therapy, both those of RPE with lymph node removal (see below lymphadenectomy) and radiotherapy (possibly with additional, temporary hormone therapy).RPE has also been recommended and performed for several years in patients with an advanced metastatic stage in selected cases with a low metastasis load. Nevertheless, the number of RPEs in Germany is declining by more than 25%. The reason for this is the better selection of patients for surgery and the renunciation of surgical intervention in low-risk tumours in which active surveillance is favoured.
Surgery for lymph node infestation
In the case of a histologically (by tissue examination) confirmed lymph node infestation, RPE and radiotherapy are available for local treatment, and immediate or delayed hormone therapy for systemic (general) treatment. A direct comparison of the methods, either alone or in combination, is not possible due to the current scientific data. The decision must therefore be made individually after detailed medical consultation (see also below for lymphadenectomy). An already clinically recognizable lymph node infestation (cN1) usually proves to be pronounced on histological examination.