In this article, you will learn what prostate cancer is, which screenings you should undergo and when, and what treatment options are available.
Prostate cancer is the most common cancer in men. In Switzerland, 30% of all cancer cases affect the prostate. Each year, about 7,400 Swiss men are newly diagnosed with prostate cancer. Almost all patients are over 50 years old at the time of diagnosis. The survival rate significantly depends on the tumor stage at the time of diagnosis. The 5-year survival rate is 95-99% at stage I and 34-50% at stage IV.
Prostate tumors are therefore common but rarely fatal. This is partly because they often grow slowly and are not very aggressive. In many cases, they cause no or barely noticeable symptoms, which is why they are often discovered by chance, if at all.
This means that there is a larger window of time in which prostate cancer can be treated and even cured.
This article gives you an overview of what prostate cancer is, how it develops, and how it can be treated. Additionally, you will learn about the preventive screenings available in Switzerland to detect prostate cancer as early as possible.
What is the Prostate?
The prostate is a gland located directly below the bladder, surrounding the upper part of the urethra. Its primary function is to produce part of the seminal fluid.
(Graphic showing the location of the prostate in the human body)
What is Prostate Cancer?
Prostate cancer, also known as prostate carcinoma, is a malignant disease of the prostate. It is the most common cancer in men. The two main risk factors for developing prostate cancer are increasing age and genetic predisposition.
A prostate carcinoma usually grows slowly and causes few symptoms. It is often discovered by chance or through targeted early detection screening. Therefore, regular screening is so important.
As long as the cancer remains within the prostate (localized), it is well-treatable and removable. However, if it has already spread to other organs or bones (metastasized), the chances of treatment decrease significantly.
What Causes Prostate Cancer?
The main causes of prostate carcinoma are age and family history (genetic factors). Hormonal factors, environmental influences, and diet are not yet sufficiently researched. Below, we briefly discuss the various causes.
Age
Age is the most significant risk factor for developing prostate carcinoma. Before the age of 40, the likelihood of developing prostate cancer is very rare. From the age of 50, the risk increases rapidly. About 60% of prostate carcinomas occur from the age of 65.
Family History
In up to 20% of cases, prostate carcinoma occurs more frequently within families. For example, if your father or brother has prostate cancer, your risk is about twice as high. If both father and brother are affected, your risk increases more than fivefold. Besides the number of direct relatives, their age also plays a role in risk calculation.
Other Factors
Several other factors are discussed as potential causes of the disease. However, in most cases, numerous studies with often different and contradictory results exist, making it impossible to make definitive statements.
Regarding environmental factors, it is noted that prostate cancer is less common in certain regions (including Asia). However, whether differences in genetic makeup, hormonal balance, or diet are responsible is not sufficiently researched. An indication that environmental factors may play a role is the fact that the risk of disease among Asians who migrate to the USA aligns with the risk of native US citizens in the next generation.
Obesity is also frequently discussed as a cause. Increased body weight correlates with an increased risk of developing an aggressive form of prostate carcinoma.
What Symptoms Can Indicate Prostate Cancer?
The challenge in early detection of prostate carcinoma is that it typically does not cause easily recognizable or cancer-specific early symptoms. Often, there are no symptoms at all until the cancer is far advanced. Therefore, early detection is so important.
Moreover, the symptoms that do appear usually affect the sexual organs and can have many other causes. For example, the prostate naturally enlarges with age (benign prostatic hyperplasia), which can compress the urethra and impair urine flow. Symptoms such as a weakened urine stream or frequent urination can also result from benign prostatic hyperplasia and are not necessarily signs of prostate cancer.
Nonetheless, you should have such symptoms clarified immediately, especially if several occur simultaneously. Below are the most common signs of possible prostate carcinoma:
- Problems with urination (weak urine stream, difficulty starting urination, inability to urinate)
- Increased frequency of urination
- Blood in the urine (hematuria)
- Erectile dysfunction
- Blood in the semen (hematospermia)
- Pain during ejaculation
- Pain in the lower back
How Can Prostate Cancer Be Prevented?
