Wednesday, November 08, 2006
Prostate Cancer Treatment Options
Prostate Cancer Treatment Options
Proceeding strategy in patients with the prostate cancer depends on the degree of histological malignancy, the degree of local stage of development, coexisting diseases and age of a patient. There are many controversies as far as the choice of treatment is concerned. Radical treatment is possible in T1, T2 and N0 and Mo stages. In advanced cases (T3, T4, N-+, M-+), the procedure is restricted to delay the cancer progression and mitigate its effects (palliative treatment).
Surgery treatment - radical prostatectomy
The surgery consists in the prostate gland removal together with spermatic vesicles and adjacent tissues. Surgery is done through retropubic, transcoccgeal, perineal approach or through laparoscopy. Lymphadenectomy constitutes an integral part of the surgery. If the approach makes it impossible to remove the gland and lymph nodes (perineal approach) at the same time, a separate surgery is carried out. It precedes the operation proper. It is believed that cancerous cells found in the removed lymph nodes are the reason why prostatectomy cannot be performed. Invasion of lymph nodes to a certain extent suggests PSA level over 40ng/ml together with grade >7 in Gleason’s scale.
Recommendations for surgery:
1) cancer limited to the prostate gland (T1BN0M0Gx - T2N0M0Gx, T1AN0M0G3) 2) predictable life span over 10 years 3) consent of a patient If positive chirurgical margins, capsule infiltration or cancerous changes in the removed lymph nodes are found in postoperative microscopic assessment, the prognosis is worse – such patients are qualified for palliative treatment. The death rate in the postoperative period does not exceed 5%. Intraoperative complications first of all include: bleeding from Santorini’s plexus, damage of rectum wall, underpinning of ureter. Early complications after surgery: thrombotic and embolic complications (phlebothrombosis 3-12%, lung embolism 2-5%) and lymphocele. Late postoperative complications after prostatectomy include: urinary incontinence, erection disorders and narrowing of urethro-vesicular junction).
Radiotherapy
Apart from radical prostatectomy, radiotherapy is an effective method of treatment for patients with regional advanced prostate cancer. In radical treatment, the most frequently done using radiation from external sources, the dose of 50-70 Gy in fractions continuing over 5-7 weeks are given. T1ABC - T2ABCG1 and T1ABCG2 stages require radiation limited to the prostate. In other cases, area that is radiated includes adjacent lymph nodes as well. In recent years, multidimensional imaging with CT (3D conformal radiotherapy) is used in the treatment planning.
Brachytherapy constitutes another method that is used.
Recommendations for radical radiotherapy of the prostate:
1) prostate cancer confined with the organ 2) sufficiently long predictable survival span 3) no disorders in lower urinary tract 4) no disorders in rectum and colon 5) consent of patient to carry out treatment 6) early complications of radiation energy treatment (30% of patients) include dysuria, haematuria, diarrhoea, rectal tenesmus, inflammation of large intestine and rectum. Among later complications (11% of patients) chronic diarrhea, ulceration of rectum, bladder neck stenosis and intestinal fistula stenosis are observed.
Control of patients after radical prostatectomy and radical radiotherapy:
- per rectum test, PSA level in blood serum each 3 months. PSA level should be lower than 1 ng/ml (after radical prostatectomy it should be near to 0). Increase over 0.5 ng/ml within a year means failure of radiotherapy. Hormonotherapy
Hormonal therapy is mainly used as palliative treatment in advanced prostate cancer. It makes it possible to stop symptoms of the disease for some time and then, further progression of the disease takes place. Nowadays, the use of therapy in pulsation system is considered as it delays the development of hormone-resistant cell clones.
Ways of hormonal treatment include: 1) surgery castration (orchidectomy) 2) anti-androgens a) non-steroid b) steroid 3) analogues LH-RH 4) oestrogens, progestogens, inhibitors of androgens synthetase Hormonotherapy by analogues LH-RH is also recommended before planned radical radiotherapy. In the case of hormone-resistant cancer, treatment with combined cytoctatic and hormone (estramustine), however without significant effects.
PROGNOSIS
Prognosis depends on the development stage, degree of differentiation and PSA level (see: prognostic factors).
In T1A, B stage prognosis is good. 10-years survival 35-80%, death rate of the cancer 7-30%. In T2 stage, overall survival equals 34-85%, death rate equals 8-26%. In T3 stage, among patients who undergo non-invasive treatment for 9 years, overall death rate equalled 63%, from cancer – 30%. Depending on the degree of cancer differentiation, 10-year survival of patients is the following: for cells well differentiated - 81%, for cells moderately differentiated - 58% and for cells poorly differentiated - 26%.
By: Radoslaw Pilarski
Radoslaw Pilarski is a PhD candidate working on anticancer properties of Uncaria tomentosa - www.uncariatomentosa.com - at PAS, Poland. mLingua Worldwide Translations, Ltd. - mlingua.pl - provides professional language translations.
