Prostate cancer is being treated successfully! Types of operations for the disease
Malignant tumors of the prostate cells lead to a serious disease of men, treatment of prostate cancer can be carried out by various methods - from surgery to folk remedies. It is important to notice the signs of the disease in time and be observed by a doctor in order to minimize the risk of complications. In advanced stages of prostate cancer, it is difficult to achieve full recovery if the body already has metastases.
What is prostate cancer?
According to a medical definition, prostate cancer in men is an oncological disease of the prostate gland in men. It enters the organs of the reproductive system, serves for the partial production of seminal fluid, participates in the process of ejaculation and retention of urine. The presence of malignant tumors in the prostate gland leads to cancer. It affects men over the age of 55.
Today, prostate cancer occupies a leading position among male oncological diseases around the world. The peculiarity of its course is the slow development without noticeable symptoms. To exclude the risk of complications, men after 45 years of age are regularly advised to undergo an examination with andrologists and take tests. Early detection of prostate cancer will give you a better chance of recovery.
Is prostate cancer treated?
A possible diagnosis of a prostate tumor is based on the following symptomatic signs:
- pain when emptying the bladder, difficulty in the process,
- sexual disorders, erectile dysfunction.
Such symptoms are similar in cancer with a benign tumor (prostate adenoma) and hyperplasia (enlarged prostate). The difference in a malignant formation is the ability to disrupt an erection when it affects the nerves and reduce sperm volume due to blockage of the ejaculatory channel. In the later stages of prostate cancer, blood in the urine, painful sensations throughout the body are noticeable. With the formation of metastasis, the back and legs hurt; development occurs in the liver, adrenal glands, lungs, and bones.
The fourth pathological stage of cancer requires long-term serious treatment, but even here the doctors are not sure of a favorable prognosis. Risk factors for oncology are:
- genetic predisposition
- bad ecology,
- the problem of malnutrition - a large number of taken meat, milk, eggs,
- progressive adenoma.
To prevent the occurrence of prostate cancer, doctors recommend that you follow simple rules:
- lead a healthy lifestyle, give up alcohol, smoking,
- do sport,
- include more tomatoes, cabbage, broccoli, soy, grapes,
- limit intake of foods based on animal fats and with a lot of calcium.
Types of surgery for prostate cancer
As you know, all oncological diseases are treated with an operable or conservative method. If we talk about drug treatment, then this is definitely hormone therapy, which is indicated both in the early stages of prostate cancer and in an advanced form, when metastases spread to neighboring organs and systems.
And yet, in the vast majority of clinical cases, the doctor recommends surgerywhose main task is the excision of the affected area, the destruction of cancer cells, an obstacle to their further division and spread. Additional therapeutic measures are radiation therapy and chemotherapy.
An operation is prescribed for prostate cancer after and in combination with drug treatment, observational tactics, and represented by the following surgical procedures:
- cryosurgery, i.e. the destruction of cancer cells at a low temperature,
- radical prostatectomy (removal of the prostate as an organ),
- ultrasound exposure,
- lymphadenectomy, that is, excision of foci of metastasis.
In any case, such procedures are of dubious success, although there are reliably known cases where the patient was able to achieve a final recovery.
The main factors that determine the choice of an appropriate treatment method:
- Your age and expected life expectancy,
- do you have other serious illnesses
- stage and extent of your cancer,
- Your opinion (and your doctor’s opinion) about the need for cancer treatment,
- Will the use of a topical treatment method cure cancer (or assess the benefits of this method),
- Your attitude to the side effects that are inherent in each treatment method.
It may seem to you that you should make a decision as soon as possible, but take your time, summarize and carefully study all the information. Discuss everything with your doctor. Consult a prostate cancer specialist who has studied all treatment methods well. You must weigh all the pros and cons of each treatment method, you must also think about their shortcomings, side effects and weigh all the possible risks. Only after that you should make a decision.
Prostate Cancer Treatment
Any treatment procedure begins with a diagnosis, on the basis of which a decision is made on the accepted method of treatment of prostate cancer:
- digital rectal examination - to probe the tissues of the prostate for tumors,
- transrectal ultrasound.
- blood test for specific antigens,
- biopsy and histological examination of cells,
- CT scan,
- osteoscintigraphy - to determine the degree of spread of cancer.
According to doctors, cryosurgery is one of the smallest methods for the destruction of a malignant tumor in the prostate.
During the procedure a probe with a freezing liquid is injected into the affected area, as a result of which the cancer cells first freeze briefly and then lose their activity when thawing (ability to divide) and die off.
Since cryosurgery does not require radical surgical intervention, it is the most sparing and safe in oncology practice, and it also purposefully affects the focus of the pathology without affecting neighboring tissues.
Among the indications for surgery, it is worth highlighting the following conditions of the patient’s body:
- the presence of chronic diseases that prevent the radical removal of the tumor,
- a prostate tumor of the first and second stage predominates,
- retirement age,
- low effectiveness of radiation therapy.
If the doctor prescribed cryosurgery, then each patient should approximately know what awaits him. So, the procedure is performed under general or epidural anesthesia, and its duration is 2 hours.
After the indicated time interval, the procedure can be repeated and also guarantees a stable therapeutic effect without consequences and complications.
However, the operation has its drawbacks., among which it is worth highlighting:
Such anomalies progress infrequently, however, if they prevail, the attending physician recommends corrective treatment to further relieve seizures and prevent complications. The consequences of prostate cancer surgery give hope for the patient’s final recovery.
Stages and features of the course of prostate cancer
The prostate gland is a small organ (the size of a ping-pong ball) located at the base of the bladder. Its main function is the synthesis of the secret, which is part of the sperm, and participation in the process of ejaculation.
Prostate cancer implies the appearance and increase in size of a tumor capable of rapid growth and metastasis (transfer of malignant cells to other organs and tissues). This disease can occur at any age, but in the vast majority of cases it is diagnosed in men over 60 years of age.
Prostate cancer is the third most common cancer among men in Russia after lung cancer and stomach cancer. It is found in one of fifteen men over 40 years old. Every year in the world, malignant prostate tumors are diagnosed in a million people, and about one in three of them die due to this pathology.
Why does prostate cancer develop? It is known that this is associated with changes in the hormonal background, genetic predisposition, malnutrition and the impact of some other factors, the role of which is still not fully established.
From the moment the first cancer cell appears to the development of symptoms that lead the man to a consultation with a doctor, usually several years pass. For this reason, often the patient is seen by an oncologist with a neglected, overgrown tumor that is difficult to cure.