Since the primary causes of prostate carcinoma are advancing age and family history, regular screening is the most effective means of cancer prevention.
This screening can be done annually from the age of 50, or earlier if there is a family history. The costs for the first step of screening, the digital rectal examination, are covered by the Swiss Mandatory Health Insurance (OKP). This includes the deductible, but the annual franchise does not apply. For other or follow-up examinations, it depends on your insurance status whether you may have to cover part of the costs yourself.
Of course, the earlier the tumor is detected, the better the treatment options. In advanced prostate cancer (metastasized carcinomas), more intensive therapeutic measures may be necessary, and there is a higher risk that even these will not completely or permanently remove the cancer.
It is scientifically unproven but highly likely that a healthy lifestyle reduces both the risk of developing prostate carcinoma and the growth rate of existing tumors. This includes:
- Regular Exercise: At least three hours of moderate to intense training per week is recommended. This also helps avoid overweight, which is associated with more aggressive forms of prostate carcinoma.
- Red Fruits, Cruciferous Vegetables, and Soy Products: Several components of a plant-based diet are also associated with a protective effect against prostate cancer. These include lycopene (found in tomatoes and other red fruits), sulforaphane (found in cauliflower, Brussels sprouts, and broccoli), and isoflavones (found in soy).
- Limit Dairy Products: Moderate consumption of dairy products and calcium intake from plant-based foods may help reduce the risk of disease. Some studies show a possible link between high calcium and dairy product intake and an increased risk of prostate carcinoma, although other studies have not confirmed this.
How is Prostate Cancer Diagnosed?
Prostate carcinomas are most commonly found during screening examinations with your urologist. These check-ups typically consist of a digital rectal examination (DRE) and possibly an additional PSA (Prostate-Specific Antigen) test.
If there is suspicion after these initial examinations, your doctor will recommend a transrectal ultrasound (TRUS) or an MRI scan.
Therefore, MRI is a more direct and reliable method for diagnosing prostate cancer. Additionally, it can detect many other types of cancer and cover most generally recommended screenings (see article on screenings). As it is used significantly before the age of 50 – Dr. Felix Harder recommends regular MRI scans from about age 30 – MRI usually allows for earlier diagnosis of prostate cancer. This is invaluable for the success of cancer therapy.
The final and definitive diagnostic step is a prostate biopsy, where tissue samples are taken and analyzed in the lab.
Below, we provide a brief explanation of the individual diagnostic methods.
Digital Rectal Examination (DRE)
After a consultation, your urologist will ask you to lie on your side and relax. Then, they will insert a finger into your rectum to feel the prostate for enlargements, hardening, lumps, or other changes.
If there is an abnormal finding during palpation, your doctor will order further diagnostic methods.
PSA Test
In addition to the DRE, you can also have a Prostate-Specific Antigen (PSA) test. This involves analyzing your blood (after a simple blood draw) for a protein produced in the prostate and part of your seminal fluid.
An elevated PSA level may indicate the presence of prostate cancer. However, an elevated PSA level can also have other causes, such as prostate inflammation, cycling, or sexual activity. Therefore, the usefulness of the PSA test is quite controversial. Nevertheless, it remains an important tool for early detection of prostate cancer due to its simplicity. It should be used in combination with other diagnostic methods (e.g., MRI).
Transrectal Ultrasound (TRUS)
Transrectal ultrasound (TRUS) is an imaging method often used in addition to DRE. As the prostate is located between the bladder and pelvic floor in front of the rectum, it can be well reached by ultrasound.
Magnetic Resonance Imaging (MRI)
Unlike X-rays or CT scans, MRI is completely radiation-free. It also offers better soft tissue differentiation, making it ideal for visualizing internal organs, such as the prostate.
