Treatment of prostate cancer : a comparison of methods , side effects of treatment
Urology / / April 28, 2016
prostate cancer, prostatectomy prostate video
Active surveillance (watchful waiting)
Active surveillance entails lifestyle changes and, if the disease progresses, a careful monitoring of prostate cancer with the transition toactive treatment.With this approach, patients do digital rectal examination, determining the blood level of PSA every 6-12 months.If the test results show the progression of cancer, the physician and patient consider treatment options (surgery, radiation, or narcotic drugs).Patients should be engaged in physiotherapy exercises and eating healthy food.Patients should inform their physicians symptoms such as weight loss, pain, urinary problems, fatigue or erectile dysfunction.Active surveillance ( "watchful waiting") is mainly due to the palliative measures (allowing to improve the quality of life of patients with life-threatening problems of disease through prevention and relief of suffering, psychosocial and spiritual support to the patient and his family, mitigation in
Active surveillance may be the most suitable for the following patients:
- men 70 years and older.More aggressive treatments (surgery and radiotherapy) are usually recommended for men 50 years of age and younger.For 60 and 70-year-old men choosing this method is more complicated.Aggressive therapy is suitable for those who have a life expectancy of more than 10 years and who have localized tumors, middle and high class.The degree of malignancy of the tumor can be the best guide for determining the risks when choosing active surveillance;
- older men with early-stage (T0 - T2) low-grade tumors;
- men with low and moderate (3-13 ng / mL) PSA.
Some doctors believe that prostate cancer grows very slowly due to the fact that it is likely that older men may die of causes unrelated to cancer.Therefore, there is a potential benefit from surgery or radiation therapy, both of these treatments create a risk for erectile dysfunction and incontinence.When choosing a method for patients is important to find a doctor who will provide them with all the necessary information to be able to make an informed and most correct decision.
Surgical treatment of prostate cancer
For men whose prostate cancer is confined to one body (localized), surgical resection (radical prostatectomy) opens up the possibility of treatment.In most patients, no specific signs of the disease if their PSA levels observed 10 years after surgery.
- Radical prostatectomy .This is the surgical removal of the entire prostate with seminal vesicles (the vessels that carry sperm) and surrounding tissues.The surgeon may also remove lymph nodes and pelvis (pelvic lymphadenectomy).Then removed iron and other structures.
- Minimally invasive prostatectomy. less invasive surgical techniques - Laparoscopy: use small incisions, which leads to faster recovery, but this method requires special surgical training.To assist the surgeon with a small video camera attached to the instrument operation.When the robotic laparoscopic radical prostatectomy surgeon directs the robotic arm through a computer monitor.
- nerve-sparing techniques. In retropubic open surgery, laparoscopic and robotic types of surgery the surgeon is required to remove more nerves in the prostate.Bilateral nerve-sparing procedure preserves the nerves on both sides of the body.Nerve-sparing techniques can improve the patient's quality of life by reducing the episodes of incontinence and erectile dysfunction.In cases where the tumor is located too close to the nerve, nerve-sparing techniques can not act.
Restoring power after surgical procedures on the removal of the prostate perdstatelnoy
patients are in the hospital for 3 days after invasive (open surgery) or 2 days after the less invasive (no deep surgery) procedures.Full restoration of the house takes about 3-5 weeks.The temporary catheter is used to transfer the urine, it is left in place and is usually removed after 3 weeks after open surgery or after a week minimally invasive procedures.Younger patients with early stage cancer recover faster and experience the least amount of side effects.
complications after radical prostatectomy
Major complications of radical prostatectomy - incontinence and erectile dysfunction.Other complications include the usual risks after any operation (blood clots, heart problems, infections, bleeding).Less invasive procedures usually bring less pain and not much interfere with the patient's activity.
- Incontinence urine is a common complication.When the urinary catheter is removed after surgery, almost all patients impaired bladder control functions estrus occurs and urine for at least several days and sometimes even months.Normal bladder function is usually returned within approximately 18 months.However, some men will remain small in heat and possibly loss of sexual activity.If incontinence persists year, patients can use drug therapy or to consult a surgeon.
