of Prostate cancer
leaflet will be of interest in particular to those men who
have been diagnosed as having Cancer of the Prostate.
of Prostate Cancer
Cancer is usually diagnosed in one of two ways:
a prostate biopsy, performed either because the prostate
gland felt abnormal or the PSA test was abnormal
microscopic examination of the prostate tissue removed at
a prostatectomy (TURP)
have been told that I have prostate cancer – what happens
scan is a special scan using nuclear medicine techniques.
Prostate Cancer that has spread has a tendency to settle in
some of the bones of the skeleton and a bone scan will usually
detect this. Detecting the presence of such metastases (as
they are known) may affect the treatment your doctor would
like to give you. Bone scan is not required in every patient
and Mr Puri will discuss this with you.
scan To confirm that the cancer is localised to the prostate
gland a MRI scan
required. Not every patient will need a scan as patients with
low grade (Gleason 6 or lower), early stage(tumour localised
to prostate gland) or PSA below 10 have low risk of spread
beyond the prostate and do not require a scan
of Prostate cancer that appears localised to the prostate
for treating this kind of cancer are;
treatment, also known as "watchful waiting"
in the form of a "radical prostatectomy"
Energy Focused Ultrasound (HIFU)
which treatment is given depends to a large extent on your
age and general fitness, the exact stage of the tumour, the
level of the PSA test, and your wishes after you have been
counselled by the doctor.
based on the fact that many men will die of other causes not
related to the diagnosis of their prostate cancer. This form
of treatment is obviously more appropriate in older men older
whose life expectancy is generally less than 10 years from
the time of diagnosis. This does not mean that
men over 70 years old are automatically excluded from having
therapy does not mean no treatment; rather it
means that you will undergo regular check ups with the consultant
with a rectal examination and a PSA check.
Prostatectomy is a major operation to remove the whole of
the prostate gland. The operation is performed by keyhole
surgery (Laparoscopic Radical Prostatectomy) or through
an abdominal wound (Open Radical Prostatectomy). The
length of stay is variable but most men will expect to stay
on the ward for about 2-3 days after the operation.
true extent (stage) and aggressiveness (grade) of prostate
cancer can be determined.
the cancer is confined to the prostate and completely removed
the operation should be curative
value should decrease to <0.1 six weeks after the operation
operation also relieves the obstruction caused by enlargement
of the prostate gland and relieves symptoms as poor flow
and getting up at night to pass water.
cancer recurs PSA rise will detect this 4-5 years before
symptoms so the radiotherapy can be given.
of Radical Prostatectomy
- following the operation there is a risk of impotence (failure
to get adequate erections). Potency (erection) rates differ
amongst surgeons. Good potency rates would be 50% of patients,
at 12 months after surgery.
- The return to normal control occurs in three phases, and
you should try to be patient with the speed of your recovery.
first phase is that you will be dry when you are lying down
phase two you will be dry when walking around.
in phase three you will be dry when you get up from a sitting
position, cough or sneeze.
majority of men find that they experience some urinary leakage
when they cough, sneeze or change posture suddenly. This is
called stress incontinence and is controlled by using pads.
Good continence results will be 70% pad free by 3 months and
95% pad free by 1 year.
option is Radical Radiotherapy, which uses high-energy rays
that destroys the prostate cancer cells. This may be achieved
in two ways
a beam of x-rays directed at the prostate to kill the prostate
cancer cells. A complete course of treatment takes up to six
of External Beam radiotherapy
40% and 60% of men will have some degree of impotence and
up to 3% will develop a degree of incontinence. Side effects
on the bowel usually disappear once treatment is complete
but some rectal discomfort and bleeding (in up to 30%) can
radioactive seeds that are inserted into the prostate under
general anaesthesia. Their radiation is released slowly to
destroy the cancer cells over a period of time.
a relatively new treatment and unwanted effects on the bladder
may be more sever and long lasting than external beam radiotherapy,
but risk of bowel damage is expected to be lower.
of Prostate Cancer which has spread beyond the boundary of
the prostate, but not widespread disease (Locally Advanced)
treatment is inappropriate for this disease - the ultimate
aim of surgery is to try and remove (and hopefully cure) the
which has spread outside the prostate cannot be cured, but
may be effectively controlled. Possible treatments
for this condition include radical radiotherapy or hormonal
manipulations to control the prostate cancer
of Disease which has spread to involve other parts of the
body (Metastatic disease)
and radiotherapy are inappropriate for this condition and
most treatments use a variety of hormonal therapies to keep
the prostate cancer under control
Therapy - How does it work?
Cancer relies on the presence of the male hormone, Testosterone,
for growth. In actual fact Testosterone is converted to a
more active form known as Di-hydro-testosterone (DHT).
therapies all work by reducing the level of Testosterone in
the body to very low limits. There are three ways this can
by which Testosterone can be reduced
operation to remove the inner part of the testicles
and disadvantages are compared below. After reading this you
may find it useful to discuss the options further with your
doctor when you next visit the clinic.
Non-invasive (IE no injections
or operations required)
- Tablets must be taken
up to three times a day for life
- Some side effects are
common (e.g. tiredness, lethargy, diarrhoea)
Only needs to be given
once a month, or sometimes once every three months
- Sometimes painful to
receive the injection
- Can develop hot flushes
(can be treated)
Once operation is performed
it is likely that no other treatment will be required
in the short term - i.e. no tablets or injections
- Requires an admission
to hospital for 1-2 days and a general anaesthetic
- Possible psychological
problems of reduced testicle size after operation
- Hot flushes may develop
(this is treatable)
Consultant will carefully follow up, whichever
is recommended to you
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