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Side effects of prostate cancer treatment

Hormonal therapy for prostate cancer

Prostate cancer is one of the most serious problems of modern medicine. According to statistics, this common disease is in second or third place among the causes of death from malignant neoplasms. Hormonal treatment of prostate cancer is widely used in modern oncology and gives good results.

Thus, in the United States, the number of diagnosed cases was 317 thousand per year (according to 1996), while more than 41 thousand deaths from this disease were recorded. If at the end of the 80s the number of cases of Prostate cancer (PT) was 8.4 per 100 thousand people, then after 10 years the incidence increased to 11.3 per 100 thousand. And the mortality rate from this pathology reached 18.5% .

Hormonal treatment of prostate cancer

The causes of malignant neoplasms in the prostate are still not fully understood. But today, many experts agree that the mechanism of development of such diseases is associated with a change in the background of sex hormones due to endocrine dysfunction. Such disorders may be due to the peculiarities of the hypothalamic-pituitary system associated with changes in the processes of hormone formation in the testicles and adrenal glands.

The dependence of the prostate on the testicles is confirmed by the fact that in a castrated animal, it begins to atrophy.

The study of the hormonal background of patients with pancreatic cancer confirmed a significant increase in the level of androgens relative to estrogen. Also, in these patients, the amount of gonadotropins in the urine increases, the level of a number of 17-ketosteroids decreases, and the ratio of estrogenic fractions changes.

Numerous studies and medical practice have confirmed the high sensitivity of prostate tumors to hormone treatment. At the moment, hormone therapy is considered the most promising way to combat PROSTATE CANCER. The results of its application surpass the effect of other common methods (surgery, chemotherapy and radiation therapy). First of all, hormonal treatment is indicated for a local tumor process that captures areas outside the pancreas, as well as in case of detection of metastases, that is, at stages C and D according to the Jew-Whitemore system adopted by American urologists (the classification of prostate cancer can be found on our website ). In stage C, after a course of hormonal drugs, Surgical treatment (prostatectomy) is possible. In stage D, the goal of hormone therapy is to reduce the effects of male hormones, which activate the growth of prostate epithelial cells.

The goal of therapy for early-stage prostate cancer is known to be the complete cure of the patient. For early detection of a tumor, screening is recommended - an annual analysis for the level of PSA (for some men, such a study is recommended every six months). With a positive result, a digital examination is carried out and echography is performed transrectally. This technique is very informative - it allows you to detect prostate cancer in 95% of cases. But, according to oncologists of the Russian Academy of Medical Sciences, the majority of men who seek medical help already have metastases (in 60 - 80% of cases).

For many years, synthetic estrogens have played an important role in hormone treatment. These are drugs such as fosfestrol, honvan, sinestrol. Many authors have evidence that five-year survival after courses of such hormones reached 18-22%.

At the same time, today the use of such hormonal drugs has to be limited due to pronounced Side effects. After taking synthetic estrogens in patients, immunity is often suppressed, blood clotting is disturbed, and disturbances occur in the work of the cardiovascular and digestive systems. In some cases, even death was noted. Due to the possibility of complications, a course of estrogens is currently used only as a second-line therapy.

Another type of drug currently in use is luteinizing-releasing hormone (LH-RH) analogues. This group includes the drugs leuprorelin and goserilin.

Goserilin is a synthetic analogue of LH-RH, and therefore has the ability to inhibit the release of luteinizing hormone by the pituitary gland. Because of this, the level of testosterone in the patient's blood serum drops (this process is completely reversible). At the same time, it is interesting to note that at an early stage of therapy, the drug can provoke a short-term increase in testosterone levels.

With prolonged use, there is a suppression of the usual release of LH-RH, and the susceptibility of receptors to it worsens. The main side effect of this therapy is the appearance of ERECTILE DYSFUNCTION. For this reason, in some cases, the drug is canceled. Also in the process of treatment in men, arthralgia is observed, blood pressure rises.At the beginning of the course of treatment, pain in the bones may increase.