In total, it is customary to distinguish four stages of prostate cancer:
- Stage 1 characterized by small tumor sizes, the absence of involvement of lymph nodes in the pathological process (cancer cells can get there with lymph flow) and the patient's well-being. As a rule, at this stage, prostate cancer is detected by chance - during the treatment of another disease of the gland. The prognosis for the life of the patient is favorable; therapy does not take much time.
- 2 stage Prostate cancer means that the neoplasm has increased in size. It can be probed - during a rectal examination (the prostate is adjacent to the front wall of the rectum, so the doctor can reach it with a finger). In this case, the symptoms of the disease are often still not manifested. Therefore, it is so important to regularly undergo a preventive examination by a urologist. About 80% of patients whose prostate cancer was diagnosed in stage 2 recover.
- 3 stage The disease is characterized by the growth of the tumor beyond the envelope of the prostate. Cancer cells are found in the lymph nodes of the pelvis and in some neighboring organs. At this point, the patient usually feels discomfort: urination is disturbed due to the deformation of the gland, pain in the perineum appears. Surgery is no longer enough to defeat a tumor, which is why oncologists often use combined tactics, combining different approaches to the destruction of cancer cells. The survival rate at this stage of prostate cancer is less than 40%.
- 4th stage implies that, in addition to the prostate, the cancer has affected distant organs or lymph nodes. Metastases can be found in bones, lungs, liver, etc. If the patient is an elderly person with severe chronic diseases, doctors will decide to abandon the operation in favor of gentle methods of therapy that will prolong the life and alleviate the suffering of the patient, although they will not help to defeat cancer .
Observation and Waiting Tactics
Since prostate cancer usually develops very slowly, some men (especially older men or those who have other health problems) may not need any treatment. Instead, the doctor can choose the so-called tactics of observation and waiting.
This means that the doctor will closely monitor (monitor the PSA level in the blood) for the cancer, but will not use any method of treatment, for example, surgical or radiation therapy. This can be a good solution if the cancer does not cause any complaints and may develop very slowly and is located in only one part of the prostate gland. If the patient is at a young age, does not have side diseases, and if the tumor grows very quickly, this method is rarely used.
Observation tactics are a reasonable decision if the patient has a slowly growing tumor, since it is not known for sure whether active treatment will prolong his life. Many men choose the tactics of observation, because, in their opinion, the side effects of treatment clearly exceed the possible benefits from it. However, others are prepared to tolerate possible side effects in order to overcome the cancer or reduce its development and / or symptoms.
Observation tactics do not mean that they will forget about you. On the contrary, the doctor will carefully monitor the development of cancer. Every three or six months, you will need to conduct PSA tests and palpation of the prostate, and a biopsy of the prostate will be required annually. If you have any complaints or the tumor begins to grow faster, you should discuss the possibility of active treatment. The weak point of the observation method - you can skip the moment when the cancer begins to sharply progress, and this can reduce the effectiveness of the treatment.
Further treatment options depend on the stage of development of prostate cancer. The main methods are:
- surgical, including transurethral resection of the prostate,
- radiation therapy - radiotherapy,
- hormone therapy
Another surgery to remove prostate cancer is a radical prostatectomy, which involves complete or partial removal of the affected gland.
If the tumor is localized exclusively in the prostate gland, then the prostate must be completely removed, thus preventing damage to neighboring organs. Neighboring tissues are also subject to partial excision in order to avoid further division and spread of cancer cells.
In surgical practice, isolated:
- transvesical prostatectomy,
- perineal prostatectomy.
The choice depends on the focus of the pathology and the spread of cancer cells, life-threatening metastases.
Cancer treatment without surgery is carried out with medication. In the treatment of the prostate gland, pathogenetic drugs are used that contribute to the restoration of impaired functions, improve metabolism, and strengthen immunity. Here are the popular drug groups:
- Aspirin - inhibits the synthesis of prostaglandins - hormone-like substances,
- Veroshpiron - inhibits the production of certain hormones,
- extracts of ginseng, echinacea, Befungin, Dorogov stimulant, ASD - adaptogens,
- Thalidomide - modulates the immune system,
- Cycloferon, Reaferon, Viferon - affect the interferon system,
- to facilitate urination - Omnic,
- antibacterial agents - Vibramycin, Unidox Solutab,
- analgesics - Paracetamol, Diclofenac, Tramadol,
- liver-supporting agents - Leukomax, Epithalamin,
- for relieving neuropathic pain - Lyrics,
- homeopathy - Hepar sulfur.
In the drug treatment of prostate cancer in the elderly, several other drugs are used that reduce the production of testosterone and androgen:
- Buserelin Depot,
- Estracyte - injection,
To date, information about this progressive technique is mostly theoretical, and US scientists continue their clinical studies of the likely treatment of prostate cancer without surgery.
The procedure itself consists in the use of special ultrasound equipment with focused ultrasound of high intensity. High-frequency waves get to the focus of the pathology, as a result of which the affected tissues are heated and their further destruction. This method is especially effective in treating prostate adenoma.
The operation lasts up to three hours, but at low efficiency its repeated execution is strictly possible according to indications. The cost of surgery for prostate cancer can vary within a few thousand dollars, and this is without a rehabilitation period, for which you need to pay separately.
Indications for prostate cancer surgery
Before deciding to operate on a patient, the doctor collects an anamnesis, assesses the location, structure of the lesion, symptoms and age of the patient. If the disease is in the initial stage (1 and 2), then it will be enough to conduct therapy by irradiation, without resorting to surgical intervention.
Before deciding to operate, the doctor collects an anamnesis
As a rule, men begin to sound the alarm when the situation goes beyond the bounds of simple discomfort and takes on the size of a global problem. This indicates that capsule infiltration has occurred (the tumor has gone beyond its limits). The main indications for surgery to remove prostate cancer are:
- stopped cancer, i.e. the tumor was localized in one or both lobes of the prostate,
- difficulties in the outflow of urine, indicates the development of stage 3 cancer,
- acute prostatitis with complications,
- kidney damage
- neglected stage, which does not suggest another method of treatment.
Prostate cancer in stage 3 is subject to immediate removal and surgery, otherwise rapid cell division will lead to the spread of metastases to nearby organs.
Surgical treatment is orchiectomy for prostate cancer, which is the removal of the testes responsible for the production of testosterone from the pelvic area. The procedure is used for patients with metastases, has a quick effect. The benefits of prostate surgery include an effective clinical result, an instantaneous decrease in testosterone production without increasing blood prolactin levels.
The following varieties of surgical intervention in the prostate gland are distinguished, characterized by the result and complexity:
- bilateral total - complete removal of the organ, does not always reduce testosterone to castration values,
- radical prostatectomy - localized removal of the prostate, an endoscopic intervention is a less traumatic method, after which the patient is guaranteed 10-15 years of life,
- subcapsular epididymorchiectomy - when it does not remove the protein coat and appendage, the procedure is more acceptable for cosmetic reasons.
