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Prostate Cancer :Treatment
Options (Traditional)
Once a diagnosis of prostate
cancer has been made, the patient and the physician have some decisions
to make in regards to treatment options. Let’s look at the therapies
currently available. Keep
in mind that the option recommended by your doctor will be based on the
stage of the cancer (how much it has spread) and the grade of the tumor
(how aggressive the cancer cells are).
No treatment: Sometimes,
depending on the stage and grade of the tumor, or based on age and/or
health condition, the physician may choose a wait and see posture,
keeping an eye on the progression of the tumor.
It is not unusual for prostate cancers to be fairly
non-aggressive.
Surgery: Surgery is often employed in early stages of prostate cancer.
When the entire prostate is removed, the operation is called a
prostatectomy. The prostate
is either removed through an incision in the abdomen (usually adjacent
lymph nodes are removed as well), or through a surgical opening between
the scrotum and anus (sometimes a separate incision is made in the
abdomen to remove nearby lymph nodes).
A pathologist examines the lymph nodes after surgery.
If there is lymph node involvement, there is a high probability
that the cancer has spread (metastasized).
Prostatectomy may cause permanent
impotence (inability to have a penile erection).
Occasionally prostatectomy results in urinary incontinence (loss
of bladder control). These
unpleasant consequences are not as common as they used to be due to more
sophisticated surgical techniques.
However, all men who have their prostate removed will have dry
orgasms, in other words they will not produce semen.
Radiation: Also known as
radiotherapy. There are two
types: external and internal. In
external radiation the patient generally receives treatment 5
days per week for 6 weeks. The
radiation is aimed at the pelvic area.
Often a final “blast” is aimed at a smaller area where the
tumor developed. Internal
Radiation is defined as radiation therapy that is given internally.
This is done by placing radioactive material that is sealed in needles,
seeds, wires, or catheters directly into or near the tumor. Internal
radiation is also called implant radiation or brachytherapy.
Radiation therapy may cause the
patient to feel tired. Patients
may also experience diarrhea and/or frequent and uncomfortable
urination. External radiation causes redness of the skin.
Radiation may cause impotence (much more common in external
radiation).
Hormone Therapy:
Prostate cell growth depends on testosterone, the male sex
hormone. The goal of
hormone therapy is to deny the prostate cells testosterone.
The most radical technique is the removal of the testicles, as
the testicles are the major source of testosterone. Removal
of the testicles is called orchiectomy.
Another hormone therapy involves the administration of a
“luteinizing hormone releasing hormone agonist.”
These agonist (shorthand LHRH) are available as two different
prescription drugs which are much easier to pronounce:
Lupron, and Zoladex. These
drugs prevent the testicles from producing testosterone.
Sometimes the female hormone estrogen is also prescribed.
For an even more potent hormonal therapy, physicians sometimes
also prescribe antiandrogens such as Eulexin or Casodex. Hormone therapy can hold prostate cancer in check for
years, but eventually the cancer continues to grow without testosterone.
Patients on hormone therapy often have side effects such as
decreased libido (sex drive), impotence or hot flashes.
Patients on antiandrogen therapy sometimes develop tenderness or
swelling of the breasts.
Article
by Michael Guthrie, R.Ph.
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