Prostate Cancer.

Prostate cancer is the most common type of cancer (26%) and the third most common cause of death among male cancer patients in Germany (10%). Over recent years, the incidence rate has increased steadily, ranging around 63,400 in 2008. As regards incidence rates, there is a significant difference between industrialised countries and developing countries. In Europe, the incidence rate is about 87/100,000, which is nearly 20 times higher than in Asian countries such as China and Japan (4/100,000).

Within Europe, the incidence rate in Scandinavia is significantly higher than in the Mediterranean region. Counting 58,000 new diagnoses in Germany, prostate cancer accounted for about 25% of newly diagnosed malignant diseases among male patients in 2004. Overall, three-quarters of all cases are diagnosed in men aged over 65 years. This is also reflected in the age-related incidence rate of 1-2/100,000 among 40-year-old patients compared to 1,200/100,000 among 80-year-old patients.

A clear reason for the significant difference between individual countries and ethnic groups has so far not been identified. It is most likely attributable to multiple factors. Genetic and environmental factors as well as diet are believed to play a role in aetiology. Body height, weight, smoking and alcohol as well as sexual activity have no influence on the risk of prostate cancer.

However, screening programmes and targeted initiatives as well as the associated education of patients play an important role. The possibility of detecting especially asymptomatic tumours at an early stage by means of the PSA test is available in industrialised countries rather than in emerging countries. In particular in the U.S., PSA-based screening is widely used and is probably the main reason for the increase in incidence rates. This has entailed a stage and age shift, with early prostate cancer stages having increased considerably, especially among young men.

Prostate cancer screening is now among the most commonly performed screenings in male patients and forms an essential part of urological practice. It consists of several parts, each of which having a different clinical value in the early detection of prostate cancer. The major pillars of prostate cancer screening include the digital rectal examination, the measurement of serum PSA (prostate-specific antigen) levels as well as the transrectal ultrasonography. In the case of specific issues, additional methods, such as magnetic resonance imaging, special ultrasound-based techniques or urine analyses (e.g. PCA3), can be employed.

Special knowledge. State-of-the-art therapies.

As operative-surgical or even conservative-medicinal, the treatment of prostate carcinoma is among the University Hospital Tübingen‘s special strengths. Prostate carcinoma is the most frequent male tumour disease and therefore very significant for the Urological Clinic. Consequently, a functioning urological oncology unit also requires proven standards in its diagnosis and therapy. These standards are achieved within the scope of a certified Prostate Carcinoma Centre. Weekly tumour conferences (MDT–Multidisciplinary Team), pre- and post-therapeutic– as well as interdisciplinary consultation hours are the backbone of the Prostate Carcinoma Centre.

Illustration of a prostate gland’s tumour-bearing area based on a large-surface section.

Especially patients with high-risk prostate carcinoma benefit from the comprehensive consultation. The robot-assisted transperineal prostate biopsy serves as the basis for active monitoring. By means of image fusion, this procedure can essentially improve the prostate biopsy and make reproducibility within the scope of active monitoring possible in the first place. As aresult, this procedure opens up a new horizon in the diagnosis and therapy of prostate carcinoma.

Circulating tumour cells in the blood vessels: New methods make it possible to detect them.

The radical prostatectomy is possible by means of open surgery, laparoscopy and the da Vinci^® robot. Above all, the systemic therapy has an essential significance in the metastasis stage. The access to studies allows patients to receive state-of-the-art therapies under controlled conditions. Innovation and evolution are motivating forces in the further development of therapy for prostate carcinoma.