An important place in the practice of treating pancreatic cancer is occupied by drugs that have an antiandrogenic effect. These are androgen receptor antagonists. At the moment, there are drugs with both steroidal and non-steroidal structures. The first group includes megestrol acetate and cyproterone acetate, and the second group includes bicalutamide, flutamide, nilutamide. The drugs of the last group are much easier to tolerate and do not give as many side effects as drugs with a steroid structure.

Flutamide is one of the widely used and well-studied agents. The action of the drug is based on the ability to inhibit the binding of testosterone and dihydrotestosterone (DTH) to receptors, as a result of which the manifestation of their biological effect is difficult.

The indisputable advantage of flutamide is that it does not reduce the concentration of testosterone in plasma and the patient's potency does not worsen. However, it should be noted that an increased concentration of testosterone sometimes negatively affects the result of treatment, since the receptors are "unblocked". For this reason, flutamide is often combined with other drugs (goserilin or leuprolide). The effectiveness of this combination has been proven by several controlled studies. The results confirmed that combined therapy courses increase life expectancy not only in patients with early stages of prostate cancer, but also in the case of a widespread tumor process.

So, during one of these studies, experts evaluated the possibilities of combined hormonal courses before surgery. It turned out that the combination of flutamide with an LH-RH agonist gives a noticeable result - the number of resectable tumors increased by 28%, that is, they can be removed surgically.

But even therapy with an antiandrogen alone can give a good therapeutic effect. Specialists involved in studies of the effects of such drugs give the following data: in 20-78% of patients, the malignant tumor partially regresses, in 16-43% of cases the process stabilizes, in 2-20% of patients the disease continues to progress. When antiandrogens were combined with castration (medication or surgery), the results of treatment were as follows: 40-80% partial regression, 16-53% stabilization, 1-16% further tumor growth.

Side effects of hormone therapy for prostate cancer

One of the most common complications of hormone therapy, which greatly worsens the quality of life of the patient, problems with potency and a decrease in sexual desire. After completion of the course of treatment, potency, as a rule, returns to normal. Hot flashes are another typical side effect. During the flush, the patient feels hot, his pulse quickens and sweating increases. Such conditions do not occur immediately, but after three months of the hormonal course and can disturb the patient for a long period. To reduce unpleasant manifestations, additional hormonal agents and even antidepressants are prescribed.

Other side effects of hormonal treatment of pancreatic tumors include:

G Feeling constantly tired;

G Breast enlargement and pain in it;

G Osteoporosis, spontaneous bone fractures not associated with metastases.

G Metabolic disorders leading to weight gain and reduced muscle tone. Moreover, sarcopenia and excess body weight are complications that appear already in the first year of hormone therapy. The patient can gain up to 10% fat and lose about 3% muscle mass.

G Violations in the activity of the cardiovascular system, heart attacks, pressure surges.

G Memory problems.

G Risk of developing diabetes.

Prevention of side effects in prostate cancer hormone treatment

Prevention of the development of these complications includes the following activities:

Compliance with the diet. Men undergoing hormone therapy are advised to reduce the amount of fat in their diet. It is also desirable to use less salt and spices. Healthy food - vegetables, fruits, dairy products. It is recommended to eat often, in small portions. With a deterioration in appetite, you can not refuse food. To prevent the development of osteoporosis, you need to consume more calcium and vitamin D. The correct diet is usually helped by a doctor. If necessary, he will advise vitamin preparations.

Refusal from cigarettes and alcohol.

Limit caffeinated drinks.

Compliance with the daily routine, regular rest, eating at the same time.

Be outdoors.

Moderate exercise (under no circumstances should overexertion be allowed). It is better to coordinate the lesson plan with your doctor.

Hiking with a gradual increase in their duration.

Consumption of adequate fluids (about two liters per day).

It is also advisable to avoid nervous strain, stress and be careful, protecting yourself from bruises and other injuries.

