If prostate cancer grows slowly and at an early stage, treatment does not in any case must be absolutely necessary. Still, a therapy for older men may can be inadvisable as is to be expected with other serious medical problems. The doctor may propose the so-called "watchful waiting", so a "watchful waiting", here. This means regular check-ups of the patient and the latest treatment of may be later occurring symptoms.
Surgery (radical prostatectomy)
The radical surgery is a common treatment for the early stages of prostate cancer. The primary objective of this intervention is to heal those affected. The radical surgery (total or radical prostatectomy), the vas deferens, a part of the bladder neck and - if necessary - the neighbouring lymph nodes removed are the entire prostate gland with a margin of surrounding tissue, the seminal vesicles.
It is sensibly only in those patients a radical removal of the prostate in question, where the tumor still has not exceeded the organ boundaries (prostate capsule), because otherwise inevitably remain cancer cells in the body.
Irradiation is a familiar long way to treat prostate cancer.
In the early stages of prostate cancer, radiation therapy can replace surgery; She can be applied also after surgery to destroy any residual tumor cell in the area of the operation. Radiation therapy can be used in advanced stages for the relief of pain or other problems.
The radiation may be as outer (external) or internal (internal) radiation be used. In some cases, patients are irradiated both internally and externally.
External radiation is set specifically from the outside through an apparatus on the body. In the body, the prostate is located between bladder and bowel. Both bodies are very sensitive to radiation so the irradiation treatment must be carefully. For this purpose a computer tomography is made prior to the actual start of irradiation. The best technique is then determined using three-dimensional calculation. The radiotherapy itself takes several weeks, but each time only a few minutes is irradiated - this healthy tissue can recover better in the meantime. The therapy can be carried out usually as an outpatient.
Permanent seed brachytherapy (internal radiation), also known as "seed implantation" or "prostate Cerclage", the insertion of weakly radioactive, as rice grain large titanium pins through fine needles is through in the prostate - so without cutting operation!
It is given a precisely calculated high radiation dose directly into the prostate. Since the radiation far reaches only a few millimetres, this significantly reduces the radiation exposure to the surrounding tissue so that there are fewer side effects. The idea of permanent seed brachytherapy (also low dose rate (LDR) brachytherapy called) is that the local application of the radiation source allows a higher dose of stove in the prostate, while largely sparing the surrounding tissue. It must be not only blasted through healthy tissue, to reach the tumor.
While the radiation at the time, the small titanium pins easily stay in the prostate. Brachytherapy can be performed alone or in combination with hormone therapy or external irradiation. Usually it's only a short hospitalization, it directly then all physical activities can be resumed.
Seed brachytherapy is also "persistent low dose rate (LDR) brachytherapy" named because the weak radioactive seeds in the prostate to remain, even after the radiation has ceased completely after about a year. In contrast, if the so-called "high dose rate (HDR) brachytherapy" not permanent process, whereby a radiant element is driven by tubes inserted into the prostate usually in several meetings in and out again. The hoses are removed after the irradiation. The single dose of this HDR brachytherapy is higher and is usually combined with a monthlong external radiotherapy.
In the latest treatment of prostate cancer, the chemotherapy is applied today if the tumor is no longer is limited on the prostate and despite hormone therapy not brought under control can be. There are today relatively well-tolerated chemotherapy drugs available for this situation.
The best for him therapy - concept must be created individually for each patient. This requires special medical knowledge and experience with treating cancer and dealing with cytotoxic drugs. Often, to adopt treatment modality is interdisciplinary decided that Oncology is experienced doctors of various therapy discuss together the therapeutic approach best for the patients.
Prostate cancer cells need to grow the male sex hormone testosterone, a finding which was rewarded with the Nobel Prize in 1966. The prostate tumor cells it prevents the formation of testosterone, it drains a large part of their diet. This is the hormone therapy comes in. You inhibit the formation and effects of the male sex hormone testosterone - so of the hormone, which promotes the growth of existing prostate cancer.
Hormone deprivation leads rarely to a complete regression of prostate cancer, but very often to a halt of the progression. This growth arrest can take a long time.
