Methods of treatment of prostate cancer
Decide on the most appropriate methodTreatment of prostate cancer is not always easy to do a number of factors must be considered. The most important of these include the patient's age, general health and stage of the cancer, on the basis of which it is possible to judge the likelihood of its spread to other organs.
Since in many cases the growth of cancerous tumorsprostate proceeds slowly, the initial stage is often no need for treatment; instead it should be regular screening, to make sure the cancer has not spread to other organs. Many older men, in spite of his illness, have a chance at a normal life for quite a long time. Many people find that very difficult to accept life approach "watching and waiting", but as a rule, though it go, because side effects of treatment can sometimes be worse than the manifestation of the disease itself.
There is quite a wide choicemethod of treating cancer of the prostate: surgery, radiotherapy, hormone therapy, at least - chemotherapy. Sometimes the best results gives a combination of several methods. But in some cases, and relatively frequent, it is advisable to abandon any interference and limit the patient's regular inspection. Since this type of cancer develops slowly, for the study it takes many years; however, does not stop the test and the tests to establish the most effective treatment.
Perhaps, in the hospital, you pay attention to that,that other patients are not assigned such treatment as you. Often this can be due to the fact that their disease is manifested in a different form, but also by the fact that each doctor has their own point of view on the most appropriate treatment. If you have any questions regarding your assigned treatment, do not be afraid to ask them to your doctor or look after you nurse. To nothing to forget, make a list of your questions and take with you to talk with a doctor close friend or relative.
Some patients find that decideHis method of treatment might help an opinion about this other doctor. Most doctors are happy to refer you to a specialist if you feel that it will bring you favor.
Surgical treatment of prostate cancer
Your doctor will discuss with you the most for youa suitable type of surgery depending on the type, size and spread of the cancer. Before any operation, make sure you thoroughly discuss with your doctor all the related issues, so that you understand well what it is and what has consequences. Remember that no operation or procedure will not be carried out without your consent.
Transurethral resection (TUR)
Often there is a need in the operationalintervention for removal of the tumor, which occludes the urethra (the urethra) through which urine withdrawn from the bladder. In this case, often resort to surgery, which is called a "transurethral resection of the prostate."
This operation is usually done under general anesthesia, butsometimes used and spinal anesthesia. In this case, produce analgesia corresponding portion by injection of anesthetic into the spine, so that the patient does not feel anything during the surgery.
As it follows from the title of thisoperation, it is in the urethra (urethritis) administered through the penis tube; inside the tube is attached a special tool that allows you to eliminate clogging while advancing the tube through the urethra.
After surgery, transurethral resection
After surgery, you will be recommended as soon as possible to begin to move. Probably, during the day you'll be on his feet.
After surgery, TUR you might dointravenous infusion (with a dropper) for normal liquid contents in the body. IV will be removed as soon as you will be able to drink. The bladder will introduce you to a small tube (catheter) to drain urine into a urinal. lavage of the bladder can be carried out to prevent catheter blockage of blood clots. For this purpose, the bladder is introduced fluid is then discharged through the catheter. Gradually urine brighten, and the catheter can be removed. At first, you may find it difficult to do without the catheter while urinating, but soon everything will work out.
Sometimes you need to leave the catheterfor some time after discharge from the hospital. Before you go home, a nurse will explain to you how to handle the catheter; In addition, it is possible to agree with the district's sister, who will visit you pa home and help with any problems within its competence.
Although in a few days after surgery youYou may experience painful or uncomfortable, you can always take off thanks to the disposal of various types of very effective painkillers. If the pain you do not stop, you must as soon as possible to put notify your doctor or nurse, so that they have replaced the medication prescribed to you.
Most patients can go home 3-6days after the surgery. If you assume that at home you can meet with certain difficulties after surgery, notify your nurse or social worker, so they organized a prompt service.
Many social workers are able to not onlygive practical advice, but have also trained as consultants capable of providing greater support for both the patient and his family, both in hospital and at home. If you want to talk to a social worker, ask your doctor or nurse to arrange a talk for you
Before you leave the hospital, you will beappointed day visit to the clinic as delivered on an outpatient records, as for a certain postoperative period you will be under supervision. Thus you will be able to discuss all the problems that you will encounter after the operation.