When to start hormone treatment for prostate cancer

The question of the timing of hormone therapy in patients with pancreatic cancer has not yet been resolved. It is not yet clear when exactly you should start taking hormones: immediately after the discovery of a locally advanced tumor / asymptomatic cancer with metastases, or only when there are clear signs of disease progression.

There is no consensus on this issue due to the fact that a sufficient number of controlled studies have not been conducted. The studies carried out so far cannot be considered accurate, since they involved very few patients, and there was no stratification by cancer stage (locally advanced process, metastatic cancer, lymph node involvement).

For this reason, recommendations for when to start therapy are based on a report from the US Agency for Health Care Policy and Research. The report presents data supporting the important role of early hormone therapy in improving survival rates. In doing so, the report refers to a number of studies where hormonal treatment was prescribed as primary therapy. However, a generalized analysis did not reveal a significant difference.

In addition, some authors argue that androgen blockade (chemical castration) is more economically and psychologically justified when it is prescribed after the development of symptoms associated with metastases.

In another study, patients with a common tumor process took part. They underwent courses of early and delayed treatment with hormonal drugs. Such therapy was carried out both as primary and as adjuvant after surgery. The results obtained confirmed that early hormone therapy can stop the further development of the disease and prevent complications. But at the same time, it does not affect tumor-specific survival rates and only slightly improves overall survival (the risk of death decreases by about 5% after 10 years).

Recently, the feasibility of early hormonal treatment in patients with stage N + (according to the TNM system) and who have undergone prostatectomy has been called into question. Doubts of physicians are caused by several reasons. One of them is a micrometastatic lesion of only one node, which cannot be equated with the extensive metastasis to the lymph nodes, which is mentioned in the study.

More than 700 cases were analyzed by American experts, as a result of which scientists came to the conclusion that the effectiveness of early hormone treatment after removal of the prostate in stage N + is very doubtful.

After the introduction of PSA screening (blood test), approximately the same results were obtained. The difference was a slight improvement in overall survival. The tumor-specific survival rate remained unchanged. Moreover, it has been confirmed that only young patients with elevated PSA can expect a good result of early hormone treatment.

A review of the scientific literature (ASCO American Society of Clinical Oncology guidelines) regarding primary hormonal treatment in patients diagnosed with androgen-dependent metastatic recurrent or progressive prostate tumors concludes that it is currently not possible to formulate clear guidelines related to timing implementation of hormonal therapy in a common but asymptomatic malignant process. This will be possible only after the publication of data obtained as a result of scientific research using modern diagnostic techniques and standardized follow-up schemes.

Meta-analysis leads to the conclusion that treatment is economically and socially justified only in the event of the onset of symptoms of the disease. The data of modern studies do not confirm the positive effect of monotherapy with antiandrogenic drugs on long-term outcomes in patients with localized prostate tumor after the use of non-radical methods of treatment. The expediency of using monotherapy after a course of radiation has not yet been proven.

Several randomized controlled trials have shown the following result: the combination of radiation therapy with an auxiliary hormonal course increases the period before the onset of tumor progression in patients with localized or locally advanced forms of cancer (provided that the disease is asymptomatic). In addition, the overall survival rate is improved compared to treatment regimens when hormone-delayed radiation therapy is used.

Indications for hormone therapy in patients with prostate cancer

Hormonal treatment or chemical castration indicated:

1. M1 with symptoms. Removal of discomforting symptoms and prevention of serious complications (fractures, ureteral obstruction, metastases outside the bones, spinal cord compression). Although there are no controlled studies, castration is a standard treatment.

2. M1 with no symptoms. With the help of early castration, you can prevent the occurrence of unpleasant symptoms and serious consequences caused by the development of the disease. If the main goal is to prolong the patient's life, dynamic monitoring of the patient's condition is considered an acceptable tactic.

3. N+. Early castration improves patient survival (relapse-free and overall). After removal of the prostate and pelvic lymphadenectomy in patients with micrometastases, the feasibility of castration has not been confirmed.

