Prostatakrebs

Prostate cancer develops in the prostate gland, which sits below the bladder in men. It is very common with increasing age, and its behaviour ranges widely: many cancers grow so slowly that they never cause harm, while others are aggressive and need prompt treatment.

The central decision is therefore not only how to treat but whether to treat. Low-risk cancers are usually best managed by active surveillance. For cancers that need treatment while still confined to the prostate, surgery and radiotherapy give similar cancer control, with different side effects on continence, erections and bowel function.

Symptome

• No symptoms at all in most early cases, with the cancer detected through a PSA test
• A weak or interrupted urine stream, hesitancy or getting up at night, which more often reflect benign enlargement
• Blood in the urine or semen
• New difficulty getting an erection
• Persistent pain in the back, hips or pelvis if the cancer has spread to bone
• Unexplained weight loss and tiredness in advanced disease

Ursachen und Risikofaktoren

The main risk factors cannot be changed: increasing age, a father or brother with prostate cancer, and Black African or Caribbean ancestry, which roughly doubles the risk and brings earlier onset. Inherited BRCA2, BRCA1 and other DNA repair gene changes and Lynch syndrome raise the risk of aggressive disease, so a family history of breast or ovarian cancer matters. Obesity is associated with more advanced cancer. No food or supplement has been proven to prevent it, and vitamin E supplements appeared to increase risk in one large trial.

Wie es diagnostiziert wird

• PSA blood test and examination: PSA is a prostate protein that rises with cancer, benign enlargement, infection and recent ejaculation. A raised level prompts further tests rather than proving cancer.
• Multiparametric MRI: Performed before biopsy. It shows suspicious areas, scored with PI-RADS, and lets some men avoid biopsy altogether.
• Targeted prostate biopsy: Samples taken through the perineum or rectum, guided by MRI fusion. The pathologist assigns a Gleason score and grade group from 1 to 5.
• PSMA PET-CT: A sensitive scan for spread in intermediate and high-risk disease, replacing CT and bone scan in many centres.
• Genetic testing: Considered in men with metastatic disease or a strong family history.

Behandlungsmöglichkeiten

• Active surveillance: Regular PSA tests, repeat MRI and occasional biopsies for low-risk and some favourable intermediate-risk cancers, with treatment only if the cancer progresses.
• Radical prostatectomy: Removal of the prostate and seminal vesicles, commonly by robotic surgery, with nerve sparing where safe. Temporary leakage is usual, and erections are affected to varying degrees.
• External beam radiotherapy: Given in 5 to 20 sessions with modern schedules, often combined with hormone therapy for 6 months to 3 years in higher-risk disease.
• Brachytherapy: Radioactive seeds or temporary high-dose sources placed in the prostate.
• Focal therapy: HIFU or cryotherapy directed at one area of the gland. Long-term data are still limited and it suits only selected men.
• Hormone and systemic therapy: Androgen deprivation with newer hormonal agents, chemotherapy, PARP inhibitors or lutetium-PSMA therapy for advanced disease.

Wenn es dringend ist

Seek emergency care near you for complete inability to pass urine, for back pain accompanied by leg weakness, numbness or loss of bladder or bowel control, which may be spinal cord compression, or for heavy bleeding with clots. Fever and shivering within days of a prostate biopsy can signal a serious infection and need same-day hospital treatment.

Reisen nach Türkiye zur Behandlung

Prostate cancer rarely requires a rushed decision, so there is time for a second opinion, a good-quality MRI, targeted biopsy or PSMA PET-CT. Robotic prostatectomy abroad needs about 10 to 14 days, because the catheter stays in for 7 to 10 days. Short-course stereotactic radiotherapy can fit within 2 to 3 weeks. Active surveillance, hormone injections, continence and erectile rehabilitation and PSA monitoring over many years must be set up with a urologist at home.

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