Therapy

When choosing a therapy, the benefits and potential side effects of the treatment will also be carefully weighed with you.

Immediate treatment may not be necessary
Men with very early-stage prostate cancer do not always need to begin therapy right away. In certain cases, it may even be reasonable not to treat the cancer immediately but to monitor it closely. In such situations, doctors often recommend active surveillance as an appropriate strategy.

The rationale behind active surveillance is that low-risk, slow-growing prostate cancers rarely progress or may take decades to do so, often without causing any problems during a man's lifetime. For this reason, it is important to carefully select patients who are likely to benefit from this approach.

Through active surveillance—including regular blood tests, digital rectal exams, follow-up MRI scans, and occasional biopsies—the progression of the cancer can be closely monitored. If signs of progression are detected, various treatment options such as surgery or radiation therapy can still be considered.

The main risk of active surveillance is that the cancer may grow or spread between monitoring intervals, potentially reducing the chances of a cure. However, based on current scientific knowledge, this risk is considered negligibly low—particularly because strict clinical criteria are used to determine which patients are suitable candidates for active surveillance.

Local therapy – surgical removal of the prostate (prostate cancer) and radiation therapy

Surgical removal of the prostate

The possibility of a surgical procedure for the treatment of prostate cancer involves the removal of the prostate gland (radical prostatectomy) as well as parts of the surrounding tissue and some lymph nodes. The following options are available:

• Surgical procedure using a robotic system
  In a robot-assisted surgery, surgical instruments attached to a mechanical device (robot) are inserted through several small incisions in the lower abdomen. The surgeon operates the robot via a control console. Robotic-assisted prostatectomy allows the surgeon to perform even more precise movements with the instruments than is possible with conventional minimally invasive procedures.
• Laparoscopic prostatectomy
  During a laparoscopic prostatectomy, the surgeon operates through small incisions in the lower abdomen using a small camera (laparoscope). This technique requires a high level of experience and skill on the part of the surgeon and carries a significant risk of injury to surrounding tissue. For this reason, this type of surgery is no longer commonly used for prostate cancer in the United States.
• Surgery via an incision in the lower abdomen
  In a so-called retropubic procedure, the prostate gland is removed through an incision in the lower abdomen.
• Surgery via an incision between the anus and the scrotum
  In this method, called perineal radical prostatectomy, access to the prostate is gained through a skin incision between the anus and the scrotum. A perineal approach can allow for quicker recovery; however, the removal of surrounding lymph nodes and the preservation of nerves are more challenging with this technique.

Consult your physician to determine which surgical option is most suitable in your specific case.
A radical prostatectomy always carries the risk of urinary incontinence and erectile dysfunction.

Ask your doctor about the specific risks you may face based on your individual situation, type of treatment, age, body type, and overall health condition.

Radiation Therapy

This form of treatment uses high-energy radioactive beams to destroy cancer cells. In the treatment of prostate cancer with radiation therapy, two main types of radiation techniques are distinguished:

• External beam radiation therapy ("percutaneous radiation therapy")
  In percutaneous radiation therapy, you lie on a treatment table while a radiation machine moves around your body, delivering high-energy beams—such as X-rays or protons—precisely targeted at your prostate cancer. The treatment usually takes place over several weeks, with sessions scheduled five times per week.
• Internal radiation therapy ("brachytherapy")
  In brachytherapy, many small radioactive sources, each about the size of a grain of rice, are inserted directly into your prostate tissue. These emit a low dose of radiation over an extended period. Your doctor places these small radioactive particles into your prostate using a thin hollow needle under ultrasound guidance. The implanted particles stop emitting radiation on their own after a certain time and do not need to be removed.

Possible side effects of radiation therapy include painful urination, increased and urgent need to urinate, and rectal issues such as irregular, soft, or painful bowel movements. Erectile dysfunction may also occur.

Focal Therapy

Focal therapy refers to the targeted destruction of cancer cells within the prostate without the need to remove or irradiate the entire gland. One method used in our department is HIFU therapy. In this procedure, the tumor is localized via an ultrasound probe inserted through the rectum and then destroyed under anesthesia using high-intensity focused ultrasound (HIFU). Compared to established treatments such as surgery or radiation, this method is still considered experimental. Careful patient selection based on clinical parameters remains key to treatment success. The main advantage of focal therapy is that it generally causes fewer side effects.

Early attempts to use focal therapy for prostate cancer resulted in high complication rates and unacceptable side effects. However, new technologies have helped reduce complications, improve cancer control, and make the procedure more tolerable for patients.

Systemic Therapy

If prostate cancer has progressed further, local therapy alone is no longer sufficient. In such cases, a treatment that affects the entire body—known as systemic therapy—is necessary.
Most commonly, this involves a combination of hormone therapy (androgen deprivation) and an additional treatment such as another form of androgen therapy or chemotherapy.

Hormone Deprivation Therapy (Androgen Deprivation Therapy)

This treatment method works by suppressing the body’s production of the male sex hormone testosterone, as it promotes the growth and multiplication of prostate cells—especially prostate cancer cells. Lowering testosterone levels slows down cancer cell growth or causes them to die.

Possible hormone deprivation therapy options include:

• Medications to suppress testosterone production
  Drugs known as LH-RH agonists (luteinizing hormone-releasing hormone agonists) block the production of testosterone in the testicles.
• Medications that prevent testosterone from reaching cancer cells
  These are called anti-androgens. They block the effect of testosterone on tumor cells. Examples include bicalutamide (Casodex), flutamide, and nilutamide (Nilandron).
• Surgical removal of the testicles (orchiectomy)
  Surgically removing the testicles leads to a significant drop in testosterone levels in the body.

Hormone deprivation therapy is used in men with advanced prostate cancer to shrink the tumor or slow its growth.
In men with early-stage prostate cancer, it can be used before radiation therapy to reduce the tumor size and thereby significantly improve the chances of treatment success.

Possible side effects of hormone deprivation therapy include erectile dysfunction, hot flashes, loss of bone density, decreased libido, and weight gain.

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Chemotherapy

Chemotherapy uses medications to kill rapidly dividing cells, particularly cancer cells.
It is administered to the patient intravenously, in tablet form, or as a combination of both methods. Chemotherapy can be a suitable treatment option when prostate cancer has already spread to distant areas of the body.

Anti-Androgen Therapy

This form of therapy affects testosterone metabolism beyond its production in the testicles.
The goal is to inhibit testosterone—an essential hormone for cancer cells—on additional levels. For example, the testosterone receptor is blocked, which prevents the cancer cells from “using” the hormone effectively.