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Management of Prostate Cancer

Dr. Prem Kumar, MS (Surgery), DNB (Surgery), DNB (Urology), Consultant Urologist & Uro-Oncologist, Ranchi Urology Center, Ranchi, Jharkhand

Published: Oct 13, 2021 02:05:38 PM IST
Updated: Oct 13, 2021 02:09:13 PM IST

Management of Prostate Cancer

It's important to discuss all the treatment options, including their goals and possible side effects, with the doctors to help make the decision that best fits as per the patient's needs. Some important things to consider include:
•    The stage and grade of the cancer
•    Patient's age and expected life span
•    Any other serious health conditions
•    Feelings about the need to treat the cancer right away
•    The likelihood that treatment will cure the cancer (or help in some other way)
•    Feelings about the possible side effects from each treatment

Immediate Treatment may not be Necessary

Low-grade prostate cancer may not need treatment right away. For some, treatment may never be needed. Instead, doctors sometimes recommend active surveillance. In active surveillance, regular follow-up blood tests, rectal examination and prostate biopsies may be performed to monitor progression of the cancer. If tests show that cancer is progressing, patient may opt for a prostate cancer treatment such as surgery or radiation. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult.

Surgery to Remove the Prostate

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Surgery is an option for treating cancer that's confined to the prostate. It's sometimes used to treat advanced prostate cancer in combination with other treatments. The following types of surgery are used:

Radical Prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. Removal of nearby lymph nodes may be done at the same time. (Pelvic lymphadenectomy).

Transurethral Resection of the Prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This is done to relieve the voiding symptoms & it’s not curative.

Radiation Therapy
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy treatments may involve:

Radiation that comes from outside the body (external beam radiation): It is an option for treating cancer that's confined to the prostate. For prostate cancer that spreads to other areas of the body, such as the bones, radiation therapy to such areas can help slow the cancer's growth and relieve symptoms, such as pain.

Radiation source placed inside the body (brachytherapy): Brachytherapy involves placing radioactive sources in the prostate tissue. Most often, the radiation is contained in rice-sized radioactive seeds that are inserted into the prostate tissue. The seeds deliver a low dose of radiation over a long period of time.

Freezing or Heating Prostate Tissue (Minimally Invasive Treatment)
Ablative therapies destroy prostate tissue with cold or heat, usually done for small tumor as primary treatment or as salvage therapy after radiation failure. Options may include:
Freezing Prostate Tissue: Cryoablation or cryotherapy for prostate cancer involves using a very cold gas to freeze the prostate tissue. The tissue is allowed to thaw and the procedure repeated.

Heating Prostate Tissue: High-intensity Focused Ultrasound (HIFU) treatment uses concentrated ultrasound energy to heat the prostate tissue and cause it to die.

Hormone Therapy
Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly. Hormone therapy options include:
•    Medications that stop your body from producing testosterone
•    Medications that block testosterone from reaching cancer cells (androgen receptor targeting drugs).
•    Surgery to remove the testicles (orchiectomy)

Chemotherapy may be a treatment option for treating prostate cancer that has spread to other areas of the body. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

Follow-up Care
Even if the patient has completed the treatment, the doctors will still want to watch closely. It's very important to go to all of the follow-up appointments. The doctor visits will usually include PSA blood tests, possibly with Digital Rectal Exams (DREs) if the prostate hasn't been removed. These will probably begin within a few months of finishing treatment. Patient need to talk with the doctor about developing a survivorship care plan.

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