Prostate cancer symptoms diagnosis therapy yellow list

Prostate cancerThe prostate carcinoma is by far the most common malignant tumor in men. Diagnosis is based on digital rectal examination, determination of the PSA value and transrectal prostate biopsy.

Prostate carcinoma, PCa, malignant prostatic hyperplasia, prostatic malignancy

Prostate carcinoma is a malignant growth of the glandular tie of the prostate gland. Histologically, more than 98% are adenocarcinomas. Neuroendocrine tumors, squamous cell carcinomas, lymphomas and urothelial carcinomas are diagnosed much less frequently. The tumor is one of the most common cancers in men. After lung and colorectal cancer, prostate cancer is the third most common cancer that ends in death. In the early stages, prostate cancers are asymptomatic. As the disease progresses, the carcinoma grows destructively, crossing organ boundaries. At the first symptoms, the tumor has usually already metastasized. The locoregional lymph nodes and the skeleton (spine, rib and pelvic bones) are primarily affected. Metastases can also occur in the liver and lungs.

Epidemiology

In Germany, prostate carcinoma is the most common cancer in men, accounting for 25.4% of all diagnosed malignancies. Each year, about 65.000 men are diagnosed with prostate cancer. In 2013, 67 people were diagnosed with.600 men new to prostate cancer. The age-standardized incidence rate is about 110 out of 100.000 males. The number of cases varies considerably depending on age. For example, the annual incidence in 60-year-old men is about 50 out of 100.000 men. In 80-year-olds, by comparison, up to 400 cases are reported per 100.000 males diagnosed with. Men under the age of 40 are almost never diagnosed with prostate cancer. The average age of onset is approx. 69 years.

Among fatal cancers in men, prostate cancer ranks third in Germany after lung cancer and colorectal carcinoma, accounting for 11.3 percent of all cases. In Germany, about 12,000 men die of prostate cancer each year.000 patients suffer from the consequences of prostate carcinoma.

The incidence of prostate cancer has been steadily increasing since 1980. However, age-standardized mortality has decreased by 20% during this period. However, many experts do not believe that there is actually an increased incidence of the disease. On the contrary, as a result of greatly improved diagnostic measures. early detection examinations as well as the generally higher life expectancy, more prostate carcinomas are probably diagnosed.

Worldwide incidence rates vary widely. There appears to be a wide geographical variation in prostate cancer. Ethnic differences to give. The highest number of cases is found in black Americans and Northern Europeans, the lowest incidence is found in men in Southeast Asia. However, worldwide case numbers are based on estimates only and may not be certain or. reliably.

Causes

The causes of prostate cancer are still largely unknown. There are, however, various risk factors that can promote the occurrence of the disease. Age is the most important risk factor for the occurrence of prostate carcinoma. As life expectancy continues to increase, so do the number of cases of prostate cancer. In addition, genetic predisposition, place of living and general lifestyle, as well as comorbidities and drugs, play a decisive role in the development of prostate cancer.

Genetic predisposition

16 to 19% of men with prostate cancer have a positive family history in Germany. Men whose fathers have prostate cancer have a twofold increased relative risk (RR) of developing prostate cancer in their lifetime (RR 2.1 to 2.2). In men, with an affected brother, the risk increases to three times that of the rest of the male population (RR 2.9 to 3.4). The risk also increases the more family members have the disease and the younger they were at the time of diagnosis. If two or more first-degree relatives suffer from prostate cancer, the relative risk is 3.5 to 5.1, and for affected second-degree relatives it is still 1.7.

