Prostate Cancer Surgical Treatment | Prostate Gland | Endourology Speciality Treatment | Aastha Healthcare | Super Speciality Center Hospital | India

What is prostate gland?

The prostate is a glandular organ, about size of a walnut, present in males. The prostate is normally about 3 cm long and it lies at the neck of the bladder and in front of the rectum. The prostate gland produces fluid that makes up part of the semen.

What is prostate cancer?

Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer. Prostate cancer is often a very slow-growing disease. It can take 10 years or more for a small tumor to spread beyond the gland and pose a serious threat to health.

Cancer occurs when normal cells undergo a transformation in which they grow and multiply without any control. There are four stages of prostate cancer: Stage I - In stage I, cancer is found in the prostate only. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. Stage II- In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage III- In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles. Stage IV- In stage IV, cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones.

Stages Of Prostate Cancer

What are the causes?

The cause of prostate cancer is unknown, but hormonal, genetic, environmental, and dietary factors are thought to play roles. The following risk factors have been linked with development of this condition:

Age: There is a strong correlation between increasing age and developing prostate cancer. Autopsy records indicate that 70% of men older than 90 years have at least one region of cancer in their prostate. Race: African American men are 1.5-2 times more likely than white men to develop prostate cancer. Genetic factors: Men, who have a history of prostate cancer in their family, are at an increased risk. Diet: A diet high in fat has been associated with an increased risk of prostate cancer. Chemical agents: Exposure to chemicals such as cadmium has been implicated in the development of prostate cancer.

What are the symptoms?

Prostate cancer can produce many symptoms. Some of them have been listed below. But presence of these symptoms does not necessarily indicate prostate cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur. Some of the symptoms are:

Weak or interrupted flow of urine. Frequent urination (especially at night). Trouble urinating. Pain or burning during urination. Blood in the urine or semen. A pain in the back, hips, or pelvis that doesn't go away. Painful ejaculation.

How is it diagnosed?

The doctor may perform necessary test to detect and diagnose prostate cancer. The following procedures may be used:

Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.

Digital rectal exam (DRE)

Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate). Transrectal ultrasound: A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure.

Transrectal ultrasound showing a series of prostate ultrasound images used to construct a 3-dimesnsional image of the prostate (volume study) and treatment plan. Key: Red line = prostate; Blue line = limit of radiation to be delivered

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will examine the biopsy sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread. There are 2 types of biopsy procedures used to diagnose prostate cancer: Transrectal biopsy: The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide the needle. A pathologist views the tissue under a microscope to look for cancer cells. Transperineal biopsy: The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate. A pathologist views the tissue under a microscope to look for cancer cells.

If prostate cancer is diagnosed, the other tests( e.g Radionuclide bone scan, MRI. Pelvic lymphadenectomy, Seminal vesicle biopsy) are done to find out if cancer cells have spread within the prostate or to other parts of the body.

What are the treatment options?

Treatments for prostate cancer are effective in most men. But one should remember that they do cause both short- and long-term side effects that may be difficult to accept. So you and your life partner or family members must discuss the treatment options in detail with their urologist and other physicians. It is essential to understand which treatments are available, how effective each is likely to be, and what side effects can be expected. All these must be weighed carefully before making a decision about which course to pursue.

Surgery

There are different types of treatment for patients with prostate cancer. Patients in good health are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:

Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment. Radical prostatectomy: This approach makes especially good sense for relatively healthy patients under age 65. For one thing, such men generally have the strength to handle a major operation. A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are 2 types of radical prostatectomy: Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time. Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen.

The two types of radical prostatectomy

Transurethral resection of the prostate (TURP): The standard surgical treatment for an enlarged prostate is Transurethral Resection of the Prostate or "TURP". This is sometimes called a scraping or "Roto-Rooter" of the prostate. It is the "gold standard" against which all other prostate remedies are compared. Under a full general or spinal anaesthetic, a resectoscope (a thin, lighted tube with a cutting tool) is inserted through the urethra. Under direct vision, an electric current passes through the loop, this can then carve out the channel inside the prostate. The chips or pieces of prostate tissue are rinsed out of the bladder with water. After surgery, a soft rubber tube or catheter is left in the bladder for several days to help control bleeding and allow healing to begin. This procedure is sometimes done to relieve symptoms caused by a tumour before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.

Transurethral resection of the prostate (TURP).

