Prostate Cancer (cont.)

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What are the treatment options for prostate cancer?

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Deciding on treatment can be difficult, partly because the options for treatment today are far better than they were 10 years ago but also because not enough reliable data are available on which to base the decisions. Accordingly, scientifically controlled, long-term studies are still needed to compare the benefits and risks of the various treatments.

To decide on treatment for an individual patient, doctors categorize prostate cancers as organ-confined (localized to the gland), locally advanced (a large prostate tumor or one that has spread only locally), or metastatic (spread distantly or widely). The treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery, radiation therapy, hormonal therapy, cryotherapy, combinations of some of these treatments, and watchful waiting. A cure for metastatic prostate cancer is, unfortunately, unattainable at the present time. The treatments for metastatic prostate cancer, which include hormonal therapy and chemotherapy, therefore, are considered palliative. By definition, the aims of palliative treatments are, at best, to slow the growth of the tumor and relieve the symptoms of the patient. Palliative treatments can prolong life in some and relieve symptoms in many such patients, though these treatments come at the expense of side effects.

What about prostate cancer surgery?

The surgical treatment for prostate cancer is commonly referred to as a radical prostatectomy, which is the removal of the entire prostate gland. The entire prostate, seminal vesicles, and ampulla of the vas deferens are removed, and the bladder is connected to the membranous urethra to allow free urination.

The radical prostatectomy is the most common treatment for organ confined or localized prostate cancer in the United States. The potential complications of a radical prostatectomy include the risks of anesthesia, local bleeding, impotence (loss of sexual function) of patients, and incontinence (loss of control of urination).

Great strides have been made in lowering the frequency of the complications of radical prostatectomy. These advances have been accomplished largely through improved anesthesia and surgical techniques. The improved surgical techniques, in turn, stem from a better understanding of the key anatomy and physiology of sexual potency and urinary continence. Specifically, the recent introduction of nerve-sparing techniques for the prostatectomy has helped to reduce the frequency of impotence and incontinence.

Radical prostatectomy can be performed by open surgery, laparoscopic surgery, or by robotic surgery (robotic assisted radical prostatectomy). Currently, many radical prostatectomy surgeries in the U.S. are performed using the of the Da Vinci robotic system. For robot-assisted surgery, five small incisions are made in the abdomen through which the surgeon inserts tube-like instruments, including a small camera. This creates a magnified three-dimensional view of the surgical area. The instruments are attached to a mechanical device, and the surgeon sits at a console and guides the instruments through a viewing device to perform the surgery. The instrument tips can be moved in a variety of ways under the control of the surgeon to achieve greater precision in surgery. So far, studies show that traditional open prostatectomy and robotic prostatectomy have had similar outcomes related to cancer-free survival rates, urinary continence, and sexual function. However, in terms of blood loss during surgery and pain and recovery after the procedure, robotic surgery has been shown to have a significant advantage.

If post-treatment impotence does occur, it can be treated by sildenafil (Viagra) tablets, injections of such medications as alprostadil (Caverject) into the penis, various devices to pump up or stiffen the penis, or a penile prosthesis (an artificial penis). Incontinence after treatment often improves with time, special exercises, and medications to improve the control of urination. Occasionally, however, incontinence requires implanting an artificial sphincter around the urethra. The artificial sphincter is made up of muscle or other material and is designed to control the flow of urine through the urethra.

Transurethral resection of the prostate (TURP) involves the removal of a part of the prostate by an instrument inserted through the urethra. It is used as an alternative to prostatectomy in patients with extensive disease or those who are not fit enough to undergo radical prostatectomy to remove tissue that is blocking urine flow. This is often referred to as a channel TURP.

Medically Reviewed by a Doctor on 12/9/2013

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