Radical prostatectomy (complete removal of the prostate)
The second type of surgery used for cancerprostate cancer, radical prostatectomy is called. In this case we are talking about the removal of the prostate gland is surgically from the abdominal cavity. To it is resorted to only when prostate cancer metastasis has not yet given, and if the patients - young men with fairly highly malignant tumors. The consequence of such an operation can sometimes be impotence (lack of erection) and incontinence, but through the use of modern techniques of these complications is now less common. Because doctors can not predict who the operation of patients giving this complication, it is important that every patient in advance was aware of the risk linked to such an operation. Your doctor will discuss with you in detail the question of the operation, as well as talk about other forms of treatment.
After surgery, radical prostatectomy
After prostatectomy, you will be madeIntravenous catheter and introduced, optionally with bladder washing (see. the above section transurethral resection). In the stomach, you will have the wound from the incision. Probably the wound drainage tube will be inserted to drain excess fluid formed. Probably within a few days after the surgery you will feel pain, especially when walking. Regular intake of painkillers help ease the pain, if you designated drugs do not provide the desired effect, please inform the medical staff that you were replaced.
After 7-10 days after surgery you, Probably will be able to go home. If you have problems with urination, you will go home with a catheter inserted. You can also arrange to visit you at home health nurse, and in the event of any problems, you should as soon as possible contact with the doctor.
To slow the growth of cancer can bemaking operation called orchiectomy, which consists in the removal of the testicles, which leads to lower levels of the male hormone testosterone. This is not a difficult operation, and most patients can go home after 3 days of its execution. Make a small incision in the groin or in the scrotum. However, many men feel the need to undergo a huge misfortune such an operation, especially because of the possible side effects - throwing hot and impotence. Sometimes surgery may be accompanied by the insertion (attachment) plastic prosthesis mimics the shape and appearance of the testes. Often they do not as a radical operation is removed and only the inside of the testes (orchiectomy subcapsular), so eliminating the need for prosthesis.
Currently, newer methods developedhormone therapy, which can be used instead of orchiectomy, unfortunately, they give the same side effects as surgery. hormonal method described below in the appropriate section.
The method of radiotherapy treatment of cancer based onthe use of high-energy radiation that destroys cancer cells, causing the minimum possible damage to normal cells. In the case of prostate cancer is usually performed outside the irradiation, but some patients receive intracavitary irradiation.
There are two different forms of radiotherapythe case of prostate cancer: curative and palliative. How about the name suggests, it involves the first impact on the very cancer and, when possible, can achieve healing. The second is assigned for relief of symptoms, particularly to reduce pain in the bones, and improve the patient's subjective well-being. For more information palliative treatment described below in the appropriate section.
Treatment by radiation therapy is conducted inhospital setting radiotherapy in the office, as a rule, 5 sessions per week (Monday to Friday) with a break for the weekend. The duration of the course may be several weeks. This duration in each case will depend on the type, size and spread of the cancer. Your doctor will discuss with you in advance of the chosen treatment for you.
Treatment planning by radiotherapy
To ensure that a course of radiotherapybrought to the patient the maximum benefit, you need to carefully prepare for the meeting. At your first visit radiotherapy office you will be asked to lie down under the big machine, which is called the modeling device. With the help of X-rays get to be the zone treated. Sometimes, for the preparation of the treatment produces a CT scan. Treatment planning is very important, sometimes you may need to visit a few preliminary radiotherapy cabinet, before the doctor, planning your treatment, will be satisfied with the result.
On the skin of the patient is applied labels tohelp radiographers who will carry out the radiotherapy procedure put the patient in exactly the right position and to show where to direct rays. These labels must be maintained throughout the treatment period, but can be washed off immediately upon its completion. Before you start a course of radiotherapy, will explain how to follow up on the skin area to be irradiated.
Before each session of radiotherapyroentgenographer help you take the right position on the couch and make sure that you are comfortable. During the procedure, which lasts only a few minutes, you'll be in a room alone, but you can talk to radiographers who will be watching from the next room you.
Radiotherapy - a painless procedure, but during it you must lie very still for several minutes.
Side effects of radiotherapy
Radiotherapy can cause sideGeneral acts as nausea and fatigue. These side effects may be either weak or rather painful depending on the radiation dose and duration of treatment.