- Erectile dysfunction after radical prostatectomy caused by nerves that have been damaged or removed during surgery.Almost all the people after the operation will have problems with erection.It may be up to 1 year or 2 years until erectile function is not recovered, becauseduring surgery in men with prostate gland removed seed.
When using nerve-sparing technique males under the age of 60 years who were sexually active before surgery were more likely to return to sexual function.PDE-5 inhibitors, which includes drugs such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) or Avanafil (Stendra), may help some men regain erectile function.Other treatments for erectile dysfunction: alprostadil injection, vacuum devices, etc.
Radiation therapy for cancer of the prostate
Radiation therapy may be used as an initial treatment for localized prostate cancer, as well as - for the treatment of cancer, which was not completely removed or repeated after surgery.In advanced cancer radiation therapy is used to reduce the size of the tumor and relieve symptoms.
two main types of radiation treatment for prostate cancer:
- external beam radiotherapy;
- brachytherapy (internal radiation).
In some cases, these methods can be used for the prophylactic treatment of men with high risk for prostate cancer.
external beam radiation therapy (EBRT) uses a machine in which the radiation beam is focused directly into the tumor.The treatment lasts several minutes and is given 5 times a week for 7-9 weeks.Doctors use imaging techniques - such as CT and MRI to accurately map out what exactly the tumor cells directed beams.
most new types of DLT will allow doctors to increase the dose of radiation while minimizing damage to surrounding tissue.Higher doses of radiation can reduce the risk of cancer recurrence and increase survival outcome.Three-dimensional conformal radiotherapy (3D-CRT) uses a computerized program and a three-dimensional image of the prostate, just focusing on the tumor.
There are other methods associated with 3D-CRT:
- modulation of the radiation beam intensity therapy (IMRBT);
- guided radiation therapy (IGRT), etc.
Side effects of radiation therapy
- Fatigue is a common side effect for several months after radiation therapy.
- Complications in the gastrointestinal tract. Short - nausea and loss of appetite.Diarrhea is a common side effect and can last for the entire period of treatment.Usually it later passes, but in some patients, for many years after that may still be outbreaks of diarrhea.New 3D-CRT-methods are less likely to cause diarrhea than standard DLT.
- problems with urination. Many patients feel the need for frequent urination shortly after radiation therapy, and some patients have urgency of this problem is long-lasting.Some men may incontinence (involuntary urination), but less than with surgery.
- Erectile dysfunction . In contrast to the effects of surgery, usually immediately after radiation therapy for erectile dysfunction do not happen.Nevertheless, the risk of this complication increases gradually, for a year or more.For the treatment may help drugs.
brachytherapy (internal radiation)
Brachytherapy is used mainly for men with early stage prostate cancer (localized form).It can also be used in combination with DLT.
Brachytherapy involves the implantation of radioactive pellets ( "seeds") directly into the prostate.Implants can be permanent or temporary.
The permanent brachytherapy implanted pellets in place - for the continuation of low-dose radiation for weeks or months.
In the time of brachytherapy granules deposited and temporarily stored at the site within the catheter during the treatment session, which lasts 5-15 minutes.Catheters are then removed and pellets.The patient usually receives 2-3 procedures within 2 days.high doses of radiation can be used for temporary brachytherapy.
Side effects with brachytherapy
- Seed migration . In some cases, sperm can move (migrate).Then they usually fall into the urethra or bladder and passed out of the body through urination or ejaculation (semen after implantation during the first sexual intercourse need to use condoms).Spermatazoidov can migrate through the bloodstream to other parts of the body, but it is extremely rare and usually does not cause long-term problems.
- radiation exposure.At constant brachytherapy patient can last several weeks emit small, low doses of radiation.During this period, the patient should minimize contact with pregnant women and young children, and during sex, wear a condom.