Indications and contraindications for intervention
An operation to remove prostate cancer is indicated for a locally advanced tumor, that is, if the carcinoma has grown no further than the tissue around the gland and has not affected neighboring organs.
Intervention is contraindicated in such conditions as:
- bleeding disorders
- severe respiratory and cardiovascular failure,
- common infections
- purulent-inflammatory foci in the region of the anterior abdominal wall.
Radical prostatectomy is not recommended if:
- the expected result is not better than with conservative therapy (life expectancy less than 10 years),
- low probability of cure (the tumor grows in the seminal vesicles, there are metastases in the lymph nodes).
Endoscopic prostatectomy also has its limitations. It is not recommended in situations where access to the organ may be difficult:
- for obesity
- gland volume up to 20 ml and more than 80 ml,
- radiation therapy, brachytherapy,
- surgery on the prostate, for example, transurethral resection for benign hyperplasia.
If the patient has plans for childbearing, sperm must be handed over and frozen before prostatectomy; after the intervention, fertility is lost.
Laparoscopic technique is especially popular. The procedure consists in performing two small incisions through which a video camera and a medical instrument are passed, that is, the progress of the operation is fully visible on the screen.
Laparoscopy has its advantages and disadvantages. Among the positive aspects, doctors say low risk of injuries, minimal complications and preservation of adjacent healthy tissues. The main drawback is that the operation can be safely compared with complex jewelry work.
In any case, after prostate cancer surgery long rehabilitation period required and specialist control at the dispensary.
The following methods of radical prostatectomy are available.
- Radical prostatectomy with access above the pubic bone
Most surgeons choose this method. The incision is made in the lower abdomen. The patient is under general anesthesia (euthanized) or he has been given medications that make the lower body insensitive (epidural anesthesia) and sedatives.
First, the doctor removes the lymph nodes near the prostate and sends them to the laboratory, where they are examined under a microscope. If cancer cells are found in one of the lymph nodes, this means that the cancer has already spread beyond the prostate gland. Since surgery can no longer cure cancer, the doctor may decide not to continue the operation.
The nerve, which is responsible for erection, is very close to the prostate gland. Sometimes during the operation it is possible to maintain this nerve (this is called the method that spares the nerve). This reduces, but does not completely reject, the possibility of impotence (inability to achieve an erection) after surgery. If you still have the ability to have an erection before surgery, your doctor may try to preserve this nerve. Of course, if the cancer has already touched this nerve, then the doctor must remove it. Even if you manage to maintain the nerve, it may take many months after the operation before your ability to erect is restored. This is due to the fact that during the operation, the nerve is still slightly affected, and for some time it is not able to function normally.
- Perineal Radical Prostatectomy
During this operation, the surgeon makes an incision in the perineum - in the space between the anus and scrotum. This method does not allow you to remove the lymph nodes and save the nerve. Since this operation requires less time than the above, it can be performed in men who do not need to preserve the nerve or in those who have other health problems, because of which it is difficult to transfer the operation of the first type.
The operation with access to the pubic bone lasts from about one and a half to four hours. Perineal surgery requires less time. After the operation, it is necessary to spend about three days in the hospital; you can get to work in about three to five weeks.
Usually, after surgery, a tube (catheter) is inserted through the penis to urinate. This is done while you are still under general anesthesia. The catheter remains in the bladder for one to three weeks and during the cure period will help urine to drain. After removing the catheter, you can lower your urine yourself.
- Laparoscopic radical prostatectomy
Both of the above methods of surgical intervention are “open” methods, since the doctor makes a longitudinal incision in the skin to remove the prostate. The latest technology allows the surgeon to make only small incisions and use special long instruments to remove the prostate. This is called laparoscopic radical prostatectomy, and this method is being used more and more often.
Advantages of laparoscopic surgery: slight bleeding, less pain, short hospital stay, short postoperative period. With laparoscopic surgery, you can save the nerve that is responsible for erection, this operation can cause the same side effects associated with nerve damage, as well as the operation of the "open" type.
- Transurethral resection of the prostate
Transurethral resection of the prostate is performed in order to reduce problems (for example, problems with urination) in men whose other operations are contraindicated. This method does not cure or completely remove the entire tumor. This method of surgery is usually chosen to alleviate the problems of patients with benign prostatic adenoma.
During the operation, a special instrument is inserted into the urethra through the penis, at the end of which there is a wire loop. This wire is heated, and with it, that part of the prostate gland that presses on the urethra is removed. With this operation, large incisions are not made on the skin. During surgery, spinal anesthesia is used (the lower body, starting at the waist, becomes insensitive) or general anesthesia (anesthesia).
The operation lasts approximately one hour. Typically, the patient is discharged from the hospital within one to two days after surgery, you can go to work after about one to two weeks. After surgery, a tube (catheter) must be inserted into the urethra for urination, which remains there for two to three days. Some time after surgery, a slight admixture of blood may appear in the urine.
Risks and side effects of radical prostatectomy
Any prostate cancer surgery can have different risks and side effects.
This surgery may have the same surgical risk as any other surgery. Problems with anesthesia, a slight risk of a heart attack, stroke, blood clots in the legs, infection and bleeding may occur. What complications you can expect depends on your age and the general state of your health.
The most significant adverse events after radical prostatectomy are urinary incontinence (incontinence) and inability to achieve an erection (impotence). But the same side effects can cause other methods of treatment.
Urinary incontinence Urinary incontinence means that you cannot control the leakage of urine or you constantly have a small flow of urine. There are different types of urinary incontinence. If you have such a problem, then it can affect both your physical and emotional state.
- Stress incontinence is the most common type of urinary incontinence after prostate surgery. In men with stress incontinence, urine leakage can occur when coughing, exercising, laughing or sneezing.
- Incontinence with a crowded bladder - in this case, men urinate for a long time, urine flows in a weak stream and for a long time.
- Urgent incontinence or overactive bladder is a sudden and unstoppable need to empty the bladder, having no way to control this process. The need to empty urine depends on the volume of urine in the bladder.
In rare cases, a man may lose all ability to control bladder function. This is called persistent incontinence.
In most men, the ability to fully control bladder function is restored within a few weeks or months after surgery. The doctor cannot anticipate your body's reaction to surgery.
If you have urinary incontinence, tell your doctor. Your doctor should get information about your problems and help you solve them. There are special exercises that help strengthen the muscles of the bladder. Urinary incontinence can be prevented with medication or surgery. There are also many hygiene products that will make you feel dry and comfortable.
