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National Prostate Cancer Awareness Month, cont'd...

Man To Man is a support group for all men who have been diagnosed with prostate cancer or benign prostatic hyperplasia (BPH).  There are approximately 20 to 40 attendees each meeting.  Every other month is designed for prostate patients only.  When an informational speaker is scheduled, spouses and significant others are invited to attend.  Man To Man is held in cooperation with the American Cancer Society.

What are my treatment options?
Great progress has been made in cancer treatment in recent years, and the treatment of prostate cancer is no exception. Remember that if detected early, prostate cancer is highly treatable!

Treatment choices for prostate cancer depend primarily on the patient’s age and stage of the disease. However, the major options include:
  • Watchful waiting
  • Surgery
  • Hormone therapy
  • Brachytherapy (seeds & HDR)
  • External beam radiation therapy
  • Chemotherapy
  • Combination therapy

Watchful waiting is often the preferred approach for patients older than 75 who are suffering from other significant medical conditions. The reasoning behind this is that prostate cancer is generally less aggressive in older individuals, and less likely to impact a person’s life. For such men, it may make more sense for their doctor to monitor the disease closely and begin treatment only if it becomes necessary rather than putting them through rigorous treatment.
In radical prostatectomy, the entire prostate gland is surgically removed. This technique can be very effective if the cancer is confined to the prostate gland. Sometimes, hormonal therapy is used before surgery to shrink the tumor so that it can be removed more effectively. A sample from the pelvic lymph nodes is also removed for a biopsy to determine if the prostate cancer has spread outside the gland. If so, other treatment measures must also be used. A patient should expect to stay in the hospital several days after the procedure, and full recovery may take a month or more. Side effects may include impotence and incontinence.

Transurethral resection of the prostate, or TURP is performed while the patient is under general or spinal anesthesia. It is used on men who are not candidates for radical prostatectomy due to age or other health concerns. It is also sometimes used to relieve certain urinary problems and non-cancerous enlargement of the prostate.

Cyrosurgery can also be performed to treat localized prostate cancer. In this technique, a probe filled with nitrogen is guided through a small incision into the cancerous area using transrectal ultrasound. The nitrogen then freezes and destroys the prostate.

Orchiectomy - In this procedure, the testicles are completely removed, leaving only the adrenal glands to produce a small amount of testosterone. Orchiectomy is also considered a hormonal therapy because, like certain drugs, it reduces hormone levels.
LH-RH analogs stop the production of testosterone by the testicles. Antiandrogen therapy is sometimes used along with an LH-RH analog in the treatment of advanced prostate cancer. This is done to combat the small amount of testosterone the adrenal glands produce.

Hormone therapy is an important treatment option for prostate cancer, but it is not considered a “cure.” Sometimes it is used in combination with other therapies to improve their success rate.
For radioactive seeds, HDR and external beam radiation, side effects may include:
  • Sexual dysfunction
  • Skin irritation and hair loss in the pelvic region
  • The need to urinate frequently
  • Burning during urination
  • Diarrhea and rectal burning

Side effects usually subside after treatment has been completed.

External beam radiation is a very common treatment to combat prostate cancer in its early stages. This technique uses radiation, or x-ray technology, to destroy cancer cells. Patients receiving this form of therapy are treated 5 days a week for a period of six to eight weeks.
Brachytherapy involves the implanting of radioactive “seeds” directly into the prostate gland. The seeds then release radiation over a period of three to nine months.

This brachytherapy procedure is usually done in 1-2 hours on an outpatient basis. A team of specialists including a urologist, radiation oncologist, and medical physicist work together to perform the procedure. During brachytherapy, radioactive “seeds” are positioned according to the patient’s unique treatment plan using hollow needles. An ultrasound rectal probe is used to view the prostate so that the seeds can be placed very precisely.

Brachytherapy allows the use of a higher dose of radiation with potentially less damage to surrounding tissue. The procedure can be done in a much shorter time frame than a full course of external beam radiation treatment.

The radioactive seeds are very small, but they offer some very big advantages to patients:
  • First, major surgery is not required to implant the seeds.
  • Second, daily treatments are not necessary.
  • Third, patients can resume there normal activities almost right away.
  • And fourth, the risk of impotence and incontinence are significantly less with brachytherapy than they are with surgery and external beam radiation.

In HDR brachytherapy, we use a computer-controlled radioactive source to deliver the prescribed treatment to the patient. Although the source of the therapeutic radiation is very small, it is also extremely intense and powerful.

HDR brachytherapy can be delivered on an outpatient basis with relatively few complications. A medical physicist works closely with the patient and radiation oncologist in developing the patient’s treatment plan, and the physicist is present during all HDR brachytherapy procedures.
Intensity-modulated radiation therapy, or “IMRT,” may lead to a higher cure rate for local prostate cancer patients, as well as those with head, neck, and certain other types of cancer. In IMRT, the radiation oncologist first enters a prescription into the computer. The computer then does a thorough search of the many alternative treatment options available to determine the best way to meet treatment goals.

IMRT makes it possible to deliver higher doses of radiation to the prostate while at the same time minimizing damage to other organs, such as the bladder, rectum, and the heads of the femoral bones. We can save more of the rectal wall from radiation injury when using IMRT than when conventional or conformal radiation therapy is utilized.
Chemotherapy is not a main treatment option for prostate cancer but may be considered if cancer continues to grow and the other treatments have been tried. Chemotherapy is the use of drugs to destroy active cancer cells to keep them from dividing and growing out of control.

The specific side effects of chemotherapy differ depending on the patient and which medication is used. However, common adverse effects are:
  • Fatigue
  • Nausea
  • Diarrhea
  • Mouth sores
  • Hair loss
  • Low white blood cell count

We monitor the number of treatments and amount of medication used in chemotherapy very carefully. We often give supportive medications to lessen the effects and help make patients more comfortable while receiving chemotherapy.

There are several different options and choices for the treatment of prostate cancer but ultimately the decision of which treatment is right for you is up to you!

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