4. M0. Locally widespread process. Early castration is an effective method of increasing relapse-free survival.

- Locally advanced tumor after a course of irradiation.

- High-risk prostate cancer (D-Amico classification). Treatment with hormones (combined and prolonged) is indicated.

- Prostate cancer (moderate risk according to D-Amico classification).

Contraindications for hormonal treatments for prostate cancer

1. Complete chemical castration is contraindicated if the patient is psychologically unprepared for such a procedure.

2. Taking estrogens is contraindicated in cardiovascular pathology.

3. Monotherapy with the use of LH-RH agonists is a tumor process with metastases and a high probability of the so-called "outbreak".

4. Antiandrogen therapy - as the primary treatment for patients with localized tumor.

Prognosis for hormonal treatments for prostate cancer

The prognosis for malignant tumors depends on how differentiated the tumor is and at what stage of prostate cancer it was detected.

In patients with stage M1 prostate cancer, the median overall survival is 28-53 months. And only a small number of patients (about 7%) who received hormone therapy live at least 10 years. Also, the prognosis depends on the level of PSA, Glisson scores, the degree of metastatic process, the presence of symptoms associated with bone damage. In patients with locally advanced process, the median survival is usually greater than 10 years.

Side effects of prostate cancer treatment

SIDE EFFECTS OF THE treatment of prostate cancer Improvements in the treatment of prostate cancer have significantly reduced the severity of side effects over time. However, it is important to understand how and why these effects occur and how best to minimize these effects, if any.

In the treatment of prostate cancer, there are usually six categories of side effects:

Intestinal dysfunction

Erectile dysfunction (impotence)

Infertility (impaired fertility)

Effects associated with decreased testosterone levels

Side effects of chemotherapy

The occurrence and severity of these effects depends on the cancer treatments used. It is also important to understand that some symptoms are not so terrible for the patient, and some may require immediate medical attention.

Urination disorders are divided into Urinary incontinence, which can be of varying severity, and irritation of the urinary tract, which are manifested by pain and burning during urination, as well as frequent urination. Urinary dysfunction is the most common side effect of prostate cancer treatment. Especially during surgical treatment (prostatectomy).

This complication occurs in approximately 25% of men undergoing surgical treatment for prostate cancer. Within six months after treatment, they are forced to use special absorbent pads. About a year after treatment, the percentage of such men decreases to 10.

With external radiation therapy, there may be irritation of the mucous membrane of the bladder and urethra, or swelling of the prostate. Most of these symptoms improve over time without any medical intervention. In 10% of men, these symptoms may persist. After 2 years, Drug treatment is required to eliminate them.

After brachytherapy, urinary symptoms are more pronounced. During the first six months after the implantation of radioactive seeds, these symptoms occur in 70% of cases. This requires medical treatment. After two years, the number of such patients decreases to 25%.

Urinary incontinence is a common complication of prostate cancer surgery and radiation therapy in men. You should prepare for this complication and understand that at least some time incontinence will occur after treatment for prostate cancer.

There are different types of urinary incontinence and different degrees of severity. In some men, this can be expressed in the release of a couple of drops, and in some, in a rather pronounced release of urine. The most common type of urinary incontinence after surgery for prostate cancer is the so-called stress urinary incontinence, when urine is released when coughing, sneezing, laughing. On the other hand, the need to urinate frequently with episodes of urination often complicates radiotherapy for prostate cancer.

Why urinary incontinence occurs

Let's first look at how the bladder holds urine. When urine enters the bladder through the ureters from the kidneys, it is stored there until the urge to urinate appears. The bladder is a hollow sac, the wall of which has a muscular layer - the so-called detrusor muscle. When the bladder contracts, urine exits it through the urethra (urethra). At the same time, the muscles surrounding the urethra relax and urine can flow out of the bladder. In addition to muscles, the prostate also surrounds the urethra. When it increases (with adenoma, cancer), it squeezes the urethra, and to empty the bladder, a man has to push to increase intra-abdominal pressure in order to push urine out of the bladder with force.