In addition, BRCA gene mutations play a role. Thus, men with a BRCA mutation have a significantly higher risk of prostate cancer than men without this gene mutation. From 2.019 prostate cancer patients had a BRCA1 mutation and 61 men had a BRCA2 mutation, according to a study by the Centro Nacional de Investigaciones Oncologicas (CNIO) in Madrid (2013; DOI 10.1200/JCO.2012.43.1882). The global distribution of prostate carcinomas shows a significant east-west divide in favor of the Asian region. A north-south divide in favor of southern European countries within Europe. Thus, U.S. African-American men have an increased risk of prostate cancer compared to Europeans or Asians. Interestingly, however, the descendants of emigrants do not carry the disease risk of their ancestors. Rather, the risk of disease adapts to that of the new home country. This in turn supports the hypothesis that lifestyle is important in the development of prostate cancer. Lifestyle appears to play a role in the development of prostate cancer. Dietary habits to play a crucial role. According to this study, the low incidence rate in Japan is thought to be due to the Asian lifestyle with adequate physical activity. Relaxation, as well as the dietary habits there, may be due to. In particular, a plant-rich diet high in phytoestrogens (especially soy) and lycopene, isoflavones, and other phytochemicals (especially in tomatoes and pomegranate juice) is thought to protect against prostate cancer. However, this benefit has been demonstrated with certainty and evidence-based.

Comorbidities and drugs

Other risk factors for the development of prostate cancer include obesity, diabetes mellitus, hypertension and dyslipoproteinemia (metabolic syndrome), and local inflammatory processes such as chronic prostatitis. Sexually transmitted diseases are also thought to be closely associated with the development of prostate cancer. If the risk for the presence of prostate cancer in a healthy male is amed to be 1, the odds ratio for any STD increases to 1.5 and for prostatitis to 1.6.

Since tumor cells are stimulated by androgens, testosterone levels in prostate cancer are also in focus. For example, men without male sex hormones (so-called eunuchs) have not yet been diagnosed with prostate cancer.

Protective effect of drugs

In addition to a healthy lifestyle and stable psychosocial health, drugs may have a protective effect on the development of prostate cancer. Thus, 5-alpha reductase inhibitors decrease finasteride. dutasteride reduces the risk of prostate cancer by 20 to 25%. However, due to undesirable side effects such as erectile dysfunction, declining libido and gynecomastia, preventive use is not advised.

Pathogenesis

As with all malignant tie alterations, a mutation of the cell DNA and apoptosis alterations are also present in prostate carcinoma. However, there is no classic mutation pattern in prostate cancer. No typical adenoma-carcinoma frequency. Rather, heterogeneous point mutations, allele and chromosome loss, and polyploidy are observed. In the metastasized stage of prostate cancer deletions occur. Mutations of tumor suppressor genes such as TP53. In addition, there are changes in the gene encoding the androgen receptor.

Currently, most scientists ame a biphasic malignant transformation in prostate cancer. In this context, a nonandrogen-sensitive. An androgen-sensitive phase distinguishes. The nonandrogen-sensitive phase is initiated by chronic inflammatory responses. The androgen-sensitive phase begins with the prostatic intraepithelial malignant manifestation of the neoplasia. More specifically, certain gene mutations, carcinogens, and O2 radicals interfere with prostate cell differentiation and proliferation. This results in inflammatory atrophy of the prostate epithelium. In addition, the regulation of apoptosis is disturbed, so that programmed cell death is impaired. Epigenetic inactivation of certain tumor suppressor genes further increases the mismatch between proliferation and apoptosis. At the same time, the expression of androgen receptors decreases, leading to a greatly reduced androgen sensitivity. In addition, abnormal expression of estrogen receptors is often observed. ER-alpha receptor overexpression, for example, mediates the carcinogenic proliferative effect of estrogens on prostate epithelium. As the disease progresses, epithelial cells change from differentiated, androgen-sensitive cells to increasingly undifferentiated, androgen-resistant cells. The greater the de-differentiation of the cells, the higher the malignancy and aggressiveness of the prostate carcinoma.

