Prostate Cancer treatments
It is the commonest malignant tumor in humans. The adenocarcinoma of the prostate is up, however, that third of cancer deaths. Indeed, its evolution is variable and through early detection and adequate treatment, the disease is tackled effectively.
Some prostate cancers develop slowly while others tend to spread quickly. The degree of aggressiveness is highly variable. The likelihood of contracting such a disease increases with age. Depending on the progress of cancer, there are various treatment options.
Treatment of cancer of the prostateEn advanced cancers, treatment is hormonal or radiation-hormonal (combination hormone treatment and radiotherapy). The hormone is associated with chemotherapy (palliative treatment in cancer cases with metastases).
Hormonal medication does not “disappear” the adenoma of the prostate and thus requires regular monitoring of the patient.
When the tumor is localized in the prostate (stage T1 and T2), the current reference treatment are surgery and radiotherapy.
Radical prostatectomy
This solution is to surgically remove the prostate, seminal vesicles, the vas deferens, a part of the neck of the bladder and surrounding lymph nodes. When prostate cancer is localized, it is the benchmark treatment for young patients. This removal is done at a relatively heavy (3 to 4 hours) but very well controlled. The postoperative mortality at thirty days is less than 1% in patients under 75 years of age in good general health. In terms of efficacy, survival to 10 years is 90%. However, this treatment has side effects that are essentially impotence and urinary incontinence. Contrary to what was previously thought, these two complications can diminish up to two years after the opération1. Patients should be encouraged and advised that the improvement of their condition may last for months or years after the operation.
External radiation
External radiation therapy involves exposing the prostate to radiation. These rays of very high energy create lesions in the DNA of the cell nucleus. Faced with this assault, the cells respond with a less efficient repair in cancer cells. Thus, radiation preferentially causes cancer cell death. This treatment requires no anesthesia and is generally delivered during regular sessions over several weeks.
In terms of efficiency, the 10-year survival is 70%. Complications may include inflammation (rectites which is an inflammation of the rectal mucosa), intestinal, urinary, sexual (erectile dysfunction) and urinary disorders.
External radiation therapy is recommended for older patients or with other health problems.
Evaluation of treatment by the ANAES
At the request of the Caisse Nationale d’Assurance Maladie, l’Agence Nationale d’Accreditation et d’Evaluation en Santé (ANAES) conducted a study of data available to assess the efficacy and safety of treatment of prostate cancer . Released in January 2001, the report concludes that only the prostate ablation and radiotherapy by external have proved effective, none of the two methods seemed to outweigh the other.
The ANAES wishes to clarify that “the patient must have at least 10 years of life expectancy to gain one of these two treatments. For a lower life expectancy, monitor the cancer seems to be preferable. Thus, patients should preferably be young and have benefited from early detection of disease. Given the possible effects of different treatments, the Agency recommends that the patient be “integrated in the therapeutic decision.” Doctors are obliged to inform the patient about the pros and cons of both techniques.
As for the other proposed techniques, experts are cautious, emphasizing the lack of comparative studies and a long-term effectiveness and side effects. But what are these techniques?
Alternatives recent
Recently new techniques have been developed in order to minimize side effects and complications of the two reference treatments. Among these are:
* The brachytherapy or brachytherapy: This treatment, proposed in some centers, is to be implanted in the prostate of the radioactive seeds that will destroy cancer cells. Brachytherapy has demonstrated its effectiveness in the United States and is being evaluated in France;
* Surgery coelioscopique by which estimates the ANAES “still insufficient data to provide the patient the equivalent of surgical treatment of reference”;
* Cryotherapy and treatment by focused ultrasound, which remain under ANAES the field of experimentation.
All these techniques have the advantage of being less invasive, but currently we do not have enough back in terms of effectiveness and side effects. Further studies are needed before any of these techniques can be officially recommended.