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Prostate Cancer (Prostate Carcinoma): Risk Factors, Symptoms & Treatment

Prostate cancer is the most commonly diagnosed tumor disease in men, with about 40% developing prostate cancer in the course of their lives [1]. On this page, we inform you about common symptoms, causes and risk factors as well as current scientific research with regard to individually available treatment options.

Since 2005, we have been offering high-precision outpatient treatments for patients with benign and malignant tumors at the European Radiosurgery Center Munich (ERCM) – one of the most advanced centers for robot-guided radiosurgery in Germany – effective and gentle.

Discover the advantages of modern radiosurgery for prostate cancer now and contact us – we are there for you.

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According to the Center for Cancer Registry Data (ZfKD) at the Robert Koch Institute (RKI), there were approximately 74,895 new cases of prostate cancer in Germany in 2022. This diagnosis can be unsettling and even cause anxiety. It is therefore important for us to share comprehensive knowledge with you and provide you with easy-to-understand information. This can also help provide you with emotional support, so that you can find the right treatment option for you together with your treating physicians and in light of your personal life situation.

As an alternative to surgery, conventional radiation therapy, or other treatment methods, certain types of prostate cancer can now be treated effectively and with minimal side effects using robot-guided, non-invasive precision radiation therapy – CyberKnife therapy. This state-of-the-art radiosurgical system expands the treatment spectrum for prostate cancer with a gentle and extremely precise method (accuracy of less than 1 mm).


Our passion for precision

The robot-guided, non-invasive treatment with the CyberKnife, as performed at ERCM, is a safe and highly precise method for the effective treatment of prostate cancer with minimal side effects. High-dose photons are directed at the prostate, minimizing damage to surrounding tissue.

We can treat patients with localized prostate cancer (Gleason score 6 or 7) that has not spread to the body or other organs (distant metastases) with precision medicine. Based on the tissue structure and cell patterns, the Gleason score allows us to determine how aggressive your cancer is.

Another prerequisite for treating prostate cancer with CyberKnife therapy is a PSA level of up to 20 ng/ml.

Data from a recent study (PACE-A) comparing robot-guided CyberKnife therapy with prostatectomy for early-stage localized prostate cancer showed that 50% of men who underwent surgery still had incontinence problems two years after surgery, compared to 6.5% of patients treated with the CyberKnife. There were also fewer problems with potency in the CyberKnife group [2].

New study data (PACE-B) have shown that the CyberKnife method can be an effective treatment option for localized prostate cancer, even compared to conventional radiotherapy [3]. The robot-guided procedure is well-supported scientifically with numerous other international studies. Data that allow you to select treatment options that best suit your individual preferences and quality of life considerations. The safe and reliable CyberKnife therapy also offers you the opportunity to significantly shorten your treatment time.

For recurrent prostate cancer: see arrow right icon prostate cancer recurrence

Our experts

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question icon Definition: What is prostate cancer?

The prostate is often referred to as the prostate gland. Its main function is to produce some of the seminal fluid that carries sperm.

Prostate cancer is a malignant tumor—a form of cancer in which malignant cells form and multiply within the prostate gland. As the disease progresses, prostate cancer can spread to neighboring tissues and organs such as the bladder or colon.

The growth rate and stage of the disease vary from patient to patient. Prostate cancers generally grow slowly and are often not particularly aggressive.

In many cases, prostate cancer can be cured. With early diagnosis and appropriate treatment, excellent treatment results can be achieved and the prognosis improved.

Common symptoms

Prostate cancer can vary in its symptoms and is often asymptomatic in its early stages. This means that symptoms you wouldn't typically expect to be associated with your prostate may also occur.

Signs and symptoms depend on various factors, including the stage and spread of the cancer. Here are some common symptoms:

  • 1

    Bladder problems

    Difficulty urinating, frequent urge to urinate, a weak urine stream.

  • 2

    Blood in the urine

    The appearance of blood in the urine can be an alarm signal and requires urgent medical examination.

  • 3

    Back pain or bone pain

    Advanced prostate cancer can spread to the bones and cause pain in the lower back or in the bones themselves.

  • 4

    Weight loss and general malaise

    In advanced stages, unintentional weight loss and general malaise may occur.

warning iconCauses & risk factors

The development of prostate cancer can be influenced by various factors. Although the exact causes are not fully understood, there are some known risk factors and potential triggers that are associated with the development of the disease.

Age

For example, the risk of cancer increases with age: men over 50 are more frequently affected, and most cases occur after the age of 65.

