Questions & Answers

What is the prostate and what are its functions?
The prostate is an organ with the size of a walnut and is located directly below the bladder and surrounds the urethra. Due to the proximity to the rectum, the prostate can be easily palpated during a rectal examination. The primary function of the prostate is to produce seminal fluid that transports sperm during ejaculation.
The prostate also produces a specific protein called Prostate Specific Antigen (PSA) that is released into the bloodstream. An increased level of PSA can be detected using a PSA test. Besides the testicles, the epididymis and the spermatic duct, the prostate belongs to the primary male sexual organs. Around 3 million men in Germany suffer from a benign augmentation of the prostate.

What are the incidence rates of prostate cancer?
Nearly 20% of all the diagnosed cancers in males are prostate cancer. Therefore prostate cancer is the most common cancer amongst men. The incidence of developing prostate cancer increases with age - less than 10% are diagnosed before the age of 60. The rate of prostate cancer is rising as the life span increases and fewer mortalities occur from other causes.

How is prostate cancer diagnosed?
The prostate carcinoma usually only causes problems in advanced stages. Difficulties during urination can occur but do not present a typical early symptom, as tumours develop in the periphery of the gland and therefore do not narrow the urethra. Consequently, the disease often can develop without being noticed and in most cases is detected in late stages.

Pain or blood in the urine or semen are not early symptoms but might be an indication that the tumour is already creating metastases.

What is brachytherapy?
Brachytherapy is a type of radiation therapy in which the radioactive sources are placed directly in the tumourous tissue. This allows for a high dose to be delivered to the tumour while sparing the contiguous healthy tissue.

How is prostate brachytherapy performed?
Using low dose rate (LDR) brachytherapy for the treatment of prostate cancer, radioactive sources of the size of a rice corn are implanted into the prostate. This procedure dates back to the beginning of the last century. However, with the development of transrectal ultrasonography, computer tomography and computer based dosimetry, conditions for modern transperineal prostate brachytherapy were created. This improvement has increased the relevance of brachytherapy as a viable treatment option. Prostate seed implantation provides irradiation with an adequate dosis delivered directly to the tumourous tissue. The tumour is destroyed while preserving surrounding tissue in the best possible way. Significantly less side effects have made brachytherapy an important alternative to other forms of treatment.

Is early detection possible?
There are two main examinations for the detection of early stage prostate cancer: a digital rectal examination and a PSA blood test.
Although the digital rectal examination remains a keystone in the early detection of prostate tumours, it can only detect the size of the gland, the overall consistency and the presence of any firm areas or nodules. Many early stage tumours may be missed if this is used alone as a diagnostic tool. An increased level of PSA can be detected using a PSA test. The earliest stages of prostate cancer may produce elevated PSA levels. However, other benign changes of the prostate tissue may also lead to increased PSA levels and therefore it is only an indication that further investigations are required. The presence of cancerous cells in the prostate can only be definitively determined by a biopsy.
Prostate cancer is mainly a slow growing tumour and an annual screening test for men after the age of 45 is sufficient. If there is a genetic predisposition to prostate cancer, screening may be started at an earlier age.

What is a PSA test?
A PSA test is a blood test which measures the presence of the Prostate Specific Antigen. This protein is produced and released by the prostate and is always present in very low levels. This blood test has developed into one of the most important tests for the early detection of prostate cancer. A level as high as 4 ng/ml may be within the normal range of a patient but should be verified by a physician.

Which patients qualify for permanent seed implantation?
Permanent seed implantion is for those patients with early stage localized prostate cancer. The cancer must be limited to the prostate capsule. The final treatment decision should always be made in consultation with your physician.

What are the advantages of permanent seed implantation?

The cancerous prostate tissue receives a high localized dose, sparing the nearby or contiguous normal tissues.
The risk of urinary incontinence and impotence is smaller compared to alternative therapies.
Permanent seed implantation is a minimally invasive procedure.
The procedure is an ambulatory procedure and may be performed within 2 hours.
There is a minimal recovery time after the procedure and the patient can return to his normal lifestyle after a few days.
The results of the outcome of the procedure are similar to other alternative therapies.

What are the advantages of permanent seed implantation when compared to radical prostatectomy?
Recent data shows that the clinical results may be similar. Seed implantation has the advantage of fewer and less severe side effects. The probability for the development of urinary incontinence is < 1% and for impotence approximately 20%. These rates are significantly lower than following a radical prostatectomy.

How is a biopsy of the prostate performed?
A biopsy should be performed after a positive digital rectal exam and an elevated PSA value (> 4ng/ml). In the case of elevated PSA levels, a second test should be performed to try and duplicate or authenticate the results before performing a biopsy. Only a biopsy can determine whether preliminarily detected changes are benign or malignant. The biopsy is performed using transrectal ultrasound guidance. A very thin biopsy needle removes a small amount of prostate tissue which is then examined microscopically. Multiple needle biopsies from different areas of the prostate are performed during the same procedure.

How can I assist a person diagnosed with prostate cancer?
A diagnosis of prostate cancer may release feelings of fear, anger, denial and helplessness in the patient, his partner, relatives, friends and others around him. This often puts individuals into a chaotic psychological state which needs to be addressed. There is an urge to help without further beleaguering the patient.
How to assist the patient is best determined by the personal individual characteristics and the stage of the disease. Generally, the patient requires support without taking away their sense of self determination and being. Assure him that he still remains a valued member of the society and your family, with responsibilities and decision making capabilities. Try not to take on responsibilities that the patient can maintain, thereby ascertaining his continued value as an individual.
Refer to experiences gained during prior crisis situations. Keep the channels of communication open and discuss both negative and positive issues. This will provide and build mutual support.

How can I, as a relative, deal with my impact?
The development of cancer in a family member affects the whole family. Feelings of fear and helplessness develop and all mutual future plans are temporarily placed on hold or are at best tentative.
The unaffected partner feels a sense of responsibility to support the affected partner as much as possible. It is very important for the unaffected partner not to over extend themselves and not to overestimate their own capabilities or energy.
Take your own personal concerns seriously, take the time to relax and reenergize and do not hesitate to ask for assistance when necessary.