Symptoms

For prostate carcinomas, there are no specific symptoms that reliably indicate a carcinoma. Prostate-typical symptoms can also be signs of inflammation or infection or benign prostatic hyperplasia (BPH). These include:

– Micturition problems: This is usually due to BPH, which affects almost all men of advanced age. Carcinoma often obstructs the urethra only when it is already relatively large. – Blood or abnormal discoloration in the urine or seminal fluid: hematuria or hematospermia can be signs of inflammation as well as carcinoma and must always be medically clarified. – Pain (for example, alguria, dyspareunia, or painful defecation; bone pain): Pain in prostate cancer usually indicates that the carcinoma has grown destructively and/or metastasized. In the early stages, prostate carcinomas are asymptomatic. Almost never cause discomfort. At this stage, they are usually only discovered in the course of early detection or screening examinations. Around 10% of all prostate carcinomas are incidental findings in histopathological examinations for suspected benign prostatic hyperplasia.

Late stage

Most prostate cancers are diagnosed only in the symptomatic late stage. The larger the tumor, the more the urethra is obstructed. This leads to the typical prostate micturition symptoms. Initially, affected men notice a delayed onset of urination, prolonged micturition and a weaker urine stream. Sometimes urine is only intermittent. At the end of micturition, a prolonged post-micturition dribble is typical. A large amount of residual urine usually remains in the bladder. This leads to irritation such as nocturia, pollakiuria, dysuria and alguria. Neuronal damage in the sacroiliac region can cause erectile dysfunction or impotence. Flank pain, anuria, and signs of renal insufficiency indicate urinary stasis kidneys.

Signs of metastasis

Some prostate carcinomas remain inconspicuous until metastases appear (occult prostate carcinoma). Because prostate cancer often metastasizes osseously, vertebral, lumbosacral pain, and pain in the pelvic region may be the first signs. If bones or spine are metastasized, spontaneous fractures and spinal compression syndromes (e.g., cauda equina syndrome) are conceivable. Pronounced iliac lymph node metastases sometimes cause lymphedema in the lower extremities or scrotal lymphatic collections. Pulmonary and pleural metastases manifest with dyspnea and coughing. For liver metastases, icterus. Pruritus indicative. General symptoms of metastasis, as with any carcinoma, include unwanted weight loss, declining performance, anemia, and night sweats.

Diagnostics

The most important diagnostic parameters for suspected prostate cancer are history and digital-rectal examination, determination of the PSA value and imaging techniques.

Palpation examination

Digital rectal examination (DRU) is a procedure that finds prostate carcinomas above a certain size. It is offered as a screening test for the early detection of prostate cancer for men over 45 years of age and is the basic diagnostic parameter for suspected prostate cancer. Hard, rough, nodular palpation findings with a painless prostate are particularly suspicious of carcinoma.

In about 1/5 of patients the carcinoma can be detected by DRU. Disadvantage is that malignancies of the anterior prostate region often cannot be palpated. In addition, it must be noted that even with negative palpation findings, prostate carcinoma cannot be ruled out with certainty. DRU is not considered sufficient as the sole measure for early diagnosis of prostate cancer.

PSA value

PSA is the abbreviation for prostate-specific antigen, which is only produced in the prostate gland and is therefore organ- or organ-specific. is tie specific. For this reason, the PSA value is also considered a tumor marker that is used in early detection (not paid for by the statutory health insurance) as well as for monitoring and follow-up of PSA-positive prostate carcinomas. The protein is ten times more concentrated in tumor tie than in healthy prostate epithelium. An elevated PSA value indicates a change in the prostate, u. a. a cancer. However, malignancies are not the only cause of an elevated PSA value. Similarly, organ manipulations such as DRU, as well as prostatitis or benign prostatic hyperplasia, may be responsible for an elevated PSA concentration.

Currently, the following recommendations apply to men between the ages of 50 and 59 (laboratory-specific variations are possible):

– PSA values< 3.5 ng/ml: findings unremarkable – PSA value from 4 ng/ml: clarification required – proportion of free PSA to total PSA< 20%: Clarification required – annual increase in PSA value of 0.35 to 0.75 ng/ml: clarification required> 10 ng/ml: risk of malignancy 90%.