Genetic predisposition

Men with a family history of prostate cancer have an increased risk of developing prostate cancer, for example, if their father or brother has already been diagnosed with prostate cancer.

Hormonal influences

Hormonal changes, particularly an increase in the male sex hormone testosterone, can promote the growth of cancer cells in the prostate.

Inflammations

Prostate infections may slightly increase the risk of cancer. Lifestyle factors, such as physical fitness, may also be associated with the development of prostate cancer [4].

Diagnostic procedures for prostate cancer

Diagnosis is usually made during routine checkups or based on specific symptoms. We briefly introduce the most important diagnostic procedures:

PSA test (prostate-specific antigen)

This blood test measures the concentration of PSA in your blood. An elevated PSA level can indicate prostate cancer, but it can also have other causes.

Digital rectal examination (DRE)

During this physical examination, the doctor palpates the prostate through the rectum to look for changes or lumps.

Imaging techniques

Magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) provide a detailed view of the prostate to identify tumors and assess their extent.

Tissue sample

If abnormalities are detected, a tissue sample (biopsy) should be taken from your prostate and examined to determine if cancer cells are present.

The Gleason score is determined based on the tissue sample. The Gleason score describes the extent or degree of tissue changes and is crucial for further treatment options.

Staging

If prostate cancer is diagnosed, other tests may be done to determine the stage and spread, including: MRI, bone scintigraphy, or positron emission tomography (PET-CT).

Gleason Score

Histological pattern

6

Well differentiated (low degree)

7

Moderately differentiated , with the subgroup:

3+4

Gleason 3 (primary) and Gleason 4 (secondary)

4+3

Gleason 4 (primary) and Gleason 3 (secondary)

8

Poorly differentiated

9-10

Very poorly differentiated

What is the prognosis?

The prognosis depends primarily on individual factors, including the Gleason score, PSA level, your age, and general health. Early diagnosis and tailored treatment plans therefore play a crucial role in improving your chances of recovery.

What treatment options are there?

Choosing the right treatment option depends on several factors, including the stage of cancer, your health status, and your personal preferences.

Let us first differentiate between the variety of other therapeutic approaches before we take a closer look at robot-guided treatment with CyberKnife therapy.

Prostatectomy

Surgical removal of the prostate can be performed openly, laparoscopically—using optical instruments and without opening the abdominal cavity—or robotically assisted. This method is a common option for locally confined tumors.

Radiotherapy

Two types of treatment can be distinguished here:

External radiation therapy

An external beam targets the prostate and destroys the cancer cells. This is often an option for patients who cannot or do not wish to undergo surgery.

Brachytherapy

In the LDR method ( low dose rate), weakly radioactive tubes – called seeds – are permanently implanted into the prostate in order to directly irradiate the cancer cells.

Unlike LDR brachytherapy, HDR brachytherapy is particularly suitable for patients with locally advanced or more aggressive tumors. HDR stands for high dose rate and means that radiation is delivered at a very high dose rate within a short period of time.

Hormone therapy

This therapy aims to suppress the body's own testosterone production, as this hormone promotes the growth of prostate cancer. Hormone therapy can be used alone or in combination with other treatments.

Cryotherapy

The word cryo comes from Greek and translates as "cold." Cryotherapy uses targeted cold to destroy cancer cells through freezing.

Active monitoring

In certain cases, especially in the case of slow and less aggressive tumors, immediate treatment can be dispensed with. Instead, regular imaging and, if necessary, biopsy checks are carried out to monitor the course of the tumor (active surveillance).

Robot-guided CyberKnife therapy: : High-precision increased safety

CyberKnife therapy is suitable for the treatment of prostate cancer with a Gleason score of 6 or 7. The goal: to eliminate the entire prostate – similar to surgery – but without surgical removal (!). Long-term data from thousands of patients with up to 10 years of follow-up show high success rates with a very low risk of side effects [5].

Before treatment, small gold markers are inserted into the prostate to determine the precise position for the CyberKnife. This procedure is performed shortly before the actual CyberKnife therapy and is generally relatively uncomplicated. In rare cases, bleeding or infection may occur.

As with all therapies, radiosurgical treatment with CyberKnife therapy can cause side effects despite careful planning and implementation. Most symptoms usually subside after a few days (or weeks). In a small proportion of patients (less than 5%), symptoms may persist for longer. Changes to the bowel and bladder may occasionally persist as long-term effects. In most cases, however, these symptoms are easily treatable and resolve or significantly improve.

