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Prostate: Treatments

 

Prostate cancer can be treated in more than one way. Depending on the rate of growth, age, life expectancy, 

stage and spread, many different therapies or a combination therapy is used. 

You may either receive direct radiation therapy to the prostate or the surgeon may place small radioactive implants in the prostate. They both work by killing the cancer cells. Today, radiation therapy is applied in a very sophisticated way to prevent toxicity. With precise focusing of radiation beams, greater doses of radiation can be without increasing the frequency of complications. During the radiation therapy, all individuals are protected by custom-designed shields. 

Radiation treatments are generally given over a 6-8 week period. The treatment is not painful and does not require anesthesia. The side effects of radiation therapy are not instant, and so one may gradually develop the following:
Frequent urination
impotence (more common in elderly men)
loose stools
rectal bleeding
urgency to defecate
rectal ulcers
rectal pain upon defecation

Once the radiation treatment course is complete, the majority of these side effects gradually disappear. However, a few unlucky men may continue to experience rectal pain, bleeding or ulcers. If these do not resolve with medical therapy, surgery may be required. 

Because testosterone is known to stimulate growth of prostate cancer cells, anti-testosterone therapy (called hormonal therapy) is frequently used to treat prostate cancer. This therapy either uses drugs to stop the production of the male sex hormones or the entire source of the hormone is surgically stopped by removing the testicle (orchidectomy). 

Hormonal therapy is most effective in men with advanced prostate cancer. The treatment does help to slow the growth and frequently shrinks the tumor. Because this therapy is effective in shrinking tumors, hormonal therapy can be used in the early stage of prostate cancer often in combination with radiation and surgery. Once the tumor size is reduced, surgery or radiation therapy can be used to destroy whatever tumor is left behind.

Most men develop side effects from these hormonal-based drug therapies. These include nausea, diarrhea, breast enlargement, decreased libido, impotence, hot flashes, weight gain and loss of muscle and bone mass. Liver function has to be regularly monitored because all these drugs have the potential to cause liver damage.

A few men elect to undergo an orchidectomy. The testes are a major source of testosterone and surgical removal of the testes eliminates the hormone. This mode of therapy is usually for individuals with advanced prostate cancer and is quite effective. The procedure is actually not as painful as it sounds. 

Surgical removal of the prostate gland is another option for patients with prostate cancer. This is a major surgical procedure which removes the entire prostate and adjacent lymph nodes. The surgeon tries to preserve the nerves and muscles which control urination and sexual function. Two surgical approaches are available to remove the prostate: retropubic and perineal. Both have been designed to prevent the complications to the adjacent organs, however, a fair number of individuals continue to have complications.

Chemotherapy drugs are frequently used to treat prostate cancer. These toxic drugs kill the rapidly growing cancer cells. This form of therapy is not curative but can help control the spread. However, chemotherapy is associated with more side effects and is generally given to men who have prostate cancer that did not respond to hormonal therapy. Today, various combinations of chemotherapeutic drugs are used and may even be combined with hormones. Early results are positive but long term resulting are not available.


 

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Greg Cryns
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