Copyright 2006 Radoslaw Pilarski
Proceeding strategy in patients with the prostate cancer depends on the degree of histological malignancy, the degree of local stage of development, coexisting diseases and age of a patient. There are many controversies as far as the choice of treatment is concerned. Radical treatment is possible in T1, T2 and N0 and Mo stages. In advanced cases (T3, T4, N-+, M-+), the procedure is restricted to delay the cancer progression and mitigate its effects (palliative treatment).
Surgery treatment - radical prostatectomy
The surgery consists in the prostate gland removal together with spermatic vesicles and adjacent tissues. Surgery is done through retropubic, transcoccgeal, perineal approach or through laparoscopy. Lymphadenectomy constitutes an integral part of the surgery. If the approach makes it impossible to remove the gland and lymph nodes (perineal approach) at the same time, a separate surgery is carried out. It precedes the operation proper. It is believed that cancerous cells found in the removed lymph nodes are the reason why prostatectomy cannot be performed. Invasion of lymph nodes to a certain extent suggests PSA level over 40ng/ml together with grade >7 in Gleason’s scale.
Recommendations for surgery:
1) cancer limited to the prostate gland (T1BN0M0Gx - T2N0M0Gx, T1AN0M0G3) 2) predictable life span over 10 years 3) consent of a patient If positive chirurgical margins, capsule infiltration or cancerous changes in the removed lymph nodes are found in postoperative microscopic assessment, the prognosis is worse – such patients are qualified for palliative treatment. The death rate in the postoperative period does not exceed 5%. Intraoperative complications first of all include: bleeding from Santorini’s plexus, damage of rectum wall, underpinning of ureter. Early complications after surgery: thrombotic and embolic complications (phlebothrombosis 3-12%, lung embolism 2-5%) and lymphocele. Late postoperative complications after prostatectomy include: urinary incontinence, erection disorders and narrowing of urethro-vesicular junction).
Radiotherapy
Apart from radical prostatectomy, radiotherapy is an effective method of treatment for patients with regional advanced prostate cancer. In radical treatment, the most frequently done using radiation from external sources, the dose of 50-70 Gy in fractions continuing over 5-7 weeks are given. T1ABC - T2ABCG1 and T1ABCG2 stages require radiation limited to the prostate. In other cases, area that is radiated includes adjacent lymph nodes as well. In recent years, multidimensional imaging with CT (3D conformal radiotherapy) is used in the treatment planning.
Brachytherapy constitutes another method that is used.
Recommendations for radical radiotherapy of the prostate:
1) prostate cancer confined with the organ 2) sufficiently long predictable survival span 3) no disorders in lower urinary tract 4) no disorders in rectum and colon 5) consent of patient to carry out treatment 6) early complications of radiation energy treatment (30% of patients) include dysuria, haematuria, diarrhoea, rectal tenesmus, inflammation of large intestine and rectum. Among later complications (11% of patients) chronic diarrhea, ulceration of rectum, bladder neck stenosis and intestinal fistula stenosis are observed.
Control of patients after radical prostatectomy and radical radiotherapy:
- per rectum test, PSA level in blood serum each 3 months. PSA level should be lower than 1 ng/ml (after radical prostatectomy it should be near to 0). Increase over 0.5 ng/ml within a year means failure of radiotherapy. Hormonotherapy
Hormonal therapy is mainly used as palliative treatment in advanced prostate cancer. It makes it possible to stop symptoms of the disease for some time and then, further progression of the disease takes place. Nowadays, the use of therapy in pulsation system is considered as it delays the development of hormone-resistant cell clones.
Ways of hormonal treatment include: 1) surgery castration (orchidectomy) 2) anti-androgens a) non-steroid b) steroid 3) analogues LH-RH 4) oestrogens, progestogens, inhibitors of androgens synthetase Hormonotherapy by analogues LH-RH is also recommended before planned radical radiotherapy. In the case of hormone-resistant cancer, treatment with combined cytoctatic and hormone (estramustine), however without significant effects.
PROGNOSIS
Prognosis depends on the development stage, degree of differentiation and PSA level (see: prognostic factors).
In T1A, B stage prognosis is good. 10-years survival 35-80%, death rate of the cancer 7-30%. In T2 stage, overall survival equals 34-85%, death rate equals 8-26%. In T3 stage, among patients who undergo non-invasive treatment for 9 years, overall death rate equalled 63%, from cancer – 30%. Depending on the degree of cancer differentiation, 10-year survival of patients is the following: for cells well differentiated - 81%, for cells moderately differentiated - 58% and for cells poorly differentiated - 26%.
By: Radoslaw Pilarski
Radoslaw Pilarski is a PhD candidate working on anticancer properties of Uncaria tomentosa - www.uncariatomentosa.com - at PAS, Poland. mLingua Worldwide Translations, Ltd. - mlingua.pl - provides professional language translations.
Copyright 2006 Radoslaw Pilarski
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