After treatment, you may experience increased bowel and urinary urgency. Urination may also be accompanied by discomfort (frequent urination, burning, weak urine stream).

Flatulence (usually diet-related) and, very rarely, diarrhea may occur. In rare cases, mucus and bloody stools, involuntary loss of urine, and bloody urine may occur after treatment.

The most significant late side effect in otherwise healthy patients is the rare occurrence of narrowing of the urethra (approximately 2 to 3%), which can usually be successfully treated by dilation (bougienage).

More serious side effects, such as fistula formation between the bowel and bladder due to chronic ulcers in the mucous membrane of the rectum or bladder, are extremely rare. Adhesions and narrowing of intestinal loops almost never occur.

If you had normal erectile function before treatment, there is approximately a 20% risk that it will worsen over the course of 12 to 18 months. However, certain medications can enable largely normal sexual activity in cases of such erectile dysfunction.

CyberKnife technology for the treatment of prostate cancer

Follow-up & monitoring

What happens after therapy? Even after successful treatment with the CyberKnife, careful follow-up care is crucial to ensure optimal healing and early detection of any relapses.

After completing your CyberKnife therapy, a personalized follow-up plan will be created for you. This includes regular laboratory appointments for PSA testing. These values serve as a marker for treatment success and are carefully monitored.

Side effects of CyberKnife therapy, such as increased urinary urgency, temporary pain, or changes in urination, should be continuously monitored. Through this monitoring, we aim to ensure that you have the best possible quality of life after your treatment.

Treatment requests

The increasing complexity of treatment options also means that your personal decision regarding therapy should always be individualized and tailored to your specific life situation. We'll support you along the way. Please contact us.

For treatment inquiries, please use the contact form. You can also reach us by phone during our opening hours or via our social media channels.

Your request will be processed individually and promptly.

Frequently Asked Questions

Prostate cancer can vary in severity. The prognosis depends on several factors, including the stage of the disease and the individual's situation. Most prostate cancers are mildly aggressive and can be safely and effectively treated.

Some prostate cancers grow very slowly and can be controlled for years or decades without treatment. Others can be more aggressive and spread more quickly. The rate at which prostate cancer grows depends on several factors, including the aggressiveness of the tumor and individual health factors.

Prostate cancer is malignant by definition, but the tumor is not always equally aggressive.

CyberKnife treatment for prostate cancer is carried out in up to 5 therapy sessions, which enables effective and gentle treatment

Radiosurgical therapy with the CyberKnife can be a gentle and effective option, especially in the early stages. Compared to many other forms of radiotherapy, which take several weeks and require multiple sessions, CyberKnife therapy is characterized by its high efficiency and the highest possible precision.

CyberKnife therapy is only considered for locally confined prostate cancer and targets the tumor directly; metastases should be absent. Treatment success depends primarily on the histological grade of the tumor (Gleason score 6 and 7). Furthermore, the PSA level should be below 20 ng/ml, and the tumor should not have expanded beyond the capsule.

Patients experience no pain during CyberKnife treatment. Side effects, usually mild (difficulty urinating), may occur within the first 2 to 3 weeks after treatment and usually improve thereafter.

[1] Jäger, T. Early detection of prostate cancer. Forum 2024; Published 24 September 2024.

https://doi.org/10.1007/s12312-024-01379-w

[2] van As, N., Yasar, B., Griffin, C., Patel, J., Tree, A. C., Ostler, P. et al., Radical Prostatectomy Versus Stereotactic Radiotherapy for Clinically Localised Prostate Cancer: Results of the PACE-A Randomised Trial. Eur Urol 2024;86(6):566-576.

https://doi.org/10.1016/j.eururo.2024.08.030

[3] van As, N., Griffin, C., Baum, A., Patel, J., Ostler, P. et al., Phase 3 Trial of Stereotactic Body Radiotherapy in Localized Prostate Cancer. N Engl J Med. 2024;391(15):1413-1425.

https://www.nejm.org/doi/full/10.1056/NEJMoa2403365

[4] Bolam, KA, Bojsen-Møller, E., Wallin, P., Paulsson, S., Lindwall, M. et al., Association between change in cardiorespiratory fitness and prostate cancer incidence and mortality in 57,652 Swedish men. Br J Sports Med 2024;58:366-372.

https://doi.org/10.1136/bjsports-2023-107007

[5] Kishan, AU, Dang, A., Katz, AJ, Mantz, CA, Collins, SP et al., Long-term outcomes of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. JAMA Netw Open. 2019;2(2):e188006.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2723641