New Methods of Treating Prostate Cancer
With around 60,000 new cases per year, prostate cancer is the most common type of cancer in men in Germany. The incidence of prostate cancer - especially the early stages - has been increasing steadily for years. This is also due to early detection methods, such as PSA screening or urological prostate exams. If diagnosed in its early stages, prostate cancer can nowadays be treated successfully with innovative methods.
Prostate cancer does not actually cause symptoms until it reaches its advanced stage, which means that the recommended annual check-up is of the greatest importance in terms of prognosis. Around 15% of all prostate tumours can be detected by a digital rectal examination, so early detection is important. The exact causes of prostate cancer are not yet clear. However, certain risk factors - such as increasing age, genetic predisposition and various environmental influences - have been identified to increase the risk of prostate cancer. A recent American study of more than 1,000 participants has identified another risk factor: patients with inflammatory bowel diseases (e.g. Crohn’s disease or ulcerative colitis) are four to five times more likely to develop prostate cancer.1 It is assumed that the systemic inflammatory reaction due to the bowel disease acts as an aggravating factor.
There are three new methods for treating prostate cancer. CyberKnife treatment is a robotic radiosurgery system using photon radiation to damage the cell nucleus and therefore the DNA of the tumour cells. This in turn prevents tumour cells from replicating. Malignant tumours decay without affecting the surrounding healthy tissue such as the bladder, rectum or nerve tracts. Small gold markers are positioned on the target organ before the start of the procedure enabling the CyberKnife system to identify the position of the prostate and target the beam at the designated area of prostate tissue as accurately and safely as possible. The procedure is currently only used on relatively small, less aggressive tumours with a Gleason score of no more than 6 or 7.
High-intensity focused ultrasound (HIFU) is another new method. This ultrasound-based treatment generates precise, high-frequency areas of heat in a predefined area of tissue. The ultrasonic probe is inserted transrectally and the tumour is destroyed with the help of precise imaging. This method of treatment leaves the prostate intact and functional. Likewise, this method is only used on small, less aggressive types of early-stage prostate cancer.
At some cancer stages, removing the entire prostate is the method of treatment with a more favourable prognosis. Radical prostatectomy is an operation to completely remove the prostate and seminal vesicles. Nowadays, the operation is increasingly performed using robotics, a minimally invasive surgical procedure. Minimal-invasive surgery results in reduced blood loss and causes less pain for the patient than open surgery. The better post-operative results in terms of quality of life with retained continence and potency are also decisive factors.
The Da Vinci surgical system is one such minimally invasive procedure that has become established in recent years. The surgeon operates robot arms that transmit the hand movements of the surgeon precisely. This extremely clear, precise method makes it possible to preserve nerve tracts. However, the tumour should be no more than one centimetre in diameter.
Summary for insurers
The incidence of prostate cancer will likely continue to increase due to demographic changes and the use of screening methods. Modern methods of treatment are already available for early stages of cancer. As such, early diagnosis and the development of new, more advanced technology will lead to better treatment methods and even cure. It is not unlikely that the innovative procedures will also be used for more advanced stages of cancer in the future, maybe even in combination with one another. This means that more favourable disease progressions are likely in the future even for advanced tumour stages.
- Jacob A. Burns, Adam B. Weiner, William J. Catalona, Eric V. Li, Edward M. Schaeffer, Stephen B. Hanauer, Scott Strong, James Burns, Maha H.A. Hussain, Shilajit D. Kundu. Inflammatory Bowel Disease and the Risk of Prostate Cancer. European Urology, 2018; DOI: 10.1016/j.eururo.2018.11.039.