Prostate carcinoma

Selection of the appropriate therapy method depends on the tumour stage, the age of the patient, and any comorbidities. However, numerous individual factors are also to be considered, such as the patient's preference.

1. Active surveillance
   Waiting, only intervening with a curative treatment once the tumour has progressed, is a possible treatment option for a locally limited PCa in the early stage, under precisely defined conditions.
2. Radical prostatovesiculectomy
   Removal of the prostate and the seminal vesicles will be considered, particularly given a local PCa without clinically recognisable metastases; this can be done using different surgical techniques (retropubically or laparoscopically) with possible preservation of the erection nerves.
3. Radiotherapy
   Percutaneous radiotherapy and brachytherapy (insertion of seeds into the prostate) can be used with localized and locally advanced PCa without remote metastases; the prerequisite, however, is an undisturbed emptying of the bladder without formation of residual urine.
4. Watchful waiting
   In certain situations, especially for elderly patients with severe comorbidities, it may also be useful to dispense with primarily stressful tumour therapy and instead to wait for tumour-related complaints, and to treat these palliatively.
5. Hormone therapy
   Androgen removal should be performed for advanced and metastasised PCa as a palliative treatment option, which is medically treated using an LH-RH analogue. However, combination with an antiandrogen is also possible.
6. Chemotherapy
   Treatment with cytotoxic drugs, for example docetaxel or newer products such as abiraterone or enzalutamide, is recommended if antiandrogen therapy has lost its efficacy (in a hormone-refractory situation).