When the patient of undergoing hormone therapy is subjected, reduces the levels of male hormones. This lower hormone levels can affect all cells of prostate cancer, even though they might have spread in other parts of the body.
There are several forms of hormone therapy. She can consist of surgical removal of hormone-producing glands (testicular tissue). This operation, known as Orchiectomy, eliminated the main source of male hormones.
Another form of hormone therapy is the application of an agonist of the hormone, which releases the luteinizing hormone (LH) (luteinizing hormone releasing hormone = LHRH).
This mechanism of action for Suppression of testosterone is not easy to understand: endogenous LHRH is intermittently released in healthy brain cells in the bloodstream and causes a release of luteinizing hormone (LH) from the pituitary (Hypophysis). LH in turn promotes testosterone production in the testes. Is now the body an LHRH similar active ingredient, a so called LHRH analogue (analogue = similar construction) led to permanently, so the normal, assigned to fits and starts stimulus mechanism USA and stop the production of testosterone. An LHRH agonist as a drug therefore prevents the production of testosterone by the testes.
The Antiandrogens are another active ingredient group of hormone therapy. Anti androgens prevent not the production of the hormone, but the effect of hormones. Anti androgens are widely used at the beginning of hormone deprivation therapy with LHRH analogues. It comes to beginning hormone deprivation therapy with LHRHAnaloga regularly to a short-term increase of in testosterone levels, which can lead to a temporary reinforcement of certain symptoms of illness (such as onset or increase in bone pain, urinary way constriction, muscle weakness and others). This increase of complaints is usually spontaneous. An additional gift of an anti-androgen at the beginning of therapy can alleviate these symptoms.
Another treatment option is the constant additional administration of Antiandrogens. After Orchiectomy or treatment with an LHRH agonist, no additional testosterone is formed in the body more in the testes. However the adrenal glands produce also small amounts of male hormones. In some cases can be in addition an antiandrogen patients, to prevent even this remaining hormonal effect. This treatment combination is called a maximum or total androgen blockade.
In a further form of therapy, the patient receives the female hormone estrogen to counteract the production of testosterone in the testes.
The growth and the spread of cancer cells of prostate cancer may be associated with the hormone therapy for a period of time, often over several years, to a standstill.
Some prostate cancers have the ability to continue growing despite a lack of male hormones or regain this ability in the course of time. If this occurs, hormone therapy is ineffective, and the doctor must propose other forms of treatment. A form of such treatment can be for example a chemotherapy.
Bisphosphonates accumulate in the bone, making it more resistant and prevent degradation of bone substance. These substances mean a great step forward in the treatment of advanced prostate cancer. Bisphosphonate drugs relieve pain and reduce skeletal complications in a bone infestation due to prostate cancer. They reduce the risk for bone fractures and can bring about a lowering of pathologically elevated calcium levels. Hormonally-treated patients, the risk of osteoporosis can be reduced by an accompanying bisphosphonate therapy probably.
Alternative methods: HiFu, cryogenic and laser therapy
Currently, some new procedures is checked whether they are suitable for permanent cure of prostate cancer. These methods include:
Intense, highly focused ultrasound (HIFU), the removal of the tumor by cold (Cryo ablation), and the use of laser.
All these methods attempt a removal of the tumor tissue by physical means (cold, ultrasound, laser). The benefit of these treatments is a low rate of side effects and the possibility of repeated applicability. The disadvantage is that even these methods only for the treatment of tumors are suitable, which are limited on the prostate gland and have not already spread to distant location or surrounding tissue.
Unfortunately these treatment methods are already advertised as an alternative to the radical prostate surgery or radiotherapy, but still not in the long run proved their effectiveness and equivalence as a healing method.
In contrast to all above mentioned local (localized) therapies are so-called systemic, usually drug treatments that can work on the whole body and hence cancer cells outside the prostate. Usually in addition to local procedure used, or when the prostate cancer is already too far advanced. In advanced prostate cancer, hormone therapy is performed frequently at first. A combination of hormone therapy with radiation therapy is often used. A better effect of irradiation is associated with itself.
Drug treatment can kill in addition cancer cells during and after irradiation, which have not been destroyed by the rays.