Only one in four men with an elevated PSA level actually has a prostate carcinoma. With a PSA value above 10 ng/ml, a prostate carcinoma is found in every second man. A prostate carcinoma without an increase in the PSA value cannot be excluded with certainty. After a positive DRU. An elevated or. If the PSA value is abnormal, a biopsy of the prostate tie is recommended.

Biopsy

Punch biopsy tie sampling should be performed if a finding suspicious for carcinoma was raised at DRU and/or:

– the controlled measurement results in a PSA value of 4 ng/ml or more – the PSA value becomes conspicuous during the course of the controls (> 0.75 ng/ml per year) has increased (the same determination procedure should always be used).

The punch biopsy should be performed under transrectal sonographic control, local anesthesia and antibiotic prophylaxis. It is recommended that 10 to 12 tie cylinders be obtained and examined histopathologically.

Repeat biopsy within six months is advised for:

– Evidence of extensive high-grade PIN (high-grade prostatic intraepithelial neoplasia) in at least four tie samples – Atypical microacinar proliferation (ASAP) – PSA level in need of control or. PSA history.

Before the biopsy, the patient must be informed in detail about the benefits, risks and possible consequences of the examination.

Imaging procedures

Imaging procedures have little relevance in the initial diagnosis of prostate carcinoma and are only used in certain cases. Transrectal sonography (TRUS) is used to examine the prostate gland. The surrounding tie structures visualized. The method is performed in addition to the palpation examination to determine the size, location and extent of the tumor. However, the method is not more reliable than palpation alone. TRUS does not allow a reliable statement on the dignity of the tumor. However, it can give indications about the condition of the capsule resp. whether the carcinoma has penetrated them.

Imaging techniques in advanced disease

In the case of micturition disorders such as oliguria and anuria, renal sonography can show whether the tumor is already constricting the draining urinary tract to such an extent that it has caused a urinary stasis kidney. Abdominal sonography is used to clarify liver metastases. By means of whole-body bone scintigraphy. X-rays of the spine can detect osseous metastases. Laparoscopic pelvic lymphadenectomy is recommended if lymph node metastasis is suspected (from T3). Both procedures can provide information on prostate volume. For localization of the tumor provide. This makes it easier to assess which therapy should be chosen and whether nerve-sparing surgery can be performed. Enlarged lymph nodes can be an indication of lymph node metastases.

If radiotherapy is planned, MRI can help to precisely define the target area. After a negative biopsy and continued suspicion of cancer, an MRI may be useful. However, MRI is not a routine examination for initial diagnosis.

Tumor localization

Zonal anatomy of the prostate is used in the localization of prostate cancer. With 85%, most prostate carcinomas originate in the peripheral zone of the prostate gland. Only about 10 to 20% originate from the transitional zone. Transition zone carcinomas are usually highly differentiated inciduous tumors. Prostate carcinomas are very rarely diagnosed in the central zone.

TNM classification

The TNM classification of prostate cancer is based on tumor size (T), lymph node status (N), and metastatic spread (M). The following classification results:

– T1: localized prostate carcinoma, but tumor not clinically detectable, negative palpation and visual findings T1a: malignant cells in< 5% of specimen material detectable T1b: malignant cells in> 5% of specimen material detectable T1c: prostate carcinoma cells in punch biopsy with nonpalpable tumor – T2: localized prostate carcinoma, tumor remains confined to prostate, capsule intact T2a: involvement of< 50% of a side lobe T2b: Incidence of> 50% of a lateral lobe T2c: involvement of both lateral lobes – T3: locally advanced prostate carcinoma, extraprostatic tumor growth, capsular penetration T3a: extracapsular tumor extension T3b: tumor infiltration of the seminal vesicles – T4: locally advanced prostate carcinoma, infiltration of neighboring organs beyond the seminal vesicle (for example, rectum, anus, pelvic wall, or urinary bladder) – N1: advanced or. metastatic prostate carcinoma, locoregional lymph node involvement – M1: advanced resp. metastatic prostate carcinoma, distant metastases M1a: extraregional lymph node metastases M1b: osseous metastasis M1c: other distant metastases.

