Prostate cancer is the most common men’s cancer and it is different from most other types of cancer. It develops slowly and can be inactive for many years.
Only a small percentage of men with prostate cancer can develop faster and in some cases may spread to other parts of the body, especially bones.
Dr. Raanan Berger – Head of the Cancer Institute, Head of Clinical Research, Medical Center, Chaim Sheba Tel Hashomer.
Prof. Jack Baniel – Head of the Urology Department (Surgery), Deputy Director of the Cancer Institute Davidof, Rabin Medical Center (Beilinson).
Prostate cancer diagnostics
Laboratory analysis of blood, including the PSA level of (prostate-specific antigen, a protein produced by the prostate gland in case of illness)
Transrectal ultrasound (TRUS) and biopsy . The procedure is performed under local anesthesia. A thin needle is carefully inserted through the wall of the anus into the prostate gland.
CT abdomen, pelvis and thorax
Bone Scan (bone isotope investigation)
There are several stages of prostate cancer:
♦ Early prostate gland carcinoma (localized cancer), the tumor is located in the prostate gland (capsule) and does not extend into the surrounding tissue or other parts of the body.
♦ Locally advanced prostate cancer – cancer cells have spread to tissues around the prostate gland.
♦ Advanced or metastatic prostate cancer – cancer has spread beyond the prostate to other parts of the body. Cancer cells can sometimes spread in the blood. Once these cells reach a new area of the body, they can continue dividing and create tumor formation called metastasis. The most common sites of spread of prostate cancer are spine bones, pelvis, hips and ribs.
In some cases prostate cancer may affect bone marrow and lymph nodes, and sometimes spreading to the lungs, brain and liver.
Prostate cancer management
Active watching, observation. At an early stage, sometimes no treatment, and doctors monitor patients for performing regular tests and inspection. Treatment begins when the disease begins to progress, and the tumor is greatly increased. Only then treatment is effective.
♦ Radical prostatectomy. Surgery, in which the entire gland is removed through an incision in the abdomen or incision between the scrotum and the anus. Performed in cases where the cancer has not spread in the body (no metastases)
Removal of the entire gland helps stop the spread of early cancer in the body and can lead to a cure. As with any surgery, with radical prostatectomy there are risks such as bleeding problems or infections. But due to present knowledge of surgeons and technology risks of such complications is very small.
♦ Laparoscopic radical prostatectomy. Endoscopic surgery in which the surgeon uses a specially designed tools inserted through small puncture 4 in the abdomen. In the body the carbon dioxide gas is supplied to fill the stomach. A tiny video camera shows the prostate gland in a larger size on the video screen.
♦ Robotic laparoscopic radical prostatectomy (Da Vinci robot)
Sometimes LRP can be carried out using a robot. Manufactured robots for laparoscopic prostatectomy machine called da Vinci ® – so this type of surgery called da Vinci prostatectomy. This operation is used only by specially trained physicians.
Operating DaVinci robot enables precision surgical manipulations to do, due to the flexibility of robotic instruments and the possibility of their turnover by 360 degrees. Instead of moving cameras and instruments the surgeon or assistant, joined robotic arms that move very delicately, stable and accurate (unlike human hands).
After radical prostatectomy in a few days set drip intravenous infusion into a vein in the arm and the tube (catheter) to drain urine from the bladder and fluids from surgical wounds. In few days catheter is removed. On the operational period the doctor prescribes pain relief and antibiotics.
Hospitalization for such operations may be 3-7 days, depending on the complexity of the operation and patient condition.
Radiotherapy – the influence on the body a high energy X-rays or electron beams to kill cancer cells. External radiation therapy is usually daily sessions from Sunday to Thursday, with a rest at the weekend. Typically, radiation therapy lasts 4-8 weeks.
Before the procedure, performed CT simulation modeling process where determined destination spot beams for irradiation. The computer program determines the exposure for each person individually.
In the treatment of prostate cancer apply conformal radiotherapy (CRT) and intensity modulated therapy (IMRT)
When conformal therapy (CRT) with the construction of 3D images, the computer generates radiation beams carefully so as to conform to the shape of the prostate gland, thereby reducing the likelihood of damage normal cells in neighboring organs such as the bladder and rectum. This reduces the side effects of radiation therapy and allows to deliver the highest possible dose to the cancer cells. This is the most effective method.
IMRT is a more complex type of conformal radiation therapy and allows the physician radiologist varied doses of radiation required different parts of the tumor.
Side effects of this procedure may be fatigue, irritation of the rectum , pain around the anus , and diarrhea. Radiation therapy can also cause inflammation of the bladder (cystitis ) , frequent urination and burning sensation when urinating. To mitigate and manage side effects must follow the recommendations of the attending physician . during this period is also important to drink plenty of liquids .
This type of radiation therapy which is named yet and internal radiation therapy or implant therapy.
There are two ways of providing brachytherapy:
♦ Low dose rate brachytherapy (Low Dose Rate). This uses the “grain” of radioactive metals, which are implanted into the tumor, slowly releasing it radiation. The particles do not udalat, but the radiation gradually disappears within six months.
♦ Brachytherapy doses of high power (High Dose Rate). This method consists of placing a tiny plastic catheters into the prostate gland. Radioactive seeds are inserted into a catheter during a certain period of time and then removed. After treatment the catheters can be easily removed and the radioactive material remains in the prostate gland.
Brachytherapy is a simpler procedure than the external radiation therapy usually includes only one session, and a simulated treatment session.
Brachytherapy may not be suitable for some men with very large prostates. Nevertheless, in some situations before brachytherapy can be assigned hormone therapy to reduce prostate size.
Side effects of brachytherapy similar side effects of radiotherapy.
Most men return to their normal activities within 1-2 weeks after treatment.
Typically, hormone therapy is prescribed before radiotherapy. This is called neo- adjuvant therapy, contributing to make radiation therapy more effective. Hormone therapy is also sometimes appointed after radiotherapy. In this case, its purpose is to decrease the likelihood of cancer recurrence.
Hormones and growth control activity of normal cells. Prostate cancer depends on the hormone testosterone. Hormonal therapy is aimed at reducing the amount of testosterone in the body. It is administered as an injection or tablets.
Precision prostate cancer treatment is drugs selected for each patient according to his DNA.
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