Impotence - the inability of a man to achieve a sufficiently strong erection for sexual intercourse. During surgery or radiation therapy, nerves that are responsible for erection can be damaged. Within 3 to 12 months after the operation, you may have problems with an erection, and you cannot achieve it without the help of medications. In most boughs, this ability is later restored, but in some men this problem may persist longer. The ability to erection is also associated with the age and type of surgery you have performed. Men at a young age are more likely to recover.
If you are concerned about possible erectile dysfunction, discuss this with your doctor. There may be ways to help you. There are various medications and devices, for example, vacuum pumps or penile implants.
Sterility During radical prostatectomy, the ducts that connect the testicles (which produce sperm) to the urethra are cut. This means that a man cannot become a father naturally. This usually does not matter much, since prostate cancer develops in older men. But if it matters to you, before the operation, discuss with your doctor the opportunity to donate your sperm to a “sperm bank”.
Lymphedema If the lymph nodes located next to the prostate gland are removed during surgery, lymphedema (increased accumulation of lymph) can occur, it causes burning and pain. Lymph nodes provide the flow of excess fluid from the organs of the body back to the heart. After removal of the lymph nodes, excess fluid can accumulate in the legs and in the genital area. Most often, lymphedema is treated with physiotherapy, but it may not completely disappear.
Penis length changes Another side effect of the operation is that the penis may contract.
Radiation therapy is a treatment method in which high-energy rays (for example, x-rays) are used to destroy or weaken cancer cells. Irradiation can be carried out from a source that is outside the body (external radiation), or from radioactive materials that are injected directly into the tumor (internal radiation or brachytherapy).
Radiation therapy is sometimes chosen as the first treatment for low-grade prostate cancer, which has not yet spread beyond the prostate and only affected surrounding tissue. Sometimes this method is used when not all tissues damaged by cancer are removed during surgery or when cancer recurs after surgical treatment. Radiation therapy has the same probability of healing as the use of surgical therapy. If the cancer is already in advanced stages, radiation therapy can help reduce tumor volume and pain.
Types of surgical treatment for prostate cancer
Several methods of treating prostate cancer are known to medicine: radical, laporoscopic, nerve-saving prostatectomy and prostate surgery using a robot. The choice of the most suitable should depend on what stage the cancer is at, the location of the lesion and the general condition of the patient. However, as practice shows, the operating method is selected based on the doctor’s specialization in one or another form, as well as the availability of necessary equipment in the clinic.
Prostate cancer surgery is carried out in two ways: postadilatous prostatectomy and perineal prostatectomy. The first option is carried out with a large spread of metastases and involves an incision in the lower abdomen with dissection of the bladder.
Perineal prostatectomy is operated on through the perineum. With this method, the surgical process itself and subsequent rehabilitation are faster and easier.
Treatment for prostate cancer can be done with radiotherapy - remote radiation exposure. It runs on linear accelerators using a computer.An individual approach to cancer treatment minimizes all side effects. After irradiation, the patient is prescribed medication, hormone therapy is performed. To increase life expectancy, a diet is prescribed.
Most often malignant a prostate tumor spreads its metastases to the pelvic lymph nodes, which will also need to be removed. This is precisely for these purposes that lymphadenectomy is used, which can be open or closed (when two incisions are made).
If an open lymphadenectomy is performed, then one incision is performed in the lower abdomen using a laparoscope, and the second on its lateral surface. First, a tube is inserted to fill with abdominal gas, then a manipulator for surgical operations and a video camera with a light for observation.
Preparation for surgery
Before RPE consultation of the therapist, anesthetist-resuscitator is mandatory. It may be necessary to examine other specialized specialists, it all depends on the chronic diseases that the patient suffers from. Before visiting doctors, it is advisable to write down all the medications that are constantly taken by patients - practice shows that at the reception many are "lost", unable to recall the full list of medicines. In the list of funds you need to include herbs, dietary supplements, if they are regularly used.
On the evening before surgery, you need to cleanse the intestines. For this, the patient is either given a special drug, or an enema is given. In the evening, in the area of future manipulation, they shave off their hair. At night, a sedative drug is prescribed.
The intake of solid food should be stopped 6 hours before the alleged intervention, water - 2 hours.
In the morning, without getting out of bed, put on compression stockings (they should be prepared in advance).
Immediately before the operation, an antibiotic and a sedative (sedative) are injected.
External radiation is similar to an ordinary x-ray, but it lasts much longer. Each exposure session lasts only a few minutes. Usually outpatient in the period from seven to nine weeks spend five sessions per week. The treatment itself is quick and painless.
At present, external irradiation is chosen much less frequently than before. The latest technology allows the doctor to more successfully treat the prostate gland itself without exposing the surrounding healthy tissue to radiation. These methods can improve the effectiveness of treatment and reduce side effects.
The use of extremely cold temperatures is used in the treatment of prostate cancer. Tumors in the tissues are frozen and destroyed. A cold application is used to treat relapses. In cryotherapy of the prostate, a very thin probe or needle made of metal is inserted into the prostate through the incision between the anus and the scrotum. To protect the urethra, a warm saline solution is fed simultaneously through the catheter.
Ultrasound is used during the process - the surgeon looks at the screen, delivers liquid nitrogen or argon gas inside, freezes the cancerous tissue. By removing heat from the prostate gland, the cell membranes rupture, the cells die. After tissue destruction, white blood cells remove dead residues, additional immunotherapy is activated. Prostate cryotherapy has advantages in the form of a non-invasive nature, the absence of general anesthesia, less blood loss, faster recovery, less swelling.
Prostate Cancer Overview
The cost of prostate cancer surgery is determined by the medical center individually. Much depends on at what stage the cancer is diagnosed, and whether metastases are present in the diseased body.
The danger of diagnosis is that a man for a long time does not realize the course of the pathological process, and learns about it too late - when a malignant tumor must be removed along with the affected gland.
That is why, in order not to be interested in the prices of prostate cancer surgery in the future, it is important today to think about preventive measures and make them an integral part of your usual life.
In this video you can see how a radical prostatectomy is performed by the laparoscopic method - the main technique for treating prostate cancer:
The prostate is closest to the bladder, so metastases can spread to it in the first place. Check out the first signs of cancer of this organ.
If metastases nevertheless have spread, read the prognosis for bladder cancer - what can I hope for?
Course of intervention
With prostate cancer, the principles of prostatectomy are the same for any technique:
- a catheter is inserted into the bladder,
- access the gland, followed by its isolation from the surrounding tissues,
- cross the urethra,
- the prostate is separated by a single block with seminal vesicles,
- on the catheter, the urethra is sutured to the bladder, the catheter is not removed,
- drainage is installed in the area of operation - thin tubes for the outflow of wound.
