Treatment of Prostate Cancer

Treatment of Prostate Cancer; Can Prostate Cancer be treated? How to treat prostate cancer
Medical Tutors Limited
December 23, 2019

03:00 PM

Summary
Taking a decision in choosing a treatment plan for most prostate cancer cases is a personal decision that needs time and proper sensitization.

Taking a decision in choosing a treatment plan for most prostate cancer cases isn’t one to be taken in an indecisive manner due to the fact that most prostate cancers are found in the early stages thus causing a slow growth. During this time, it is important to seek advice from a doctor about the risks and benefits of all treatment options and when treatment should begin. This discussion would help to address issues regarding the current state of the cancer; PSA level; health history; other related medical conditions and also check if the cancer hasn’t spread to other bones.

Although treatment recommendations would depend on these factors, there are some general steps for treating early-stage and locally advanced prostate cancer.

Treatment Options for Prostate Cancer

Depending on various prostate cancer cases, treatment options for prostate cancer might include:

  1. Active Surveillance and Watchful Waiting (Observation Surveillance)

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, doctors recommend active surveillance or watchful waiting.

  • Active Surveillance:Due to the fact that many prostate cancers grow slowly and cause no symptoms or problems, many men consider delaying cancer treatment rather than starting treatment immediately. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin with surgery or radiation therapy.
  • Watchful Waiting:Watchful waiting could be an option for much older men and those with other serious or life-threatening illnesses who are expected to live less than 5 years. With watchful waiting, routine PSA tests, DRE, and biopsies are not usually performed. Whenever a patient develops symptoms from the prostate cancer, such as pain or blockage of the urinary tract, then treatment may be recommended to relieve those symptoms. Men who start on active surveillance who later have a shorter life expectancy may switch to watchful waiting at some point to avoid repeated tests and biopsies.
  1. Surgery

Surgery involves the removal of the prostate and some surrounding healthy tissue during an operation. There are various types of surgery and each depends on the stage of prostate cancer, age, and the overall health of the man.

Surgical options include:

  • Radical (Open) Prostatectomy:A radical prostatectomy is the surgical removal of the entire prostate and the seminal vesicles. This operation has the risk of affecting sexual function or causing urinary incontinences.. To help resume normal sexual function, men can receive drugs, penile implants, or injections. Sometimes, another surgery might be needed to fix urinary incontinence.
  • Robotic or LaparoscopicProstatectomy: This type of surgery is possibly much less invasive than a radical prostatectomy and may shorten recovery time. A camera and instruments are inserted through small keyhole incisions in the patient’s abdomen by the surgeon who directs the robotic instruments to remove the prostate gland and some surrounding healthy tissue. Although, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects can be similar to those of a radical (open) prostatectomy.
  • Bilateral Orchiectomy: This is the surgical removal of both testicles.
  1. Radiation Therapy

Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in the following ways:

  • External - Beam Radiation Therapy (EBRT): External-beam radiation therapy is the most common type of radiation treatment. Here, a machine is placed outside the body where a beam of x-rays is focused on the area with the cancer. In a situation where a person receives a higher daily dose of radiation therapy given over a shorter period instead of lower doses given over a longer period is called hypo fractionated radiation. This is usually used when:
  1. Men with low-risk prostate cancer who need or prefer treatment instead of active surveillance.
  2. Men with intermediate or high-risk prostate cancer receiving EBRT to the prostate, but not including the pelvic lymph nodes.

Note: People who receive hypo fractionated radiation therapy may have a slightly higher risk of some short-term side effects after treatment compared with those who receive regular EBRT. This can include gastrointestinal side effects.

  • Brachytherapy: Brachytherapy (i.e. internal radiation therapy), is the insertion of radioactive sources directly into the prostate. These sources, called seeds, give off radiation just around the area where they are inserted and may be left for a short time (high-dose rate) or for a longer time (low-dose rate).

Brachytherapy may be used with other treatments, such as external-beam radiation therapy and/or hormone therapy.

  • Intensity - Modulated Radiation Therapy (IMRT): IMRT is a type of external-beam radiation therapy that uses CT scans to form a 3D picture of the prostate before treatment. A computer uses this information about the size, shape, and location of the prostate cancer to determine how much radiation is needed to destroy it. With IMRT, high doses of radiation can be directed at the prostate without increasing the risk of damaging nearby organs.
  • Proton Therapy: Proton therapy, also called proton beam therapy, is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.

Note: Radiation therapy may cause side effects during treatment, including increased urinary urge or frequency; problems with sexual function; problems with bowel function, including diarrhea, rectal discomfort or rectal bleeding; and fatigue. Most of these side effects usually go away after treatment.

  1. ADT (Androgen Deprivation Therapy) / Hormone Therapy

Due to the fact that prostate cancer growth is driven by male sex hormones called androgens, lowering the levels of these hormones can help slow the growth of prostate cancer. The most common type of this androgen is called testosterone. Testosterone levels in the body can be lowered either by surgically removing the testicles, known as surgical castration, or by taking drugs that turn off the function of the testicles, called medical castration.

ADT or Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy, which can increase the likelihood that radiation therapy will be successful.

Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain.

  1. Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.

Chemotherapy may be a treatment option for men with prostate cancer that has spread to remote body locations. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

  1. Cryosurgery (Cryotherapy or Cryoablation)

Cryosurgery or Cryoablation involves freezing tissue to kill cancer cells. Here, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.

  1. Biologic Therapy (Immunotherapy)

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. Sipuleucel-T is a type of biologic therapy used to treat prostate cancer that has metastasized (spread to other parts of the body).

This treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer, and then injects the cells back into your body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple treatments.

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