17 janvier 2008
Prostate Cancer Treatments
There are numerous treatments for prostate cancer and each has its own benefits and drawbacks. Patients and their physicians must weigh many factors when determining the best treatment option. Age, Gleason score (measures aggressiveness), PSA, lifestyle and quality of life issues all play a very important part in the equation of finding the optimal treatment. Treatments available in the today include:
- High Intensity Focused Ultrasound (HIFU)
- Radical prostatectomy
- Radiation therapy
- Hormone therapy
- Cryotherapy
Some patients are choosing no treatment at all, or watchful waiting, because of the effects on quality of life after treatment. The treatment modalities are described below in more detail.
IMPORTANT INFORMATION
HIFU with the Sonablate® 500 is not approved for use in the U.S. The Sonablate® 500 remains investigational in the U.S. and is being studied for the treatment of prostate cancer in clinical trials in the U.S. FDA has made no decision as to the safety or efficacy of the Sonablate® 500 for the treatment of prostate cancer.
The information below is provided for general information purposes only and is not intended to replace sound professional medical advice and care. All treatment options and potential outcomes and complications should be discussed with a qualified healthcare provider.
High Intensity Focused Ultrasound
HIFU with the Sonablate® 500 is a non invasive treatment option for prostate cancer that uses a transrectal probe to focus ultrasound waves in the prostate. In the focal zone, the temperature is rapidly elevated which causes tissue destruction. During HIFU, the entire prostate is treated or ablated. In most cases, HIFU with the Sonablate® 500 takes between one to three hours and is performed as an out-patient procedure under a spinal anesthesia. Recovery is minimal. A catheter is inserted during the procedure that is usually worn for one to four weeks. People usually are up and walking around within hours after HIFU and can return to a normal lifestyle within a couple of days. After the procedure, some HIFU patients experience frequency, urgency, mild discomfort or discharge in urinary stream. Studies preformed outside the US report that potential side effects may also include urinary stricture (18%)10, retention (0.6%)1, incontinence (0.6%)1, erectile dysfunction (20%)1 and rectal fistula (1%)1.
Radical Prostatectomy
A radical prostatectomy is surgery to remove the entire prostate gland and some of the tissue around it and may be done by open or laparoscopic surgery. The advantages of a radical prostatectomy include complete removal of the prostate and a long history of use. An open prostatectomy may take two to four hours, and a laparoscopic prostatectomy may take up to eight hours. The procedure is usually preformed under general anesthesia and requires a hospital stay and catherization.
Radiation Therapy
There are two primary types of radiation therapy: External Beam Radiation Therapy ("EBRT") and brachytherapy or seed implants. EBRT is usually recommended for men with a prostate volume less than 60 grams and involves several weeks of radiation directed at the cancer from outside of the body. Brachytherapy is radiation therapy transmitted by tiny radioactive pellets placed inside the prostate.
Hormone Therapy
Hormone therapy, which reduces the amount of testosterone in the bloodstream and thereby deprives a prostate tumor of a necessary stimulus, has been shown in clinical trials to extend life and delay time to disease progression.
Cryotherapy
Cryotherapy, also known as cryosurgery or cryoablation, is a minimally invasive procedure that involves freezing the cells in the prostate to bring about destruction or elimination. Cryotherapy begins with an infusion of toxic argon gas that results in cellular destruction of the prostate. The infusion of argon gas is immediately followed by an infusion of helium to essentially thaw the tissue. This cycle is repeated twice to achieve cancer cell destruction.
Prostate Cancer Treatment Comparison Chart
2Long JP, Bahn D, Lee S, Shinohara K, Chinn DO, and Macaluso JN. Five year retrospective, multiinstitutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology 2001, 57:518-523.
3Health-Related Quality-of-Life Effects of Radical Prostatectomy and Primary Radiotherapy for Screen-Detected or Clinically Diagnosed Localized Prostate Cancer. Joanna B. Madalinska, Marie-Louise Essink-Bot, Harry J. de Koning, Wim J. Kirkels, Paul J. van der Maas, Fritz H. Schröde
4Bahn DK, Lee F, Badalament R, Kumar A, Greski J, Chernick M. Target cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer. Urology 2002, 60 (Supp 2A): 3-11.
5Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 2001 Aug;28(3):555-65.
6Ljung G, Norberg M, Hansson H, et al. Transrectal ultrasonically-guided core biopsies in the assessment of local cure of prostatic cancer after radical external beam radiotherapy. Acta Oncologica 1995, 34:945-952.
7Dinges S, Deger S, Koswig S, et al. High-dose rate interstitial with external beam irradiation for localized prostate cancer-results of a prospective trial. Radiother Oncol1998, 48:197-202.
8Stock RG, Stone NN, DeWyngaert JK, et al. Prostate specific antigen findings and biopsy results following interactive ultrasound guided transperineal brachytherapy for early stage prostate carcinoma. Cancer 1996, 77:2386-2392.
9Potters, L, Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center. 2004. http://www.malecare.com/new_page_93.htm
10 Toyaki U., Shiro B., Akira I., et al., Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: A multicenter study.Acta Urol. Jpn. Vol. 51, No. 10, 2005.
11 Catalona WJ, Basler JW: Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J Urol 150 (3): 905-7, 1993.
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