Depending on the results of the preliminary examination, the pelvic lymph nodes may be removed or left intact. If the patient was able to have sex before surgery and allows the size of the tumor, during the prostatectomy they preserve the neurovascular bundles in which the cavernous nerve passes in order to maintain erectile function in the future.
Possible side effects of external exposure
Possible side effects of external exposure are the same as when irradiating other organs. Using the latest treatment methods, the risk of side effects is also reduced.
- Disorders of the intestines. In the period of external exposure, as well as some time after the treatment, you may have diarrhea, an admixture of blood in the feces, fecal incontinence (it is very rare) and irritation of the colon. Most of these problems disappear over time, but in some cases, after the end of therapy, bowel function does not return to normal.
- Bladder problems. It may be necessary to lower urine more often, pain during urination and a slight admixture of blood in the urine may appear. Bladder functioning problems occur in one in three patients. Most often, there is a need to often lower urine.
- Urinary incontinence. Urinary incontinence means that you cannot control the functioning of the bladder or you are leaking urine. In the case of radiation therapy, urinary incontinence is much less common than after surgical treatment. For more information on urinary incontinence, see the section on side effects of surgery.
- Impotence. Impotence means that you have problems with an erection, and you may have problems in your personal life. After radiation therapy, impotence is as common as after surgical treatment. Usually it does not appear immediately during therapy, but builds up gradually over several years. The same process is observed after surgical therapy. If you are in old age, it is more likely that you will have problems with an erection. These problems can be solved with the help of medications and various devices (see the section on surgical therapy).
- Fatigue. Radiation therapy can cause fatigue and weakness. This can last even several months after the end of radiation therapy.
- Lymphedema. Accumulation of excess fluid in the legs or genitals (see the section on side effects of surgical therapy) can occur if the lymph nodes die during radiation therapy.
Laparoscopic prostate cancer surgery
Laparoscopy is a very popular type of surgical intervention related to less traumatic. Used in cases where the patient was diagnosed with a tumor in the tissues of the prostate. This method is good because it does not require cavity sections. Access to the affected area is via the abdominal wall. It is enough to make 2-3 small punctures for the introduction of laparoscopic instruments and an illuminated optical device. The camcorder displays a picture on the monitor to monitor the progress of the cancer operation.
Laparoscopic prostatectomy has many advantages: the risk of infection, minimal blood loss, the absence of an unaesthetic suture, and quick recovery are reduced. Of the shortcomings, rather for the doctor, the complexity of the procedure itself is considered. The surgeon must have extensive experience in conducting such operations.
Laparoscopic prostate cancer surgery
A subsection of radiation therapy is the treatment of prostate cancer with brachytherapy. This variety belongs to the low-energy type. The essence of the procedure is implantation of small radioactive devices - “seeds” into the prostate gland tumor. They are introduced through the skin of the perineum with a special needle, work inside the prostate for several months, constantly radiating.
The advantages of prostate brachytherapy include minimal invasiveness, state of conservation of the organ, accurate delivery, the ability to dose radiation, reduce the likelihood of impotence, and quick recovery. Side effects of the procedure are discomfort during urination, to solve the problem, you can install a catheter for up to a month. Brachytherapy may be combined with external radiation therapy.
Selecting a Country for Prostate Cancer Therapy
As you know, the oncological branch of medicine is very developed in many countries of Asia and Europe. But the best choice is Israel. This is due to the high level of health care, which is controlled by the state, and at the same time relatively low prices (30-50% lower than in America and Europe).
However, organizing a trip for treatment in Israel on your own is not easy. Especially considering that you can not lose precious time. The Top Ichilov Clinic is ready to take on the entire organization of the trip: the staff themselves will purchase tickets, provide a transfer, offer convenient accommodation options, including near the clinic, arrange consultations and examinations, and help throughout the treatment. And it’s possible to go to Israel for treatment as soon as possible after contacting the “Top Ichilov”.
Another advantage of the clinic is the availability of modern high-tech equipment and, as a result, the high accuracy of cancer diagnosis. Top Ichilov’s specialists, including professors, presidents and board members of professional associations in Europe and the USA, are attentive to each patient and are ready to continue the accompaniment after completing the course of treatment. The team of specialists "Top Ikhilov" has doctors of various profiles who have achieved high results in their field.
Internal exposure (brachytherapy)
For brachytherapy with a low dose of radiation, radioactive microcapsules are used (each about the size of a grain of rice), which are injected into the prostate. These capsules are also called "grains." Since they are very small, they do not cause discomfort, and after treatment they are often left in the prostate.
In practice, short-term brachytherapy or high-dose brachytherapy are also used. In this case, needles are used with which soft tubes (catheters) are inserted. For 15 minutes, material with strong radioactive radiation is introduced into these tubes, then it is removed. During this treatment, you must stay in the hospital. Usually, three treatment sessions are carried out over several days. After the last session, the catheters are removed. This type of therapy is often combined with external exposure, in which the radiation dose is lower than when only external exposure is used. A few weeks after the course of treatment, you may feel pain in the area between the testicles and the anus, the urine may be brown-red.
Prostate Cancer Surgery with Da Vinci Robot
Robotic prostatectomy has gained great popularity among oncologists around the world. In technique, it resembles laparoscopy, with the only difference being that the whole process is performed not by a person, but by the da Vinci robot controlled by him. The device has built-in manipulators, a camera, a detection and control system. A robot can operate a malignant tumor alone, under the supervision of a physician. Operation with the Da Vinci apparatus is less traumatic, has a high accuracy of execution. The only disadvantage of this method is the high cost, because of which it is not available for every patient.
Da Vinci surgical robot in action
The difference between the next cancer treatment method, chemotherapy, and radiation, which destroys cancer cells in a certain area, is the effect on the whole body through the circulatory system. The option is used to detect metastases in the bones, lymph nodes, liver, lungs. Popular medications for treatment are Docetaxel and Prednisolone, their doses are prescribed by the doctor for individual indications. Side effects of chemotherapy for prostate cancer are:
- fast fatiguability,
- nausea, vomiting,
- hair loss on the head,
- changes in taste buds,
- blood cell contraction leading to infection of the body.
Before you go to the hospital, it is recommended to stock up:
- spacious soft trousers to avoid pressure on the area of the postoperative suture,
- "Seat" with filler or foam to reduce the impact on the perineum when sitting,
- urological pads or diapers - in the early postoperative period often the development of urinary incontinence (urinary incontinence).
