The treatment for prostate cancer. Surgery and therapy.
Prostate cancer is a malignant tumor that starts from the secretory epithelium of the prostate. In medicine there is
several methods of combating this disease. The choice of a particular technique depends on various factors: patient's age, degree of development and stage of severity of the tumor and presence of metastases.
Prostate cancer treatment identified in the first stage, is less dangerous and faster is treatable, so men are encouraged not to run the disease and to survey a knowledgeable person at the first suspicious symptoms.
The advantages of the radical method (operating in combination with hormonal therapy and radiotherapy) treatment of prostate cancer has not been proven, there is another method, which is called expectant management. If it is not assigned to any treatment as long as the cancer has no pronounced increase.
Expectant management is preferred for men in the elderly who have associated severe illness and vysokomehanizirovannoe slow-growing tumors. Thus not assigned to no treatment, but the patient is under constant control of a physician. Routinely performed ultrasound examination of the prostate take blood PSA levels, etc.
However, it is worth noting that even with careful selection of men with prostate cancer for this treatment to 10% of patients die.
Surgery (radical prostatectomy) is the main treatment for cancer of the male organ. For the first time this operation was completed in 1904. Radical prostatectomy – removal of the prostate gland, seminal vesicles and regional lymph nodes (around the prostate).
The operation applies only on the first stage of the cancer when the tumor is entirely within the prostate with radical prostatectomy experienced surgeon can completely remove the cancerous gland.
To make sure the cancer has not spread, the doctor performs a lymphadenectomy in the pelvic region. During this procedure removed pelvic lymph nodes, which are then examined for the presence of cancer cells.
Access to the prostate gland may be received through an incision in the lower abdomen or through the cross-section in the crotch area. After surgery, the patient inserts a catheter into the bladder. In addition, the wound itself remains a small plastic tube through which wash out the bladder. Such measures are necessary to avoid accumulation of blood clots in it.
Postoperative period usually continues for 10-15 days and is often accompanied by pain,which inhibit pain relieving drugs.
One of the most common complications of prostatectomy is impotence. Sometimes surgery leads to incontinence. In some cases, a skilled surgeon could perform surgery with preservation of the nerve bundles responsible for sexual potency, but, unfortunately, it is not always possible.
Also the removal of the prostate can cause male infertility. A rare complication of prostatectomy is disease mariona (sclerosis of the bladder neck, where the bladder completely loses its ability to contract. Such a complication is corrected by the operation of dilation of the bladder neck.
To predict the probability of development of complications an individual patient and the extent of their effects is almost impossible, so it is important to discuss with your doctor the risk surgery.
Although prostatectomy, the surgeon removes all of the prostate affected by cancer, this does not guarantee no recurrence of the tumor in the same region when locally advanced. In the case of relapse, the patient radiation therapy.
Another efficient method of treatment of cancer of the prostate is the formation orchiectomy – removal of part of the testicle. In some cases, is bilateral orchiectomy (complete removal of testicles).
The operation is carried out under local anesthesia. The advantage of this method is the lack of need for medication. But, despite this, orchiectomy currently quite rare.
Radiation therapy – the use of irradiation to destroy malignant tissue. The result of this procedure is a violation of the structure of DNA cancerous cells, they lose the ability to play, grow old and die.
This technique began to be used in the 60 years of XX century. Then with the help of this method, treated patients with early stages of prostate cancer. Currently, the first stage of the disease experts prefer surgery, and radiation therapy is used in the case where the operation is not shown or has not brought the desired result.
Two types of therapy
Distinguish between external beam radiation therapy and brachytherapy. Remote therapy – the tumor with the gamma-rays. It is an outpatient procedure and is better tolerated by patients. Unlike radical prostatectomy when carrying out a remote therapy less risk of incontinence and impotence.
The disadvantage of this method is radiation injury to the surrounding prostate tissues and organs. Primarily affects the rectum and bladderbubble. Also may develop the following complications: proctitis, cystitis, ulcer of the large intestine.
Brachytherapy (contact radiotherapy) is one of the types of radionuclide therapy in which the radiation source (isotope of radium, cesium, cobalt, etc.) is placed inside pathological changed of the prostate.
When implementing this method, 60 to 90 grains of a radioactive isotope of iodine with a special needle is placed into the parenchyma of the male organ. The procedure is performed under General anesthesia on an outpatient basis. Control the placement of seeds is carried out under the strict control of transrectal sensor.
By irradiation with the maximum dose of the tumor results are achieved several times faster with minimal impact on surrounding healthy tissue.
Cryotherapy is the destruction of malignant tumors with the use of low temperatures. The results of this method of treatment is similar to radiation therapy.
The best effect is achieved with a small volume of the tumor and in combination cryotherapy with hormonal drugs.
Male hormones (androgens) contribute to the increase of malignant cells in the prostate gland.
Hormonal therapy is used to reduce the amount of androgens in the blood of the patient. Often this treatment is used in combination with surgery.
For the treatment of prostate cancer 3rd stage experts used complete androgen blockade, i.e., the combination of antiandrogens with radiation therapy. In cancer 4th stage antiandrogens are used in combination with radiation therapy on individual and regional metastases to reduce symptoms and improve the quality of life of the patient.
Some drugs 'switch off' the production of hormones synthesized by the pituitary gland. These drugs are: leuprorelin, gecelerin, triptorelin. Injections of hormonal medications are made once in 30 or 90 days, subcutaneously or into the muscle of the abdomen.
Other hormones act by attaching to the surface of cancer cells. These hormones are anti-androgenic products administered in tablets. Such drugs include fultime and bicalutamide.
Antiandrogen drugs are taken for 14 days prior to the first injection of hormones. This prevents the sharp deterioration of symptoms after the 1st dose of hormones.
It should be noted that it is not always hormonal therapy can give a visible effect.
Testosterone is the main hormone regulating and stimulating the growth of prostate cells. However, some cancer cells develop regardless of the content of this hormone in the male body.
In this casehormone therapy may not produce the desired result, but it remains an important method in the treatment of advanced disease.
Will not result in the destruction of cancerous cells using only hormonal therapy in the treatment of the disease. In addition, side effects can be breast enlargement, erectile dysfunction, decreased libido and hot flashes.