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Treatment decisions when prostate cancer is identified early

We use the term ‘low risk’ for a tumour in category cT1-2a, a Gleason score of 6 and a PSA level below 10 ng/ml.

When assessing a presumably localised tumour (i.e. a tumour confined to its place of origin), aggressiveness is just one factor we consider when deciding on a suitable treatment. Prostate cancer is usually slow-growing, so if a tumour is identified at a very early stage, the patient’s remaining life expectancy is also an important criterion.

Radical prostatectomy and radiotherapy

A localised treatment method, such as radical prostatectomy (removal of the prostate) or radiotherapy, could be a suitable choice for tumours identified at an early stage in men with an estimated remaining life expectancy of more than 15 years. Both treatments are a suitable first-line treatment for all risk groups.

Radical prostatectomy

Martini-Klinik

Accompanies you through this topic

Prof. Dr. Lars Budäus
Faculty member

Active surveillance

Conversely, active surveillance is a sensible choice when the man’s remaining life expectancy is less than 10 or 15 years. Why? Ultimately, it is highly probable that the prostate cancer will not cause any medical problems within this period. However, it is essential that this rough guideline is evaluated by a doctor, taking into account the individual patient’s health status.

Active surveillance

Focal treatment

In the majority of patients with a prostate carcinoma, the entire prostate must be treated due to what is called a multifocal tumour. However, if the tumour is unifocal (limited to a single lesion) or confined to a specific area (e.g. a lateral lobe), it can be removed in a selective, targeted procedure without the need to remove the entire prostate. 

Focal treatment

LDR brachytherapy

Brachytherapy is a form of internal radiotherapy. It can be administered as high-dose rate (HDR) or low-dose rate (LDR) brachytherapy. It is primarily suitable for combating less aggressive tumours identified at an early stage. The radiation sources, called seeds, are implanted in the prostate and emit radiation into the surrounding tissue. 

Brachytherapy

Summary – and a few facts

Surgery is more frequently proposed for patients under the age of 70. Almost 80% of the patients who undergo surgery at the Martini-Klinik are 69 or under, while around 20% are between 70 and 75. Prostate tumours are usually multifocal, so focal therapy is only an option for less than 20% of patients.

Treatment decisions for intermediate-risk prostate cancer
Treatment decisions for high-risk prostate cancer

What treatment options are available for low-risk prostate cancer?

We use the term ‘low risk’ for a tumour in category cT1-2a, a Gleason score of 6 and a PSA level below 10 ng/ml.

Your treatment options are complete surgical removal of the prostate (prostatectomy), targeted removal of the tumour lesion (focal therapy), radiotherapy administered externally, radiotherapy administered internally with a low dose rate (LDR brachytherapy) and active surveillance – waiting and observing.