Men facing prostate cancer now have
several choices when it comes to their treatment. The man’s age, his general
health, how much importance he places on preserving sexual function and whether
the disease has spread are factors in determining the choice of treatment.
When the disease has not spread
further than the prostate gland, there is a high chance of cure with surgical
removal of the entire prostate gland or radiation therapy. Complete removal of
the prostate gland offers the highest cure rate. Another option for prostate
cancer patients is external radiation. Low-dose radiation treatments are given
daily for approximately seven to eight weeks.
The newest treatment for men with
prostate cancer caught in the early stages is called radioactive seed
implantation therapy. This treatment involves implanting approximately 100 tiny
radioactive seeds in the prostate gland where they destroy cancerous cells
while leaving healthy tissue intact. This FDA-approved procedure has proven as
effective as other prostate cancer treatment options, such as surgery or
external radiation therapy.
Prior to the implantation procedure,
the patient visits the urologist and radiation oncologist for an initial
consultation and planning study. The planning information is then used by the
radiation oncology physicist and dosimetrist to plan the implant and order the
seeds. The actual implantation procedure is done using ultrasound to guide the
placement of the seeds in the prostate gland. The seeds are distributed evenly
throughout the gland to deliver radiation in a highly-targeted way.
Compared with other methods of
treating prostate cancer, the radioactive seed implant therapy has few side
effects. Most men can resume normal activities within a day or so, although
some may experience side effects, such as more frequent urination or impotence.
These symptoms are usually temporary and disappear over time or with
medication.
By age 80 a majority of men are
found to have a small prostate cancer, if tested. In most of these cases, however,
the cancer causes no symptoms and requires no treatment. Since prostate cancer
may develop very slowly, these elderly patients may choose "watchful
waiting" instead of one of the curative therapies. In patients whose life
expectancy is five years or less, the best treatment may be conservative
management such as observation or hormonal therapy.
Choosing
a Treatment
When faced with prostate cancer, men
should discuss all of the treatment options -- radioactive seed implantation,
surgery, hormonal therapy, external radiation and watchful waiting -- with a
specialist. It is sometimes helpful for prostate cancer patients to bring a
family member along for the initial visit with the urologist and to consider
obtaining a second opinion from a radiation oncologist to discuss treatment
options. At that visit, the patient and/or family might wish to ask the
following questions:
- Is the cancer localized to the prostate gland or has it
spread to other organs?
- Will there be a biopsy of the tumor? If so, what does
this show?
- What are the options for treatment? What are the
potential risks and complications of each? What are the benefits of each?
- Given the patient’s age and other medical conditions,
what does the doctor feel is the best option?
By discussing these and other
issues, the patient, his family and his physician can make a decision that best
suits his specific circumstances, concerns and needs.
There are four Types of Laser Surgeries:
1. Green Light PVP Laser : This procedure uses green light to vaporize the prostate and useful for majority of patients with enlarged prostate. A tube with light and lens called the cystoscope is inserted into the penis. The laser beam is introduced through the cystoscope and directed towards the prostate. It creates high energy which vaporizes the excess tissue and relieves the urethral blockage. The procedure is done in a short time and the patient can go home the same day and resume daily non strenuous activities within a couple of days.
The image on the left shows an enlarged prostate constricting bladder flow. The image on the right shows the prostate after laser PVP surgery.
2. Holmium Laser : This is the most commonly used technique and is performed under general anaesthesia. The laser of 2140nm wavelength and 0.4mm penetration is introduced through the cystoscope that is inserted into the penis at the start of the procedure. The laser cuts and vaporises the enlarged prostate tissue and relieves urinary blockage. Some tissue pieces are directed to the bladder from where they are flushed out. The procedure is done in a short time and the patient can go home the same day or the next day and resume daily non strenuous activities within a couple of days. The procedure is relatively bloodless.
3. VLAP : This procedure has many disadvantages and has become virtually obsolete with the coming of Holmium Laser. The technique uses neodymium:yttrium-aluminum-garnet (Nd:YAG) laser which has a wavelength of 1064nm. The laser beam is directed towards the prostate gland via the cystscope. The beam generates a lot of heat which coagulates the gland tissue. The surgery is performed under regional or general anaesthesia. The technique was not popular among patients as the coagulated portion caused irritation. Also the urine catheter had to be kept for long. Soon this was replaced by Holmium Laser.
4. ILC : Interstitial Laser coagulation therapy was used to coagulate tumours which could not be cut and removed especially in the brain, neck, liver, pancreas etc. in this procedure the laser probe is in direct contact with the prostatic tissue and generates temperature of 60 degrees Celsius which destroys the cell protein. The destroyed cells are absorbed in due course of time and a shrunken prostate gland remains. The urethra is not affected. The procedure is performed under general or regional anaesthesia. The rigid laser probe is inserted through the cystoscope and pushed till it enters the prostate after which it is activated to produce the heat. The effect is localised to the prostate tissue only.
d) Robotic Prostatectomy : This procedure is carried out using the computer and is an advanced form of minimally invasive surgery. In this technique, small incisions are made in the lower part of the abdomen and the entire surgery is carried out using Tele-manipulator. The surgeon performs actions, which moves the Tele-manipulator which in turn is connected to the robot’s arms which replicate the surgeons hand movements and perform the surgery. The surgery is controlled remotely but involves great precision because of which it is soon becoming very popular. The procedure has resulted in favourable outcome as there is less blood loss, faster recovery and shorter hospital stay.
Surgeons also perform laparoscopic robot assisted surgeries using the Da Vinci system which uses miniature surgical tools to carry out the surgery through the keyhole incisions. This method is gradually gaining popularity in treatment of prostatic cancers as there is great precision involved while removing the prostate gland without affecting the other tissues.
e) HIFU : High intensity focused ultrasound is the new treatment approach that has evolved for the treatment of prostate cancer. The focused high energy ultrasound beam is targeted towards the cancerous cells which may be very small or very big which results in intense heating up of these cells causing their death. Since this treatment does not involve any side effects that are seen with chemo and radiotherapy, it is fast gaining popularity among the patients. The patients can go home after a single night stay in the hospital. The surgery is carried out under general or spinal anesthesia. The ultrasound probe is inserted through the rectum and emits high energy ultrasound towards the prostate gland which destroys the cancer tissue. The chance of recurrence is very less and side effects like erectile dysfunction and urinary incontinence are rarely seen. Hifu has been used successfully in Europe but is still in the clinical trial stage in United States.
After surgery, the patient is advised not to lift heavy weights or do strenuous work for 2-3 weeks and drink plenty of water. Regular physician checkup should be done as advised. Patients attain their pre-surgery status sooner in laparoscopic, laser assisted or robotic surgeries as compared to traditional open surgeries.