Bilateral Orchidectomy- Orchidectomy is a surgical procedure in which one or both testicles are removed. Testicles are sex organs in the males that produce sperms and testosterone (a hormone). It is performed under general anaesthesia. Testicles are removed through an incision in the scrotum or the groin. Some of the lymph nodes that are located deep in the abdomen or inguinal area may also be removed. Prostate cancer is known to regress after Orchidectomy, as the source of testosterone is removed.

Radiation therapy

Instead of removing the entire gland, healthy tissue and all, doctors can use radiation to target and kill the cancer cells. There are two ways to deliver the radiation. In a process called external beam radiation, a machine produces a highly focused beam of energy aimed directly at the tumour. It usually takes about five sessions a week over seven weeks to treat the tumour. Alternatively, a doctor can implant radioactive pellets or "seeds" in the tumour. This is called seed therapy or brachytherapy. Brachytherapy is a technique for treating prostate cancer, using tiny radioactive seeds of Iodine-125 (I125) that are inserted permanently into the prostate gland. 'Brachy' means close and, in this treatment, the radioactivity is inserted directly into the cancerous organ. It's a minor procedure, and most patients go home the same day it is performed. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Cross-sectional diagram of the implant process

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow.

New types of treatment

There are other new types of treatments that are being tested in clinical trials. These include the following:

Cryosurgery- Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. This type of treatment is also called cryotherapy. Because it is minimally invasive, prostate cancer cryotherapy has fewer complications than surgery. The goals of minimally invasive therapies are: To destroy the local disease To shorten hospital stay To reduce the number of postoperative morbidities To shorten recovery time To reduce the cost of the procedure

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy

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. This type of cancer treatment is also called biotherapy or immunotherapy.

High-intensity focused ultrasound

High-intensity focused ultrasound is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves.

Benefits and drawbacks

Whatever approach your doctor recommends, be sure to ask about the potential risks and benefits. And be sure to stay positive. With so many options available, most patients have a good chance of beating their disease.

TREATMENT BENEFITS DRAWBACKS Radiation Therapy The patient avoids major surgery. The recovery time is minimal. One should be able to resume normal activities within a few days. However, it is advised to lift heavy things for the first two weeks after the implant. There is little risk of serious complications, even if the patient is relatively old and sick. It can be hard on the body. Patients often feel exhausted at the end of their treatment. Up to 30% of all patients briefly suffer from other unpleasant side effects such as rectal bleeding, burning during urination, frequent urination, and diarrhoea. Roughly half of all radiation patients become impotent within two years, according to the American Academy of Family Physicians. This complication is more common with external beam radiation than with seed therapy. Radical Prostatectomy It is major surgery. Most patients have to stay in the hospital for 2-3 days, and they usually have to recuperate for a month before returning to work. The operation can also damage nearby nerves, often causing problems with urine control and erections. There are side-effects( like erectile dysfunction) associated with this operation Cryosurgery less invasive than a radical prostatectomy Not considered the first line of treatment because of uncertainity about its long-term effectiveness. Since freezing also damages nerve cells near the prostate, most men who undergo cryosurgery will be impotent. Other side effects may include blood in the urine, soreness, and swelling for a few days after surgery. Sometimes cryosurgery affects the bladder and bowels, causing pain and the urge to go to the bathroom frequently, but this usually goes away in time. Hormone Therapy The patient avoids major surgery. Many men develop enlarged, tender breasts. Other possible side effects include hot flashes, erectile dysfunction, and loss of interest in sex. Chemotherapy The patient avoids major surgery. While chemotherapy can't cure prostate cancer, it can often slow it down -- prolonging a patient's life and easing his symptoms. TURP The "gold standard' treatment- very effective surgery with little pain or discomfort Best permanent treatment for severe prostatic disease, especially if permanent damage to the bladder or kidneys has occurred. It's also appropriate where other treatments have failed to control symptoms adequately or protect the bladder and kidneys. No other treatment is as effective in relieving the blockage from prostatic enlargement Requires several days in the hospital, has a prolonged recovery period after surgery May infrequently have complications such as bleeding, infection, urinary leakage and scar tissue formation. It will cause retrograde ejaculation, which means that during sexual activity there will be no semen expelled from the penis. Instead, any semen produced will go directly into the bladder. This is not dangerous or harmful in any way and it doesn't affect sensation or enjoyment, but it's disturbing to some patients.

For more information, kindly visit : http://www.aasthahealthcare.com/Prostate-Cancer-Treatment.htm ------------------------------------