- jump PSA .After implantation PSA seed temporarily increases or "jumps", but this is not a sign of cancer recurrence and a cause for concern.
Adjuvant radiation therapy
Radiation can facilitate the selection of patients who have found an increase in PSA levels after surgery.It may even be beneficial after surgery, if the PSA level rose.
adjuvant radiotherapy (auxiliary, sometimes prophylactic supplementing surgical and radiation techniques, drug treatment, the purpose of which is the destruction of secondary cancer tumors after removal or radiation cure of the primary tumor) is radiation therapy, which is held within 6 months after radical prostatectomy.One of the dispute: whether to use adjuvant radiotherapy after surgery in patients whose PSA level is very low, or to use other test results that indicate likely to spread cancer.Patients with poor outcome and low PSA have to weigh all the possible complications of radiation therapy.
residual radiation adjuvant radiotherapy - more than 6 months after surgery.Some studies show that the rescue radiation can be more beneficial than previously thought, even for men with aggressive prostate cancer.
Cryosurgery (low temperature effect on the focus of the disease, "controlled frostbite" operation that performs the doctor with the help of modern powerful krioustanovki, cold agent which is liquid nitrogen, with a boiling point-196 ° C. The influence of ultra-low temperature on the skin tumor necrosis causes it and replacing delicate scar Cryosurgery -. effective, affordable, safe, proven, promising method of treatment) is an alternative to the standard prostatectomy for men with localized prostate cancer who are not suitable candidates forradical prostatectomy or do not wish to apply it to themselves.It is also an alternative to radiotherapy.
cryosurgery purpose is the destruction of the entire prostate and possibly surrounding tissues.The dead cells are absorbed and rejected by the body.
Cryosurgery is usually a two-hour outpatient procedure, although some patients after it may have to stay in hospital overnight.Cryosurgery may also be used as a salvage procedure for patients undergoing radiation therapy and with early detected cancer recurrence.As a rule, it is not helpful for men with very large prostates.
Almost all patients after cryosurgery, some after radiotherapy experiencing erectile dysfunction and urinary incontinence and other complications.
Some doctors still believe that the experimental therapy, and no long-term data to compare its effectiveness with standard prostatectomy.For this reason, cryotherapy is not considered as first-line initial treatment.
androgenic (hormone) therapy and chemotherapy
Androgen therapy (otherwise - androgen suppression therapy, or hormonal therapy) uses medications or surgery to suppress or block male hormones, particularly testosterone, whichIt stimulates the growth of prostate cells.Androgen therapy - not a cure for prostate cancer, but it can help control the symptoms and progression of the disease.
Androgen therapy is usually not recommended in the early stages of prostate cancer.It is mainly used for:
- advanced (metastatic) cancer - beyond the prostate;
- cancer that has not responded to surgery or radiation therapy;
- cancer that is repeated.
Androgen therapy may also be used:
- before radiation or surgery to help shrink tumors;
- along with radiation therapy of cancer, which is likely to recur;
- before, during and after radiation therapy for locally advanced prostate cancer.
There is debate about when to start androgen therapy.Doctors do not recommend to detain her for patients with recurrent or progressive prostate cancer and begin to experience the symptoms of cancer.However, when such therapy is delayed, patients should regularly visit your doctor every 3-6 months - for close monitoring of their condition.
- Prostate cancer (prostate): causes, symptoms, diagnosis, treatment
- removal of the prostate (radical prostatectomy)
- Benign prostatic hyperplasia (BPH): Causes, Symptoms, treatment, complications
- Transurethral resection of the prostate (prostate)
- prostate biopsy
first line androgen therapy include:
- removal of both testicles (bilateral orchiectomy);
- injection with luteinizing hormone-releasing hormone (LH-RH) agonist.
Combining anti-androgen drugs with orchiectomy or LH-RH agonist is sometimes used as first-line treatment, but this approach ( "Combined androgen blockade") is controversial, and it offers several advantages over conventional methods of androgen therapy.