Stage classification

Staging of prostate carcinoma is done internationally according to the UICC staging system. Corresponding to:

– Stage I: up to T2a – Stage II: T2b or T2c – Stage III: T3 – Stage IV: t4 or N1 or M1.

Risk stratification according to D'Amico

Advanced prostate malignancies are basically high-risk tumors. The risk of localized prostate carcinoma is usually assessed according to D'Amico. As a prerequisite of this stratification, the tumor must have a maximum TNM classification of T< 3 as well as M0 and N0. According to the D'Amico risk stratification, the risk of the tumor is classified as follows:

– Low-risk tumors: PSA value< 10 ng/ml + Gleason score ≤ 6 + ≤ T2a – intermediate-risk tumors: PSA level 10 to 20 ng/ml or Gleason score 7 or cT2b – high-risk tumors: PSA level> 20 ng/ml or Gleason score ≥ 8 or cT2c. The Gleason score is, in addition to the TNM classification. The PSA value the most important prognostic parameter in prostate cancer. It is based on the histological evaluation of the glandular morphology of the prostate. The Gleason score allows conclusions to be drawn about the degree of dedifferentiation of the tumor cells and thus the aggressiveness of the tumor. The numbers range from 1 to 5. The higher the value, the higher the degree of de-differentiation of the cells (Gleason grades).

Gleason grade is divided into five levels:

– Gleason grade 1: well circumscribed, microscopically unchanged glandular formation without signs of stromal invasion – Gleason grade 2: same to slightly changed glandular formation with little stromal invasion – Gleason grade 3: variable glandular formation with stromal invasion of glandular cells, individual glands still identifiable – Gleason grade 4: individual glands no longer identifiable, but origin still recognizable by cribiform growth pattern – Gleason grade 5: gland origin no longer identifiable, strand or cluster-like cell growth and central tumor cell necrosis nests.

The Gleason score is calculated from the addition of two Gleason grades. Punch biopsies of the prostate or a prostatectomy specimen are used as specimen material. For calculation after prostatectomy biopsy, the most and the worst differentiated Gleason grade are combined (the most + the worst). Prostatectomy margin assessment is calculated by summing the most common with the second most common degree of dedifferentiation. If the lower grade predominates, the Gleason score is supplemented by an "a", if the higher grade predominates by a "b".

For a better understanding, an example of a prostatectomy specimen: the histopathologist finds different glandular formations. Gleason grade 3 were most frequently identified. The second most common formations corresponded to a Gleason grade 4. After addition, a Gleason score of 7 is obtained. Since the lower grade of de-differentiation predominates, there is a Gleason score of 7a.

Diagnosis of spread

In addition to the imaging methods already described for metastasis detection, blood tests can provide information about the stage of the disease. If, for example, the alkaline phosphatase or calcium levels are elevated, this may indicate bone metastases. The PSA value can also provide information about the progress of the disease. The higher the value, the greater the likelihood that metastases are present.

Therapy

The therapy of prostate carcinoma depends on the extent and stage of the disease as well as the age and general situation of the patient. Early-stage tumors are often treated with the active surveillance strategy. This wait-and-see approach is advocated and used by very many urologists. Alternatively, the prostate can be surgically removed (radical prostatectomy) and/or radiotherapy (percutaneous radiotherapy or brachytherapy) can be performed.

Surveillance strategy

Localized tumors in the low-risk group are often initially monitored only actively and closely. The Active Surveillance concept is based on regular check-ups to detect early tumor progression. In case of progressive tumor progression, the patient may be offered surgery or radiation with curative goal. For the surveillance strategy, the following indications must be met in their entirety:

– Desire of this therapy after informing the patient about advantages and disadvantages of all therapy options – localized tumor with low risk profile according to D'Amico – small tumor mass in the punch biopsy (≤ 2 tumor-bearing punches with ≤ 50% tumor mass each.

