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Prostate Cancer Treatment

There are various treatments for prostate cancer. The treatment that’s best for each man depends on several factors. These include how fast your cancer is growing, how much it has spread, your age and life expectancy, as well as the benefits and the potential side effects of the treatment. The most common treatments for prostate cancer include the following:
Surgery (Radical prostatectomy)
Radioactive seed implants (Brachytherapy)
Surgery (Radical prostatectomy)

Surgical removal of your prostate gland, called radical prostatectomy, is used to treat cancer that’s confined to the prostate gland. During this procedure, your surgeon completely removes your prostate and nearby lymph nodes, if necessary. The advantage of this operation is that the tumour (and prostate) is removed from the body which patients often find more reassuring than treatments that are done by leaving the prostate in the patient.

•    Open radical prostatectomy: This method certainly has been the gold standard until recent years. Its results have set very high standards in terms of cancer control, continence and nerve sparing in the best units. However , the laparoscopic and robotic approaches have shown in numerous studies that they are undoubtedly equivalent in outcomes and in most series have lower positive margin rates as well as better continence and potency rates.    

•    Laparoscopic radical prostatectomy: this technique was pioneered in the 1990’s in France and set the benchmark for minimally invasive radical prostatectomy. The operation is extremely difficult to perform because in laparoscopy for all surgical areas the instruments are long, rigid and movements are counterintuitive. ( a bit like shaving left handed in a mirror!) There is little doubt that in very skilled hands there is very little difference between laparoscopic radical prostatectomy and robotic assisted laparoscopic radical prostatectomy.

In learning the pure laparoscopic method the surgeon has to considerably more cases than the robotic surgeon to achieve the equivalent level of competence. Hence there has been widespread and rapid development of robotic surgery whereas laparoscopic radical prostatectomy is performed by a select few.

Robotic surgery has gained huge popularity in the USA and to date more than 60% radical prostatectomies are done robotically. In Europe laparoscopy is still very popular but robotics is gaining in popularity .In the UK more than 90% of radical prostatectomies are done by open surgery .This is mainly driven by a lack of acceptance of the inevitable development of minimally invasive techniques .In short, most urologists in the UK don’t have the requisite skills to do radical prostatectomy in any way other than by the open method.

•    Robot-assisted laparoscopic radical prostatectomy (RALRP):
The development of Robotic Assisted Laparoscopic Prostatectomy has transformed the traditional thinking and approach to surgery of the prostate. It has given surgeons a minimally invasive way to perform the same maneuvers that they did with their hands in the open operation. Movements are fully intuitive, instruments are articulated, and the vision is extremely magnified and projected in 3D. For further description please refer to section on robotic surgery.

Side effects of radical prostatectomy can include:

•    Bladder control problems (urinary incontinence). With  laparoscopic or robotic prostatectomy you are expected to have minimal urinary leak and indeed many patients are dry from the time the catheter is removed. However if some incontinence is present these symptoms can last for weeks or even months, but most men eventually regain bladder control. Often the incontinence is “stress incontinence”, meaning they’re unable to hold urine flow when their bladders are under increased pressure.
•    Erectile dysfunction. The nerves that supply the penis to achieve erection are attached to the sides of the prostate and therefore can be damaged during the prostate removal. With the enhanced visibility and magnification in  the sparing of these nerves is improved and in good hands results of maintaining potency are excellent. Most men younger than age 50 who have nerve-sparing surgery are able to achieve spontaneous erections afterward, and even some men in their 70s are able to maintain normal sexual functioning. Men who had trouble achieving or maintaining an erection before surgery have a higher risk of being impotent after the surgery.  

Radioactive seed implants ( Brachytherapy)

Radioactive seeds implanted into the prostate have gained popularity in recent years as a treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose of radiation than do external beams, but over a substantially longer period of time. The therapy is generally used in men with smaller or moderate-sized prostates with small and lower grade cancers.

During the procedure, between 40 and 100 rice-sized radioactive seeds are placed in your prostate through ultrasound-guided needles. The implant procedure typically lasts one to two hours and is done under general anesthesia Most men can go home the day of the procedure. Sometimes, hormone therapy is used for a few months to shrink the size of the prostate before seeds are implanted. The seeds may contain one of several radioactive isotopes – including iodine and palladium. These seeds don’t have to be removed after they stop emitting radiation. Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location. This type of radiation isn’t likely to escape your body in significant doses. However, doctors recommend that for the first few months you stay at least six feet (1.83 meters) away from children and pregnant women, who are especially sensitive to radiation. All radiation inside the pellets is generally exhausted within a year.

Side effects of radioactive seed implants can include:

•    Urinary problems. The procedure causes urinary signs and symptoms such as frequent, slow and painful urination in nearly all men. You may require medication to treat these signs and symptoms. Some men need medications or the use of intermittent self-catheterization to help them urinate. Urinary symptoms tend to be more severe and longer lasting with seed implants than with external beam radiation.
•    Sexual problems. Some men experience erectile dysfunction due to radioactive seed implants.
•    Rectal symptoms. Sometimes this treatment causes loose stools, discomfort during bowel movements or other rectal symptoms. However, rectal symptoms from radioactive seed implants are generally less severe than with external beam radiation.

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