In Germany, prostate cancer is treated in large University Hospitals, which have the Departments of Urology and Oncology, as well as in specialized Competence Centers for prostate cancer. The availability of robotic surgical systems, HIFU equipment, devices for 3D conformal radiation therapy, drugs for androgen blockade and symptomatic therapy allows specialists to choose exactly that therapeutic regimen which will be most effective in a particular patient.
Therapy goals
A treatment program in Germany is developed for each man individually, taking into account his age and clinical situation. As a rule, therapeutic measures pursue the following goals:
- Tumor removal or restricting its growth
- Prevention of tumor invasion into neighboring organs (urethra, bladder, intestines) and lymph nodes
- Prevention of metastasizing
- Distant metastases removal or their growth restriction
- Preservation of physiological urination, sexual function
To assess the effectiveness of therapy, the German doctors use such criteria as life expectancy, duration of the remission and quality of life. The quality of life is assessed according to questionnaires developed on the basis of recommendations of the European Organization for the Research and Treatment of Cancer.
Treatment of localized forms of prostate cancer
According to the international classification of oncological diseases TNM, localized prostate tumors correspond to stages T1 and T2. This means that the neoplasm is located within the prostate and does not invade its capsule. At this stage, a patient can be cured completely. To this end, the doctors mostly use radical prostatectomy.
Radical prostatectomy is the total removal of the prostate gland with its capsule and surrounding connective tissue. The prostate can be removed transurethrally, via laparoscopic access or using the da Vinci surgical system. In some cases, an open removal can be performed. Open surgery is more traumatic than the endoscopic one, but it provides the surgeon with better access to the tumor. To date, prostatectomy using the da Vinci surgical system is considered as the gold standard. It allows to save the nerves and blood vessels of the penis, as well as minimizes the risk of postoperative erectile dysfunction and urinary incontinence.
High-intensity focused ultrasound (HIFU) ablation is another technique for prostate removal. The gland is destroyed by a local increase in temperature using focused ultrasound. The prostate tissue is coagulated and destroyed, while the surrounding healthy tissue remains unaffected. The HIFU technique can also be used in therapy of local relapses of prostate carcinomas after radical treatment.
Radiation therapy is mainly conducted in men with contraindications to surgical interventions. This includes brachytherapy (implantation of radioactive gold "seeds") and remote radiation therapy.
In addition, in elderly patients with serious concomitant diseases and a short life expectancy, active therapy may be substituted by active surveillance. Such tactics is possible due to the slow progression of the localized prostate cancer, without clinical manifestations and a threat to life.
Treatment of locally advanced prostate cancer
Locally advanced prostate cancer invades a capsule of the gland (stage T3), affects neighboring organs (stage T4) or metastasizes to regional lymph nodes. At this stage, radiation therapy is preferred.
Radiation therapy for prostate cancer at this stage includes 3D conformal radiation therapy. This is a type of external irradiation, in which the dose of ionizing radiation is determined individually, depending on the localization of the tumor and its positional relationship with the neighbouring organs. The specialized German clinics also offer intensity-modulated radiation therapy (IMRT). It is a type of radiation that additionally takes into account the shape and volume of the tumor.
The combination of radiation therapy with the prescription of hormonal drugs increases the effectiveness of therapeutic measures. As hormone therapy, the doctors use drugs that block the growth and spread of carcinoma under the influence of testosterone. Such drugs include analogues of the luteinizing hormone-releasing hormone, steroid and "pure" antiandrogens, estrogens.
In men with castration-resistant (i.e. resistant to antiandrogen drugs) forms of prostate carcinoma, chemotherapy can be used. The most effective chemotherapeutic drugs are docetaxel, cabazitaxel and abiraterone. As a rule, chemotherapeutic drugs are administered once every 3 weeks and combined with daily intake of prednisolone.
Prostatectomy is of low efficiency at this stage of the disease, since it is most often impossible to perform a radical surgical procedure in order to remove the entire mass of the tumor and metastases. However, a number of studies have demonstrated benefits of prostatectomy when combined with total androgen blockade using modern hormonal drugs.
Treatment of metastatic prostate cancer
Metastatic prostate cancer can correspond to any stage T in the presence of metastases in the lymph nodes of the pelvis or distant organs. The prostate tumors mostly metastasize to the skeleton bones, lungs and liver. In case of metastatic tumors, high-tech radionuclide therapy and androgen blockade are the most effective treatments.
Bilateral orchiectomy and chemical castration are used to block the stimulating effect of androgens (testosterone) on the cells of the primary tumor and its metastases. The clinical practice involves various mechanisms of androgen blockade, from the testicles (the main source of androgens) removal to the blockade of tissue androgen receptors and increasing levels of antiandrogenic substances (estrogens).
Radionuclide therapy, including Lutetium-177 PSMA therapy and Actinium-225 PSMA therapy, is the most modern and effective way to help men with metastases in the bones, liver and lungs. The therapeutic radionuclides recognize cancer cells and accumulate in them selectively, thereby destroying cancer with the help of radioactive irradiation. In this case, normal cells and tissues that do not have characteristic receptors are not exposed to radiation. Lutetium-177 PSMA therapy and Actinium-225 PSMA therapy can be carried out only in several medical facilities in Europe, since they require complex technological manufacturing of radionuclide preparations and strict measures of radiation protection.
Symptomatic therapy aims at improving the quality of life. This includes painkillers, drugs for anemia correction, restoring the reduced due to the disease body mass, and so on. The men who are diagnosed with a metastatic tumor are receive bisphosphonates, namely zoledronic acid, additionally. Zoledronic acid stops the destruction of bone tissue, reduces pain and, to some extent, has an antitumor effect (reduces blood supply of metastases). The German clinics offer modern drugs that are administered once every 4 weeks and have an extremely low risk of side effects.
Prostate cancer treatment in Germany with the Booking Health
The foreign patients who plan to undergo the diagnostics and treatment of prostate cancer in Germany should take into account the specifics of receiving medical services abroad. It is also important to choose a specialized clinic from several dozens of leading medical institutions specializing in urologic oncology. For such patients it will be much easier to entrust the responsibility for both medical and organizational issues to the Booking Health company.
The Booking Health company is the only medical tourism operator that has the international certification in this field (ISO 9001: 2015 certificate). The employees of the company can help patients and their relatives with the following issues:
- Selection of the right clinic based on the annual qualification profile
- Direct communication with your attending physician
- Preliminary preparation of a medical program without repeating previous examinations
- Provision of the favorable treatment costs in Germany, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Booking an appointment with a doctor for the desired date
- Monitoring the medical program at all its stages
- Assistance in buying and forwarding medicines
- Communication with the clinic after the program completion
- Control of invoices and return of unspent funds
- Organization of additional examinations
- Top-class service: booking hotels, airline tickets, transfer
Please, leave a request on the Booking Health website and a medical consultant or patient manager will contact you the same day.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova
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