Therapy for locally limited non-metastatic prostate cancer

In the absence of distant metastases, the patient can choose between two equal treatment options: radical prostatectomy (RP) and external beam radiotherapy.

Radical prostatectomy

Radical prostatectomy or. Radical prostatic vesiculectomy is the most commonly performed procedure for prostate cancer. The goal is an R0 resection. The procedure is performed retropubically, perineally or laparoscopically. RP is recommended as a treatment option for patients with localized prostate cancer of all risk groups. It should be used primarily when an R0 resection is possible. This is the case if the carcinoma is localized and has not yet penetrated the capsule of the prostate gland.

The prostate is removed including the capsule, seminal vesicles, and the portions of the vas deferens near the prostate. Subsequently, the men are incapable of procreation. Nerves that provide erectile function run along the prostate gland. These can be injured during surgery, so that erection is no longer possible for the affected man. For tumors that do not exceed a certain size, nerve-preserving surgery can be performed. This is not always possible with larger tumors.

In most cases, a lymphadenectomy is performed along the major blood vessels in the pelvis to check the lymph node status. In localized prostate carcinoma with a low risk profile, it can be omitted because lymph node involvement is very unlikely. If more than one lymph node is affected, a radical prostatectomy may not be necessary, as curative success can no longer be expected.

At least ten lymph nodes should be removed and examined during lymph node extirpation. In this way, it can be safely ruled out whether advanced disease is present. In case of positive findings of the incision margins (R1 resection) or additional risky findings such as an infiltration of the seminal vesicle, radiation of the tumor bed is recommended in addition to RP.

External radiation

External irradiation is recommended from an intermediate risk profile according to D'Amico or lymph node involvement in combination with hormone therapy. Radiation of the prostate is performed externally with approximately 74 to 80 Gy. Treatment lasts approximately seven to eight weeks – with daily radiation except on weekends. A three-dimensional treatment plan with subsequent marking of the patient should ensure an even dose distribution of the radiation.

Alternative therapy with LDR brachytherapy and implantation of iodine-125 seeds

Alternative treatment regimens may also be possible for some patients with localized, non-metastatic, low-risk D'Amico prostate cancer. In addition to active surveillance, this includes LDR brachytherapy with implants of iodine-125 seeds. LDR stands for Low-Dose-Rate. The tumor is irradiated from a short distance directly from the inside. The seeds, which are the size of a grain of rice and coated with titanium, are inserted into the prostate under sonographic control. Radiation sources remain permanently in the prostate gland. Radiation is delivered with a half-life of approximately 60 days. This permanent radiation allows targeted tumor therapy with preservation of adjacent organs.

Therapy for metastatic, advanced prostate carcinoma

In the advanced stage or. a tumor-dependent life expectancy ≤ 10 years and in the case of distant metastases, hormone therapy (androgen deprivation) is usually performed or. a combined hormone-chemotherapy. Agents of choice are GnRH analogues such as buserelin or GnRH inhibitors such as Abarelix. The additional administration of non-steroidal antiandrogens such as flutamide are possible for complete androgen blockade – especially in the first week of therapy. In the case of combined hormone chemotherapy, the cytostatic drug docetaxel is also administered. If tumor growth continues despite androgen deprivation, therapy with the antiandrogen abiraterone or the androgen receptor blocker enzalutamide may be considered.

Depending on the patient's condition (advanced age, poor general condition), so-called watchful waiting may also be practiced. This treatment usually has only a palliative character. The aim is to preserve the patient's quality of life as best as possible. For example, bisphosphonates or RANKL-AK (antibodies against the RANK ligand) are used for osseous metastases. In addition, symptom-oriented therapy such as adequate analgesia and surgical restoration of urinary passage is performed.

