Treatment
Once prostate cancer has been diagnosed, graded, and staged, there is a lot to consider before you choose a treatment plan. The treatment you choose for prostate cancer should also take into account your age and expected life span, personal preferences and feelings about the side effects associated with each treatment, any other serious health conditions you have, and the stage and grade of your cancer.
Surgery
The two most common prostate operations are radical prostatectomy and transurethral resection of the prostate.
Radical prostatectomy
This procedure removes the entire prostate gland plus some tissue around it. Radical prostatectomy is used most often if the cancer is thought not to have spread outside of the gland. The patient is generally put under general anaesthesia or under spinal or epidural anesthesia during the surgery.
There are two main types of radical prostatectomy radical retropubic prostatectomy and radical perineal prostatectomy. In the retropubic operation, the surgeon makes a skin incision in the lower abdomen. The surgeon can remove lymph nodes during this operation through the same incision.
A nerve-sparing radical retropubic prostatectomy is a modification of this operation. During this procedure, the surgeon carefully fells the small bundles of nerves on either side of the prostate gland. If the cancer has not spread to these nerves, the surgeon will not remove them. Because these are the nerves that are needed for erections, leaving them intact lowers the risk of impotence following surgery.
The radical perineal prostatectomy removes the prostate through an incision in the skin between the scrotum and anus.
These operations last from one to four hours. This is followed by an average hospital stay of three days and average time away from work of three to five weeks. In most cases, you will be able to donate your own blood before surgery. This blood can be given back to you during the operation, if needed.
For most patients, a catheter is inserted through the penis and into the bladder after surgery while the patient is still asleep. The catheter stays in place for 10 to 21 days and allows you to urinate easily while you are healing. You will be able to urinate on your own after the catheter is removed.
Transurethral resection of the prostate
This operation removes part of the prostate gland that surrounds the urethra. It is most often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia. The procedure is also used for men with prostate cancer who cannot have a radical prostatectomy because of advanced age or a serious illness in addition to their prostate cancer. It can be used to relieve symptoms caused by a cancer before other treatments begin. But it is not expected to cure this disease or remove all of the cancer.
A tool with a small loop of wire on the end is placed inside the prostate through the urethra. Electricity is passed through the wire to heat it and cut the tissue. Either spinal anaesthesia or general anaesthesia is used. The operation usually takes about one hour.
A catheter is inserted through the penis into the bladder after surgery. It remains in place for two or three days to help urine drain while the prostate heals. You can usually leave the hospital after one to two days and return to work in a week or two. There may be some bleeding into the urine after surgery anaesthesia used.
Cryosurgery
Cryosurgery, also called cryotherapy or cryoablation, is used to treat localized prostate cancer by freezing its cells with a metal probe. Warm saline water is circulated through a catheter in the urethra to keep it from freezing. The probe is placed through a skin incision located between the anus and scrotum, and guided into the cancer using transrectal ultrasound. The appearance of prostate tissue in ultrasound images changes when it is frozen. Spinal or epidural anaesthesia is used during the procedure.
The catheter is removed on to two weeks later. After the procedure, there will be some bruising and soreness of the area where the probe was inserted. Men usually remain in the hospital for one or two days.
Radiation therapy
Radiation therapy uses high-energy rays (such as gamma rays or x-rays) and particles (such as electrons, protons, or neutrons) to kill cancer cells. Radiation is sometimes used to treat cancer that is still confined within the prostate gland, or has spread to nearby tissue. If the disease is more advanced, radiation may be used to reduce the size of the tumour and to provide relief from present and future symptoms. Radiation usually eliminates the need for surgery. Patients who do not have a good response with radiation therapy may still have surgery at a later date.
Hormone therapy
In the early 1940s two doctors, Huggins and Hodges, won the Nobel Prize for Medicine for their discovery that most prostate cancer cells are dependent on the male hormone testosterone for nourishment.
Combination hormone therapy (CHT) means the use of two drugs to control the bodies production of testosterone. It is the most widely used of several variations of hormone therapy. CHT combines the drugs to reduce or eliminate or block the effects of the production of testosterone from the testicles and adrenal glands.
Testosterone is produced primarily by the testes (testicles), and in much lesser amounts by the adrenal glands. A combination of drugs is used to (a) prevent production of testosterone by the testicles and (b) block the cancer tumour from using the testosterone can cause a substantial reduction in the total body tumor mass of cancer in about 80 per cent of cases.
This treatment is often used of patients whose prostate cancer has spread to other parts of the body or has come back after treatment. Most evidence shows that hormone therapy works better if it is started as early as possible after the cancer has reached an advanced stage. The goal of hormone therapy is to lower levels of the male hormones, androgens.
Androgens are produced mainly in the testicles and cause prostate cancer cells to grow. Lowering androgen levels can make prostate cancers shrink or grow more slowly. But hormone therapy does not cure the cancer.
Until recently CHT was used primarily as a treatment of symptoms in late stage prostate cancer when it had spread outside the prostate capsule to surrounding tissue or the ones. However, evidence is accumulating that CHT may deserve a larger role in the management of prostate cancer.
CHT is increasingly being recommended for a few months prior to other procedures such as radical prostatectomy. Leading urologists, however, disagree on its use.
Chemotherapy
This is used for patients whose prostate cancer has spread outside of the prostate gland and for whom hormone therapy has failed. It is not expected to destroy all the cancer cells, but it may slow tumour growth and reduce pain. Chemotherapy is not recommended as a treatment for men with early prostate cancer.
Chemotherapy uses anti-cancer drugs that are injected into a vein, injected into a muscle, or taken orally. These drug skill cancer cells, but they also damage some normal cells. Sometimes, hospitalization may be needed to monitor the treatment and to control its side effect.
Watchful waiting
It is generally agreed that prostate cancer is a progressive, but slow-growing disease. It usually takes many years to determine with confidence whether prostate cancer has been cured by aggressive treatment. Therefore, following treatment patients are monitored with periodic checkups and PSA tests for progression of the disease. These periods between aggressive treatments are known as watchful waiting. Watchful waiting allows the patient and his doctor to watch for progression and make decisions about more aggressive treatment if need for such treatments is indicated by a PSA that rises too rapidly or symptoms appear.
Most men with prostate cancer die of other causes before they ever experience symptoms of the disease.
Recent studies indicate that patients of prostate cancer may do about as well in terms of survival by choosing watchful waiting instead of radical prostatectomy, or external beam radiation, the standard treatments. So a question has been raised as to when or if aggressive treatment is necessary. Watchful waiting is gaining acknowledgment as a viable first line treatment in some cases of prostate cancer, particularly when the Gleason Score is low or the patient is elderly or in otherwise poor health.
Whether or not diet can help in the prevention or cure of prostate cancer is a very difficult question to answer. In term as of prevention, the answer may be yes, but there is very little hard scientific evidence to e more certain. However, a lack of scientific evidence does not necessarily mean a lack of benefit, but simply that very little research ahs been performed in this area. There is a great deal anecdotal evidence which points to diet as benign a major factor in accelerating the disease.
Vegetarians are approximately half as likely to develop prostate cancer as meat eaters. It is not clear why this should be the case. It is not clear whether meat itself is the problem or whether a person who eats more meat is less likely to eat other beneficial foods for example.
It is observed that people in eastern countries such as India, China and Japan are far less likely than westerners to develop cancer. Also, the levels of cancer in the east are arising and this coincides with changes in lifestyle since more people are eating western style foods.
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