The patient spends the first day after a prostatectomy in the intensive care unit. At this time, complaints about pain in the area of the operation are frequent - you can ask the nurse for pain medication. Another common complaint is sore throat caused by an endotracheal tube. They can be alleviated with the help of any sucking candy.
For the prevention of postoperative pneumonia, it is necessary to perform breathing exercises (a doctor will tell about them) or inflate balls.
Drainage from the area of operation is removed after the outflow of discharge is stopped.
During coughing, it is better to squeeze the incision on the stomach with a pillow - this will reduce pain.
Possible risks and side effects of internal exposure
The microcapsules introduced inside your prostate within a few weeks produce a small amount of radioactive radiation. Although this radiation is far from spreading, you should avoid contact with pregnant women and children during these weeks. You should be cautioned in other situations, for example, during intercourse you should use a condom.
About a week after the introduction of the microcapsules, you may feel pain in this area, the urine may be brown-red. There is a risk that some capsules may extend beyond the prostate, but this is very rare. Also, as with external exposure, problems may occur in the functioning of the intestines and bladder and problems of potency. If you have any problems, tell your doctor. In most cases, you can be helped with medication or other means.
Nerve-saving prostatectomy is indicated in the early stages of cancer. This method of surgical intervention is used to prevent postoperative complications. During the operation, the surgeon does not touch the bundles of nerves that control the erection.With this method, the skill of the doctor is of great importance, because it is not always possible to remove all cancer cells without affecting the nerve bundles. Also, the decision to maintain erectal function is made based on the location of the lesion. If there is a choice between its preservation and the need to prevent the growth of metastases, then the choice will fall on the last option. In the future, after surgery for prostate cancer, an erection can be restored using a prosthesis.
Drinking is recommended 3 to 4 hours after the intervention. Eating on the first day is not recommended. Perhaps increased gas formation in the intestine - if the gases escape, it means that it is restored.
On the second day after the intervention, a light diet is allowed:
- dairy products without sugar,
- steamed fish or meat
- weak broths.
Such nutrition is aimed at preventing the formation of gases in the intestines.
On 3-4 days after surgery, it is advisable to add boiled beets or steamed prunes to the diet to stimulate bowel movement. Typically, independent bowel movement occurs 3 days after a prostatectomy, if this did not happen, it is necessary to notify the attending physician.
The goal of hormone therapy is to lower the level of male hormones (androgens), including testosterone, in the blood. Androgens, which are mainly produced in the testes, contribute to enhanced growth of cancer cells. By lowering the level of androgens, prostate cancer decreases or its development slows down significantly. Hormone therapy helps control cancer, but cannot cure it.
Preparation for the operation
After diagnosing prostate cancer, the patient undergoes a series of procedures to prepare for surgery. An oncologist conducts a survey, finds out a predisposition to allergic reactions to drugs, whether the patient took any medications the day before. No later than a week before the planned operation, it is necessary to pass a complex of tests (total urine and blood, biochemical for coagulation). Next, a chest x-ray, ultrasound and ECG are prescribed. After receiving all the information about the state of health, an appropriate method of surgical intervention is selected and the patient is sent to remove prostate cancer.
Hospitalization of the patient occurs no later than two days before surgery. A surgeon and an anesthesiologist talk with him, inform about the progress of the surgical process, the postoperative period and possible complications.
The day before the operation, the patient is forbidden to eat solid food, and its last intake should be the night before.
Doctors make a prediction of cure for prostate cancer by the type of tumor aggressiveness and stage of its development. Also, the selection of therapy affects health. The early stages of cancer after removal of the prostate show an 80-90% chance of surviving for more than five years, but even if the tumor leaves an organ capsule, the disease is treatable. There are known cases of removal of a prostate tumor in patients with the third stage and exit of the neoplasm beyond the prostate, without metastases.
If the process of metastasis is already running, Western medicine can use powerful tools to control the disease. In this case, targeted exposure is used. At stages 3-4 with metastases, drug therapy, hormones or gentle chemotherapy are used. In Russia and Moscow, everything is not so rosy - half of the cases of prostate cancer occur in stage 3-4, when the operation does not give a chance for a cure.
While in bed, every 2 hours it is advisable to change the pose, move your legs. This is necessary to prevent the formation of blood clots.
Get out of bed is allowed on the first day. At first, it is better to rise gradually: first lie on your side, hang your legs from the bed, and only then raise your torso. A seam on the stomach can be supported by a pillow. The first time you may feel dizzy - this is normal.
After the doctor allows you to actively walk, you can remove the compression stockings. Then it is necessary to move, if possible, more - "walk" along the ward, the corridor. No need to set records, let the first "walks" be only to the door of the chamber, but it is desirable to rise and move as often as possible.
The catheter is removed on the 6-8th day after the robot-assisted operation and on the 9-14th day after open access prostatectomy. Until this time, urine is collected in a special urinal. In the early days, blood clots may be released from the catheter - this is normal, you need to drink more to rinse the bladder.
Hormone therapy is usually chosen in the following cases:
- in men whose surgical and radiation therapy are contraindicated,
- in men whose cancer cells have spread throughout the body, or in those who have relapsed after the initial treatment,
- in case of an increased risk of a possible cancer recurrence after therapy, this method is used together with radiation therapy,
- sometimes it is used before surgical or radiation therapy in order to reduce the size of the tumor.
Since almost all types of prostate tumors become insensitive to hormone therapy over time, they choose this method of treatment when hormonal drugs are used for a while, then they take a break, and then hormone therapy is continued again after a while (this is called intermittent treatment). This helps to avoid some side effects (impotence, deprivation of interest in sexual life, etc.).
Immediately after surgery, the patient is transferred to the intensive care unit, where his condition is monitored and assistance is provided in case of postoperative complications. The patient must comply with bed rest, so he is placed on a mobile bed. This is necessary for transportation to the place of intensive care, if necessary.
The doctor prescribes a re-collection of tests and examination using ultrasound and ECG. After a day, if the patient's well-being has not worsened, he is transferred from intensive care to a regular ward and allowed to slowly get up, without sudden movements.
Anti-inflammatory, analgesic drugs and antibiotics are prescribed as drug therapy. The patient must follow a strict diet and not eat food that can lead to constipation or flatulence.
Estimated time in hospital 7-9 days. They let go home only after checking the healing of the bladder and removing the catheter.
The rehabilitation period after prostate cancer surgery lasts 1 year. During this time, the body functions are restored, a man can lead a normal lifestyle, not forgetting the prevention of relapse. Such events include a visit to the urologist once a year and the passage of digital rectal diagnosis.
A common way to restore erectal function after surgery for prostate cancer is through sexual intercourse twice a week. Rehabilitation depends on the condition of the patient and the functions of his body.