Prognosis

In contrast to other malignancies, localized adeno-prostate carcinoma has a relatively favorable prognosis. G1 tumors (lowest grade of differentiation) usually remain asymptomatic during the normal remaining life of the patient. Occasionally, however, localized prostate carcinomas can grow very aggressively. Treatment with curative prospects is only possible for carcinomas that have not metastasized.

According to the current cancer registry, the absolute 5-year survival rate after diagnosis of prostate cancer is 76%, and the 10-year survival rate is 59%. More meaningful, however, is the relative survival rate. This is calculated using the age-matched general population. According to the German Cancer Registry, the relative survival rate for patients with prostate cancer is 91% 5 years after diagnosis and 90% 10 years later.

Prognosis assessment

Prognosis assessment in prostate cancer is based on:

– Tumor grading by Gleason score (degree of differentiation) – TNM category (according to TNM classification) – Surgical resection margins of the carcinoma.

Patients with T3/G2 tumors, for example, have a better chance of survival than patients with T2/G3 tumors (relative 10-year survival 64%), with a relative 10-year survival rate of 77%. In the case of lymph node involvement without metastasis, the relative 10-year survival rate drops to 48%; if there are already distant metastases, it drops to 3%.

Inauspicious prognosis

If the prostate cancer has already metastasized, a cure is no longer possible. Palliative therapy is primarily intended to alleviate the symptoms caused by metastases. The aim of treatment is to slow down the progression of the disease and to maintain the patient's quality of life as far as possible. Survival time depends on the aggressiveness of the tumor and the type of metastasis and varies greatly from individual to individual. Even with advanced prostate cancer, a patient can live for many more years.

Prophylaxis

According to the statutory screening program in Germany, men can be screened for prostate cancer from the age of 45. Patients with T2/G2 tumors are older than 40 years of age and have a family history of T2/G3 tumors. Have a prostate exam once a year before the age of 18. The program is offered free of charge by public health insurers. The genitals and locoregional lymph nodes are examined and the prostate is palpated from the rectum (DRU). The PSA test, i.e. the examination of the prostate-specific antigen in the blood, is not included in the statutory benefits catalog. Nevertheless, this laboratory determination is possible as part of the IGeL service.

Lifestyle and diet

There are no proven data on the prevention of prostate cancer with regard to a change in lifestyle. Also, certain forms or components of the diet have not yet been proven to have a positive effect on the development of prostate cancer. Taking high-dose vitamin supplements may actually increase the risk of aggressive forms of prostate cancer.

General recommendations

The recommendations of the S3 guideline prostate cancer are based on those of the American guideline. The four main recommendations for the prevention of prostate cancer are:

1. Aim for healthy weight reduction resp. Avoidance of added sugars, saturated or trans fats, and alcohol. Examples of such unfavorable foods to avoid include fried or roasted foods, cookies, cakes, sugar products, ice cream, and sweetened soft drinks. 2. Regular physical activity Recommended at least 30 minutes of moderate to vigorous physical activity in addition to normal daily activities at least five days a week. 45 to 60 minutes are desirable. 3. Healthy diet with emphasis on plant products Different fruits and vegetables every day, whole grain rather than white flour products, limited intake of meat products and red meat. 4. Reduce alcohol consumption Men should have no more than two alcoholic drinks per day. One drink (12 g alcohol) is equivalent to 0.33 liters of 5% beer, 0.04 liters (4 cl) of 40% liquor, 0.14 liters (14 cl) of 12% wine or sparkling wine, 0.07 liters (7 cl) of 20% liqueur/appetizer.

Medication

Taking the 5-alpha-reductase inhibitors finasteride and dutasteride reduces the risk of prostate cancer diagnosis by 20% to 25% (at the time of early study termination). However, the preventive effect is offset by an increased incidence of carcinoma with a high Gleason score. In addition, neither cancer-specific nor overall survival was significantly affected by medication prevention. Rather, adverse side effects such as erectile dysfunction, decreased libido, and gynecomastia predominated. Finasteride and dutasteride are not currently approved for the prevention of prostate cancer.

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