At aeon, we use modern scanners with a large bore diameter, so you don't feel confined. If you want to know how an MRI examination works with us, you can check it out step by step in this article (link to MRI article).
Prostate Biopsy
The definitive diagnosis of prostate carcinoma is made by prostate biopsy. There are various methods, but usually, a transrectal (via the rectum) prostate needle biopsy under ultrasound guidance is performed.
Systematic tissue samples are taken from the prostate according to a predetermined pattern. Additionally, samples are taken from areas previously diagnosed as abnormal by MRI, for example.
The prostate biopsy is usually performed on an outpatient basis with local anesthesia. As there is a risk of spreading germs from the rectum during the biopsy, you should take antibiotics to prevent infections.
How is Prostate Cancer Treated?
Prostate cancer can usually be treated well. Of course, the choice of method depends greatly on the patient, their history, the type of tumor, and the timing of the diagnosis.
In general, prostate tumors grow slowly compared to others, and long-term survival rates are high.
The most common treatment methods for prostate cancer are:
- Watchful Waiting / Active Surveillance
- Surgery (Radical Prostatectomy)
- Radiation Therapy
- Hormone Therapy
- Chemotherapy
Below, we briefly introduce the methods:
Watchful Waiting / Active Surveillance
Since prostate carcinomas often grow slowly and cause no or few symptoms, it may be advantageous for the patient to wait attentively rather than undergoing intensive therapy. The side effects of therapy could potentially harm the body more than benefit it.
Watchful waiting and active surveillance both aim to minimize the impact on the patient's quality of life while not missing the point when further therapy becomes necessary.
Radical Prostatectomy
In a radical prostatectomy, the prostate, the urethra within it, the seminal vesicles, and part of the vas deferens are removed. The surgical team may also remove lymph nodes. Radical prostatectomy is suitable for patients whose tumor is confined to the prostate.
Radiation Therapy
In prostate cancer, radiation therapy can be administered externally through the skin (percutaneous) or internally (brachytherapy, Greek: "brachy" = "short"). Radiation is focused on the affected areas of the prostate to target and kill the cancer cells. In brachytherapy, radioactive, rice-sized titanium seeds are implanted in the prostate to irradiate the tumor "from within."
Radiation therapy can be successful in the early stages of the disease but can also help alleviate symptoms in advanced cancer.
Hormone Therapy
Prostate carcinoma cells need male sex hormones (androgens), especially testosterone, to grow. Hormone therapy aims to deprive the tumor of androgens.
This slows the growth of cancer cells but also leads to physical reactions similar to those experienced by women during menopause: sweating, hot flashes, decreased libido, etc.
Hormone therapy is typically considered for men with advanced or metastatic prostate carcinoma.
Chemotherapy
If prostate carcinoma continues to grow despite hormone therapy and has already spread to other organs and bones, chemotherapy is usually used. The use of chemical agents, usually cytotoxins, aims to stop the growth of cancer cellsand ideally force their regression (remission) without harming healthy cells.
However, it is crucial to ensure that the side effects of the therapy do not outweigh the benefits. Therefore, all chemotherapy treatments are tailored to the individual patient, from the choice of agent to the dosage and duration of treatment to accompanying measures to alleviate side effects.
What is the Life Expectancy with Prostate Cancer?
The life expectancy for prostate cancer in the early stage is 95-99% even five years after diagnosis. In advanced stages, it drops to about 34-50% five years after diagnosis.
Overall, approximately 1,400 of those affected in Switzerland die annually from prostate cancer. This is mainly due to the often slow growth of this type of cancer.
The fact is that eight out of ten men diagnosed with prostate cancer die from another cause, highlighting the importance of weighing the treatment strategy.
Conclusion
Since prostate cancer usually causes few symptoms and grows slowly, it is often detected late or not at all.
Therefore, regular screenings are crucial. The earlier the diagnosis, the less likely prostate carcinoma will affect your life expectancy and quality of life. When found early, prostate carcinoma is very treatable.