After surgery, the patient should be tested regularly to determine PSA levels.
In some hospitals, the patient is discharged from the hospital before the catheter is removed, it is better not to prevent it - the risk of purulent-inflammatory complications increases during the stay in the hospital, as the nosocomial microflora is more aggressive than usual.
If the stitches have not been removed before discharge, they can be removed by the surgeon in the clinic, the attending physician will tell you when to do it. After removing the seams, you can take a warm bath and wash in the shower. The area of the postoperative wound should be washed with soap and water, without using a washcloth, then blot the seam line with a soft cloth.
Types of hormone therapy
There are many types of hormone therapy, including surgery or medications that lower blood testosterone or block the body’s response to androgens.
- Testicular removal. Although the removal of the testicles is a surgical operation, hormonal changes occur as a result of it. During the operation, the surgeon removes the testes, which produce 90% of androgens, including testosterone. Although this operation is quite simple and cheap, the consequences are irreversible, and most men cannot put up with it. After this operation, men mostly lose interest in sexuality and they can no longer achieve an erection.
- Luteinizing releasing hormone analogue (LHRH analogue). These medications lower testosterone levels as well as testicular removal. The LHRH analog (or agonist) is injected once a month or once every 4, 6 or 12 months. Although this treatment is more expensive, and more often than when removing the testicles, you need to visit a doctor, men still most often choose this method. After the first dose of the LHRH analogue is administered, the testosterone level rises sharply for a short time, but then decreases. This is called the flash effect. If the cancer cells have spread to the bones, then during this “outbreak” the bones may hurt. To reduce the effect of the “outbreak” several weeks before the therapy of the LHRH analogue, it is necessary to take medications - antiandrogens.
- Antagonists of LHRH. These medications significantly lower testosterone levels and do not cause a “flash” effect. However, in some men, this medication causes an allergic reaction. Therefore, it is prescribed only to those men who can not use other types of hormone therapy. The medicine is injected only in the doctor’s office. In the first month, the medication is administered every two weeks, then every four weeks. You should stay in the doctor’s office for about 30 minutes so that the doctor can make sure that you do not have an allergic reaction.
- Antiandrogens. These medicines block the action of androgens in the body. After an operation to remove the testicles, or during LHRH therapy, a small amount of androgen is produced by the adrenal gland. Antiandrogens can be used together with LHRH analogues or after removal of the testicles, then this is called combined androgen blockade to completely block the production of androgens and their action in the body. So far, experts have no consensus on whether combination therapy has advantages over any of the monotherapy.
Life expectancy after prostate cancer surgery
Everyone who has survived prostate cancer is interested in the question: How many people live who have passed through such a test? It is worth noting that life expectancy in the first 5 years depends on the stage of the disease. In percentage terms, it looks like this:
- The first stage - 93%,
- The second stage - 82%,
- The third stage - 40%,
- The fourth stage is 20%.
Sometimes a relapse of prostate cancer occurs. The operated patient should be tested regularly to determine the level of prostate-specific antigen. Exceeding it indicates the appearance of relapse. Specialists call this condition "biochemical recurrence of prostate cancer." The more health care is given, the better the prognosis for
In the first week after discharge, painkillers may still be needed, especially at night. If the pain persists even longer, you should consult your doctor.
The first 4 to 6 weeks of physical activity is limited. It is impossible:
- move energetically
- use a vacuum cleaner, remove snow,
- lift more than 4 kg.
Starting from 2 weeks you can walk along the street. 3 weeks after the operation, you are allowed to drive a car.
After 2 months, you can gradually join in everyday life, return to work if it is not associated with physical activity. From this time on, sexual activity is permitted.
You will have to follow a diet for at least a month after the operation. Spicy, pickles, smoked meats, alcohol are excluded. You need to drink 2 liters of fluid per day.
To prevent constipation, fiber must be in the food: fruits, vegetables, whole grains, bran. You can’t squeeze: if there are difficulties with bowel movements, you need to see a doctor so that he prescribes a laxative.
Problems with urination can persist for up to 2 months after removal of the catheter. Perhaps a complete lack of urges or, conversely, a frequent indomitable desire to urinate, leakage of urine, enuresis (incontinence). Usually, over time, the situation normalizes: 3 months after prostatectomy, more than 90% of men recover.
Side effects of hormone therapy
Since the hormonal level of the body changes, all means and methods - removal of the testicles, analogues and antagonists of LHRH - cause similar side effects. It could be:
- decreased sex drive,
- impotence (erectile problems),
- hot flashes (over time this phenomenon decreases or disappears completely),
- breast tenderness and growth
- decrease in bone mass (osteoporosis), which with prolonged life can lead to bone fractures,
- low red blood cell count (anemia),
- memory impairment
- muscle mass reduction,
- weight gain
- severe weakness and fatigue,
- high blood cholesterol,
The risk of high blood pressure, diabetes and heart attack also increases.
Most side effects can be prevented or treated. For example, by applying certain antidepressants, hot flashes disappear. A short course of radiation therapy for the breast prevents its enlargement. Medicines are available to prevent and treat osteoporosis. Depression is treated with antidepressants or psychotherapy. Adequate physical activity helps prevent some side effects (including rapid fatigue, weight gain) and reduces muscle and bone mass loss. If anemia occurs, it is usually mild and does not cause any problems.
How are the effects of prostate cancer on the life of a man after surgery
In most cases, the postoperative period of prostate cancer passes without serious complications. But there are cases when there are troubles in the form of:
- Scar pain
- Blood impurities in the urine when urinating,
- Acute urinary retention due to edema,
- Urinary incontinence
- Infectious complications and inflammatory diseases.
To quickly get rid of the negative consequences, experts recommend a good rest and proper nutrition, moderate physical activity and pharmacotherapy.
Incontinence Prevention Exercises
You can start doing after removing the catheter. You can “detect” the pelvic floor muscles responsible for controlling urination by trying to hold a stream of urine. If there is no effect, it is necessary to reduce the sphincter of the rectum, as if holding the gases, while it should be noticeable how the base of the penis is retracted due to the work of the accompanying muscles, including those holding urine. Buttocks and hips should remain relaxed.
|The first 2 weeks after removal of the catheter: reduce perineum muscles for 2 seconds, relax for 5 seconds. Repeat 10 times three times a day.|
|Weeks after surgery||Muscle contraction time (seconds)||Muscle Relaxation Time (seconds)||The number of repetitions per day|
|3 - 4||5||5||5 repetitions, 3 times a day|
|5 - 6||7||10||10 repetitions, 3 times a day|
|7 - 8||10||10||10 repetitions, 3 times a day|
|9 - 10||10||10||15 repetitions, 3 times a day|
|11 weeks onwards||10||10||20 repetitions, 3 times a day|
Excessive zeal, exceeding the recommended number of exercises, should not be: muscle fatigue can have the opposite effect, increasing incontinence. Muscle tissue needs time to recover.