Nausea usually removed antiemeticdrugs that you may be prescribed by your doctor. If you do not want to eat, you can replace the usual high-calorie food nutritious drinks that are sold in many pharmacies.
The irradiation area may prostatehave adverse effects pas bladder and bowels. This can lead to more frequent as compared with the usual occurrence of urination and burning sensations. During this time, you need to drink as much liquid as possible. Frequently observed by irradiating the zone, and side effects such as diarrhea. In this case, the prescribed antidiarrheals. A positive result can also be achieved through changes in diet: eating small portions, more frequent meals, if possible, non-foods that are high in fiber, such as raw fruits and vegetables. These side effects usually affect the end of treatment and continued for about three weeks.
During the course of radiation therapy in the area of the skinirradiation may be red and inflamed. In various hospitals recommended different ways to skin care. In one department can advise do not wash this area during the course, in the other - to use only lukewarm water and pat dry gently with a soft towel appropriate site. By creams and lotions containing flavorings, suitable refuse. Before choosing any product for skin care, you need to consult with experts in radiation therapy. If necessary, your doctor will prescribe you a special cream for inflamed areas of the skin.
Because radiation therapy can cause severefatigue, you should rest as much as possible, especially if you often wake up at night or day pass is a great way to get regular radiotherapy session.
Passing the course radiotherapy for cancerprostate can cause impotence (erectile absence), as well as urinary incontinence, but this risk is much smaller than in the case of a surgical operation.
Before you assign a particular methodtreatment, your doctor will discuss with you all the possible side effects of treatment, which is likely to run into you. Make a list of your questions that you would like to ask your doctor, and take with you to the consultation, if you find this useful, relative or friend.
Most of the side effectsradiotherapy course after its completion gradually disappears, while some are still making themselves felt within a few weeks, while others may stay forever. If during treatment you have any problems, talk to the staff radiology department, they have extensive experience in monitoring of patients who are or have been in the same situation as you.
radiotherapy does not make you radioactive, you do not represent any danger to other people, including children, throughout the treatment period.
Currently, this form of radiation therapyIt is used very rarely. Under general anesthesia, a small radioactive pellet is introduced into the tumor, thereby providing slow release activity for a certain period of time. These pellets are subsequently removed from the tumor does not, but the activity gradually decays, and it represents no danger to other people.
Radiation therapy to relieve bone pain (palliative treatment)
If prostate cancer has spread tobone (metastasis), the radiotherapy can be administered to alleviate (removing) pain. Were irradiated or diseased bone, or the appropriate zone. Many patients feel some pain relief have a couple of days after the start of treatment, in other cases, it required 3-4 weeks to achieve a positive effect. If necessary, you can keep a regular intake of painkillers.
To remove the bone pain frequently radiotherapyadministered in a single session, but sometimes course divided into several long sessions less. Specialist radiotherapist will explain the principle of pre-assigned to your care and all possible associated with it, side effects.
If the spread of prostate cancernot limited to one area, then you may be assigned half body irradiation. As follows from the name of the method, it is subjected to irradiation of a vast area of either the upper or lower half of the body. Typically, this form of radiation therapy provides a fairly effective pain relief for a few days. However, such a treatment gives a more unpleasant side effects than local irradiation. Your doctor will prescribe you an antiemetic tablets and probably you will have to spend some time in the hospital. If necessary, you can later be subjected to radiation, and the second half of the body, after your condition returns to normal.
Hormone therapy in the treatment of prostate cancer
Hormones - a substance produced in the body which regulate the growth and function of normal cells.
Growth of prostate cancerIt is dependent on the male hormone testosterone. By reducing the content of testosterone in the body can be slowed tumor growth or reduce its size, and it is often the symptoms disappear completely.
The two main ways to reduce the level of testosterone - a surgical procedure or appointment of special preparations.
Testosterone is produced mainly intestes, and surgical removal of the testes (orchiectomy) leads to a reduction of the content of this hormone in the body. At present, instead of orchiectomy is often used hormone therapy.
