Prostate cancer is a malignant change in the tissue of the prostate gland. In Switzerland it is the most common cancer in men: around 6,600 new cases are diagnosed each year, and around 1,400 men die from it every year. Even with high awareness and optimal medical care, the disease is sometimes only discovered at a metastatic stage. At that stage a complete cure is usually no longer possible, but modern drug therapies can control the tumour very reliably over long periods. For how we detect prostate cancer early, see Prostate screening.
Early-stage strategies: active surveillance or active therapy
Not every prostate cancer requires immediate intervention. We fundamentally distinguish between different risk and malignancy levels.
Low risk: active surveillance. If a tumour has very low aggressiveness potential, it usually affects neither the patient's quality of life nor life expectancy. Large international long-term studies (such as the well-known ProtecT study) clearly show that immediate invasive therapy – such as surgical removal of the prostate or radiation – brings no survival benefit at this stage. On the contrary, it often leads early on to unnecessary functional impairments such as incontinence or impotence. In such cases we recommend active surveillance: the cancer is closely monitored through regular PSA blood tests, MRI scans of the prostate and, if needed, targeted follow-up biopsies. Only once findings show increasing activity do we start curative treatment.
Intermediate and high risk: curative treatment. If the tissue obtained by biopsy shows a higher degree of malignancy (Gleason score / ISUP grade), the disease can progress without treatment. At this still-curable stage, two equally effective, established procedures are the main options: radical prostatectomy (complete surgical removal of the prostate) and radiotherapy (targeted radiation). Working closely with the excellent uro-oncology centre of excellence at Lucerne Cantonal Hospital (LUKS), we support our patients individually through decision-making, preparation and follow-up care for the chosen therapy.
Treating metastatic prostate cancer
If metastatic disease is present from the outset, this calls for tailored, systemic medication. The focus today is on extended testosterone blockade using modern anti-androgen substances: according to current international and Swiss guidelines, hormone deprivation therapy alone (an "injection") is no longer sufficient in most cases – regardless of the patient's age. Depending on general health, comorbidities, current medication and the personal wishes of the patient and their family, we tailor the therapy individually and precisely.