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Prostate Cancer Treatment
The treatment of prostate cancer is complex and
depends on a multitude of issues that includes the grade and stage of
the cancer along with the age, overall health and the type of treatment
that the patient is comfortable with. For elderly men who may have a
slow growing tumor or a low life expectancy the treatment may just be
watching and waiting, along with keeping the man comfortable. There are
three type of treatment for prostate cancer that includes surgery,
radiation therapy, and hormone manipulation.
Surgery:
Surgery for prostate cancer includes several types of prostatectomies.
For men in the early stages of the disease the cure may be as easy as
having a prostatectomy. There are four types of prostatectomies.
• A radical prostatectomy involves removal of the prostate, prostatic
capsule, seminal vesicles, and a portion of the bladder neck. Many men
experience varying degrees of urinary incontinence and erectile
dysfunction.
• A retropubic prostatectomy is most often performed because it allows
adequate control of bleeding, visualization of the prostate bed and
bladder neck, and access to pelvic lymph nodes.
• A perineal prostatectomy is often the preferred choice for older men
or men who might be poor surgical risks. This approach takes less time
and there is less bleeding.
• A suprapubic prostatectomy is used if problems with the bladder are
expected, but otherwise is seldom used. It is more difficult to control
any bleeding because the surgical approach is through the bladder.
Radiation:
If the cancer is stage 3, or locally advanced beyond the prostatic
capsule, treatment by surgery becomes somewhat controversial because of
the likelihood of hidden lymph node metastasis and relapse. A
prostatectomy, if performed, is used to help relieve urinary
obstruction, but not to treat the cancer.
Radiation therapy may be used as a primary treatment for prostate
cancer. Long term problems of impotence and urinary incontinence may be
avoided and survival rates are comparable to that of surgical treatment.
Radiation may be delivered either by an external beam or interstitial
implants of radioactive seeds of iodine, gold, palladium, or iridium.
Interstitial radiation has a lower risk of impotence and rectal damage
than external beam radiation.
Radiation has a palliative role for men with metastatic prostate cancer,
reducing the size of bone metastasis, controlling pain, and restoring
function, such as continence.
Hormonal Therapy:
Androgen depravation therapy is used to treat advanced prostate cancer.
Many cells in the growing tumor are androgen dependent and either stop
growing or die if deprived of androgens. Other cancer cells,
unfortunately, thrive without androgen and are unaffected by therapy to
reduce circulating androgens. The effects of hormone therapy can vary
from complete but temporary regression of the tumor to no response at
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