One of the types commonly used therapy consistsin the use of drugs that "turn off" the production of male hormones in the testes. They are known as regulators of pituitary hormone levels and reduce administered by subcutaneous injection. Usually, they are administered in combination with tablets of a antiandrogen (which retard the production of hormones in testes), for example, tsinroteron acetate (Tsiprostat) or flutamide (androgens), or a new drug bicalutamide (Casodex). because it is believed that these agents are most effective when used in combination. In addition, antiaidrogeny prevent "cancer aggravation", ie a situation in which after the first dose gipofigzarnogo regulator itself symptoms temporarily worse.
The injection is usually done once a month, but inCurrently, a new injection which can be administered once every 12 weeks, and this procedure can perform as your doctor and nurse precinct.
The results of some of recenttime study suggests expediency to continue taking anti-androgen tablets during the whole course of treatment along with the pituitary hormone levels decrease regulator. This type of treatment is called complete androgen blockade.
Unfortunately, the side effects of almost allmethods of hormone therapy is the impotence (lack of erection), which is usually observed during the treatment period. Upon completion of the course, this problem usually disappears completely. Surgery can also cause impotence, but thanks to modern methods of operating it occurs less frequently. Any course of treatment may be enough to tire the patient that he is no longer interested in sex. This phenomenon is called a loss of libido (sexual desire that is), it can accompany many diseases, not just cancer. Other frequently occurring side effects of hormone therapy are not strong headache, and more rarely - nausea.
Nonsteroidal antiandrogen drugs, e.g.flutamide, who are appointed in the form of tablets without the simultaneous use of other methods of treatment, allow to keep the libido and potency in the majority of patients. These drugs are not suitable for all patients, but you can discuss this option with your doctor.
For the treatment of prostate cancer have tried to use the female sex hormones (estrogens), but is now resorting to this method is rarely because of its side effects.
After treatment is completed you willbe regularly monitored as outpatients; check will probably be to a blood test, determining the level of prostate specific antigen and X-ray examination. If you have designated in the periods between inspections are any problems, or you notice new symptoms, you should deliver as soon as possible about it to the doctor's reputation.
Possible side effects of treatment
Unfortunately, the treatment for cancerprostate may be accompanied by unpleasant and prolonged nature of side effects, so before agreeing to any treatment, it is important that you should be fully aware of its possible consequences. Clearly, the doctor can not accurately predict who is sick of the threat or that the side effects of treatment, so it is very important that you discuss in advance the degree of risk to which you are exposed.
Sexual impotence, which consists in the fact thata man is deprived of the ability to get an erection, it is extremely painful for the patient, may be affected during the course of hormone therapy. It usually is temporary and disappears after the course. The same side effects can give surgery, at least - radiotherapy.
Many men, regardless of age, believeit is very difficult to discuss these very personal matters with anyone, particularly with doctors or other medical personnel. Sexual impotence may not be permanent, and sometimes it is due not so much the application of the method of treatment as anxiety and self-doubt. In the state of some of the hospitals are provided by specially trained counselors or therapists, sexologists, who can give you useful advice and help. Some men also find it difficult to talk about it with their partners without fear of rejection; these fears are generally unfounded. At the heart of sexual relations are many things: love, trust, common experiences. Talk with your partner about your fears and anxieties. Perhaps you would benefit a joint visit to a counselor or sex therapist to discuss any questions you have.
There are practical ways to overcomeimpotence, and your doctor can give you more information about them. Sometimes in this case can benefit injection may also resort to the implantation of the implant into the penis or to the use of vacuum pumps. Remember that your doctor will most likely not had a chance to treat a patient with the same problem as you, so try not to be embarrassed and do not hesitate to turn to him for help.
It is very likely that treatment of prostate cancercancer can cause infertility, in other words, the patient after the treatment loses its ability to be a father. With such a consequence it is very difficult to reconcile, especially if you are hoping to have children in the future. Therefore, you and your partner is important to discuss this unpleasant prospect of a doctor before you start treatment.
Loss of bladder control can bedue to both the cancerous tumor, or surgery and radiotherapy for prostate cancer. In recent years, great progress for the elimination or prevention of side effects have been achieved, and there are different ways to solve the aforementioned problem. Feel free to discuss any question you are interested with your doctor or nurse. In some hospitals there are medical personnel, especially trained to advise on the problems of incontinence.
It is important to stress that these problems occurnot all men. Ask your doctor all your questions regarding your treatment and its side effects, so you'll be prepared for the challenges that may stand in front of you.