If in the first six months it was not possible to regain control of urination, you can connect physiotherapy (electrical stimulation, magnetostimulation), medications, and if necessary, perform surgical correction.A specific technique is chosen by the doctor.
Hormone therapy discussions
Many questions regarding hormone replacement therapy have not yet been fully resolved, for example, when is the best time to start and end hormone replacement therapy. Research is still ongoing in this area. If you are offered to start hormone therapy, ask your doctor to familiarize you with the process of hormone therapy and possible side effects.
Potency recovery after surgery usually occurs within 1 - 2 years if neurovascular bundles were preserved during the intervention. Otherwise, impotence will remain until the end of life, because the innervation of the cavernous bodies is disrupted. In such a situation, prosthetics of the penis is possible.
An important role in restoring an erection can be served by self-stimulation or stimulation by a partner. As already mentioned, it is recommended to return to sexual activity (taking into account well-being) no earlier than 8 weeks after surgery. Since that time, to improve sexual function, you can take medications based on type 5 phosphodiesterase inhibitors: Viagra, Cialis, Levitra and the like (but not dietary supplements). These drugs have contraindications, so before you start using them, you need to consult a doctor.
It must be remembered that after a prostatectomy, sexual discharge is not accompanied by ejaculation, since the seminal vesicles and the prostate, which produces the liquid part of the semen, are removed.
- During surgery, injury to the rectum or ureter is possible. In this case, sutures are placed on the intestinal wall and sometimes a section of the colon is removed on the anterior abdominal wall (form a 2-stem colostomy), the damaged ureter is sutured on the catheter.
- In the early postoperative period, divergence of sutures, both skin and joints between the bladder and urethra, is possible. In such situations, reoperation is necessary.
- Prolonged immobility after the intervention can provoke thrombosis. Therefore, get out of bed as early as possible and try to move more.
- Infectious complications develop when pathogenic microorganisms enter the area of the postoperative wound. For their prevention, you must strictly follow the doctor’s prescriptions regarding taking antibiotics, and follow the recommendations for caring for the catheter, urinal and penis.
- In the late postoperative period, narrowing may occur in the area of the junction of the urethra and bladder - stricture. If urine outflow is impaired due to this, surgery will be needed to restore the normal urethral lumen.
- But the most common consequences after prostate removal in cancer are urinary incontinence and erectile dysfunction. How to deal with them was described in detail above.
Side effects of chemotherapy
Although chemotherapeutic drugs kill cancer cells, they can damage normal cells, and this causes various complications. The types of side effects depend on the medication, dose and duration of treatment. When applying the main treatment regimen, observe:
- peripheral neuropathy
- hair loss,
- nausea and vomiting (rarely)
- loss of appetite (rarely).
Since normal cells are damaged, your blood cell count may decrease. This causes the following problems:
- increased risk of infectious diseases (due to reduced white blood cell count),
- the possibility of bleeding or bruising even after minor injuries and scars (due to a reduced platelet count),
- rapid fatigue (due to a reduced number of red blood cells).
After treatment, most side effects disappear. If you experience any side effects, discuss with your doctor how to prevent them. There are many ways to deal with side effects. For example, medications are available to reduce nausea and prevent vomiting. Other medicines can increase the number of blood cells.
Fighting pain and other symptoms
This material focuses on the destruction and weakening of tumor cells or methods by which their development can be slowed down. But the main goal of treatment is to improve the quality of human life. Inform your doctor or nurse about the pain and any other problems that you encounter. They can be prevented in many ways. With the right treatment, you will feel better and you will be able to pay attention to more important things in your life.
When you need to urgently see a doctor
- the area of the postoperative suture turned red, swollen, became hard,
- the edges of the wound parted
- fluid is released from the seam,
- the temperature rose above 38, chills appeared,
- in the urine there is a lot of mucus and sediment and / or clots and scarlet blood,
- urine does not pass along the catheter, flowing abundantly past it,
- dull lower back pain
- weak stream
- have to strain to urinate
Pain Relief Medicines
Painkillers are very effective. When using medications to reduce pain caused by cancer, you don’t have to worry about their harmfulness or addiction. Drowsiness or itching may appear at first, but then they disappear. Constipation may occur, but there are different methods to prevent it. Side effects can often be prevented by changing the medication or adding another medication.
Outpatient monitoring and prognosis
After the operation, the patient remains in the oncology clinic with an oncologist or a urologist at the place of residence for 5 years. It is necessary to regularly take an analysis for the level of prostate-specific antigen:
- the first year - every 3 months,
- the second - once every 6 months,
- the third and further - once a year.
Since PSA is a protein of prostate tissue, it should not be determined after its removal. An increase in prostate-specific antigen will mean a recurrence of prostate cancer.
Five-year survival after radical prostatectomy 79 - 91%. It depends on the degree of tumor differentiation (Gleason sum), stage of oncopathology, preoperative level of prostate-specific antigen.
Biophosphonates are a group of medicines to reduce bone pain. In men who are prescribed hormone therapy, these medications slow down the development of the tumor and increase bone mass.
Biophosphonates can cause side effects, such as flu-like symptoms or bone pain. In very rare cases, these medications can cause the opposite effect and affect bone tissue.
Which of these methods is the most suitable for me?
If you have prostate cancer, you need to weigh many aspects before choosing a treatment method, namely, your age, general health, purpose of treatment, and your attitude to side effects. For example, some men cannot even imagine that they will have to put up with urinary incontinence or impotence. However, others are not concerned about possible side effects because they want to completely free themselves from cancer cells.
If you are 70 years old or older and you already have health problems, you can take prostate cancer as another chronic disease. Perhaps it does not affect the duration of your life. But cancer can cause problems that you wish to avoid. In this case, the goal of treatment is to reduce symptoms and avoid side effects caused by the medicine. Therefore, you can choose the tactics of observation or hormone therapy. Of course, when choosing treatment tactics, age should not be a decisive factor. Many men over the age of 70 will have a fairly good physical and spiritual condition, but young men sometimes have serious health problems.
If you are relatively young, it is possible that for a greater likelihood of complete healing, you will be ready to endure the side effects of treatment. In the early stages of prostate cancer, choosing external radiation, or radical prostatectomy or radioactive implants, the probability of cure is the same in all cases. But each situation is unique in its own way, and different factors can affect it.