Tumor cells can be located precisely with a magnet resonance tomography. ©Adobe Stock/auremar
Your urologist told you that tumor cells have been found in the prostate? You only have a vague idea of what that implies? The good news is that today, the chances of survival for prostate cancer are very high. Doctors have a wide range of therapy options. Therefore, if you are diagnosed with prostate cancer, the first thing to do is to choose the suitable therapy. Here, you can find out which therapies for prostate cancer are available in Germany.

What is prostate cancer?

Prostate cancer, also called prostate carcinoma in technical terminology, is a malignant tumor in the prostate of a man. The prostate is part of his reproductive organs, as part of the seminal fluid is produced there. These tumor develops when too many cells have divided and multiplied uncontrolledly. The exact reasons for this modification of the cells has not been explored by scientists yet. Also, age plays a role. Prostate cancer is very rare in males below the age of 50. If the father or brother has been diagnosed, the risk of prostate cancer increases as well.

No clear symptoms

There are no early symptoms for malignant prostate cancer because it mostly occurs in the external area of the gland. Only when the tumor has already grown big and presses on the urethra which is located on the inside, problems concerning urination can occur. However, urinary problems can also be the result of a benign enlargement of the prostate, which is not dangerous. In rare cases, blood in urine or in the semen might also be an indication for prostate cancer. If the tumor has spread to other regions of the body, for example to the bones, bone pain is the result.

These signs may indicate prostate cancer

Diagnosis: from palpation examination to bone scintigraphy

The starting point of a diagnosis is a detailed discussion with the urologist, in order for him to identify the symptoms that might indicate which examinations are possible. Afterwards, the doctor carries out the following examinations:
    1.  Palpation examination: The doctor palpates the prostate through the rectum with a finger in order to assess its size, solidness and surface.
    2.  A blood test shows the doctor the level of concentration of the prostate-specific antigen (PSA). The PSA is formed in the prostate. An increased PSA level can indicate prostate cancer.
    3. During a magnetic resonance imaging, patients lie down in a magnetic resonance tomography device for about 30 minutes. During the examination, which is called multi-parametric magnetic resonance imaging (mpMRI), the most aggressive tumor centers are identified. That way, the urologist can see whether there really is a malignant prostate cancer or just an inflammation.
    4.  Sampling of tissue (biopsy) shows whether there is cancer tissue in the prostate. Usually, 10 to 12 tissue samples are taken and then examined for cancer cells under the microscope.
    5. If the doctor is sure that a patient has prostate cancer, further examinations can show how far the disease has advanced. By means of a trans-rectal ultrasound (TRUS), the examining urologist can see if the tumor has already penetrated the connective tissue capsule or if it has already grown into the seminal vesicles. For this examination, the doctor introduces an ultrasonic probe into the rectum. The ultrasonic probe provides precise images of the prostate, the seminal vesicles and its environment.
    6. Has the tumor already affected the bones? This can be determined by means of a bone scintigraphy. For this examination, small amounts of radioactive substance are injected into the blood stream which gathers especially in diseased bone. A camera can locate the radioactive radiation and thus the suspected metastatic areas.
In order to be able to make a statement about the aggressiveness of the tumor, the doctor determines the so-called Gleason Score between 6 and 10. For a value up to 6, the tumor is less aggressive, from a value of 8 onwards, the disease is already advanced.

This is how many men are treated for prostate cancer in German clinics

Therapies: Local tumor vs. tumor with metastases

Urologists distinguish between three stages of disease: locally limited prostate cancer, advanced prostate cancer and prostate cancer with metastases.

Locally limited prostate cancer
If the tumor is limited to the prostate and has not formed any metastases yet, doctors speak in terms of a locally limited prostate cancer. For this form, the chances of recovery are very good. Either surgery is recommended for the complete removal of the tumor, or a radiotherapy where the tumors irradiated by means of a linear accelerator. In the case of small tumors or older patients, tumor growth can also only be observed. Doctors call this procedure “active surveillance”.

Advanced prostate cancer
If the tumor has penetrated the connective tissue capsule of the prostate and has spread for example in the rectum or the seminal vesicle, doctors speak in terms of advanced prostate cancer. Such tumors can be treated either by means of a surgery or by a combination of irradiation and hormone therapy.

Prostate cancer with metastases
If the tumor has spread even further and has affected for example the lymph nodules or other organs, doctors speak of prostate cancer with metastases. In this case, surgery or local irradiation are no longer sufficient as forms of therapy. Now, measures have to be taken which target all tumor cells in the body. Doctors prescribe medicine that influences hormone levels. Often, they also arrange chemotherapy.

Treatment costs in Germany

The treatment of prostate cancer varies from patient to patient, thus it is impossible to say which costs will occur. It is possible that only a small tumor has to be removed from the prostate and no further measures are necessary afterwards. In this case, the expenses remain comparably low. If the tumor has spread, more complex and costlier therapies have to be applied.

In principle, foreign patients pay the same prices as German patients, because the bill complies to statutory cost catalogues. If individual services like treatment by a head physician or single room are added, prices increase. For patients from abroad explicitly, travel expenses, costs for translation and accommodation accrue.

Suppose that a patient has been diagnosed with local prostate cancer that has not spread yet. The patient is 65 years old and physically fit for his age. A doctor advises him to have surgery, because there is a high chance that he will recover well. The patient agrees. In this case, his treatment in a clinic would cost approximately 8,694 euros and he would spend 8 days in the hospital. He would be charged according to the flat-rate payment M01B which is the flat-rate that is most frequently used for prostate cancer in Germany. These costs and the days of stay are average values.

Cost allocation for the treatment of prostate cancer in the clinic

However, only the costs that accrue during the time in the hospital are included here. The follow-up examination and the preliminary medical examination are calculated separately and differ on a case-by-case basis.

Does it make sense to travel to Germany for treatment? In any case, it is recommendable to get an extensive examination in your home country. Then, you can discuss with your trusted doctor whether a therapy abroad provides added value.
If you are interested in a treatment in Germany and have questions, do not hesitate to contact us. We gladly recommend you a suitable contact person.