Removal or destruction of the prostate after radiation therapy (external beam radiation therapy or brachytherapy) interferes with the storage of urine in the bladder and can lead to urinary incontinence.

In addition, radiation therapy can cause a decrease in bladder capacity and spasms that help empty the bladder. Sometimes surgery can affect the nerve fibers that are involved in bladder emptying.

When removing the prostate, surgeons usually try to preserve as much of the tissue around the bladder and the sphincter muscle around the urethra, thus limiting damage to the sphincter, which is responsible for holding urine in the bladder. In addition, in brachytherapy, doctors today use computer simulations to set the radioisotope grains so that they have an effect on prostate tissue, and the effect on the bladder would be minimal.

However, it is not yet possible to completely get rid of urinary incontinence after prostatectomy or radiation therapy, and you need to be prepared for this complication. New treatment techniques allow, in some cases, to reduce the duration of this complication, and in most cases, restore normal bladder function.

Treatment targeting the pelvic floor muscles. These are the so-called Kegel exercises, which train the muscles of the pelvic floor. Their meaning lies in the fact that the man is trying to stop the act of urination in the middle, thus actively training the muscles.

Supportive therapy. This includes changing your behavior, such as drinking less liquids, avoiding caffeine, alcohol, spices, and not drinking liquids at night. It is recommended to urinate regularly, without waiting for the urge. In some patients, weight loss may be effective. In addition, it is important to change drugs that can cause urinary incontinence.

Drug treatment. Various medications can increase bladder capacity and decrease the frequency of urination. In order to manage the symptoms of side effects after radiation therapy, drugs that improve urination are usually used. All patients who have undergone radiation therapy for prostate cancer are prescribed alpha-blockers (tamsulosin, terazosin). They are taken for a few weeks and discontinued as symptoms improve.

If drug treatment has not been successful, minimally invasive methods are used. One of these methods is the introduction of collagen into the urethra. After this procedure, the urethra becomes denser, and the lumen narrows. This leads to a reduction in the symptoms of urinary incontinence. More than half of the patients after such a procedure have a positive effect, but it does not last long.

Neuromuscular electrical stimulation. This treatment aims to strengthen the weak bladder muscle and improve urinary control. The treatment consists in inserting a probe into the patient's rectum, through which electrical signals are applied, up to the pain threshold. These signals cause muscle contractions. The patient should squeeze the muscles while passing an electric current through the probe. After muscle contraction, the electrical signal stops.

Surgical treatment, injection therapy and devices.

An artificial sphincter. This device consists of a pump, a pressure-controlled balloon, and a cuff that surrounds the urethra. The patient himself regulates such an artificial sphincter. The effectiveness of such an artificial sphincter is achieved in 70-80% of patients.

Bulbourethral sling.A sling is a garter made of synthetic material or the patient's own tissues that supports and compresses the urethra, which helps control urination.

Other surgical methods. Other surgical treatments for urinary incontinence include the implantation of rubber rings around the bladder neck to improve sphincter function.

GI DISTURBANCES

Impaired bowel function is diarrhea (frequent loose stools) and fecal incontinence, as well as bleeding during bowel movements. These side effects are most common with external beam radiation therapy. The appropriate selection of the course of radiation therapy and the dose of radiation allows to reduce the risk of this complication.

Impaired bowel function during prostatectomy is rare, and in the first weeks after surgery. This side effect is the result of the "addiction" of the body to the increased volume after the removal of the prostate.

With radiation therapy, radiation penetrates not only into the prostate tissue, but also, due to its close proximity, into the tissue of the rectum, thereby affecting it. With brachytherapy, this complication is much less common, since in this case, the radiation does not penetrate too "far" outside the prostate gland.

After radiation therapy, the effects of radiation on the rectum increase, that is, they seem to accumulate. After 2 years, 10% of men have diarrhea up to several times a week, while rectal bleeding increases from 5% immediately after treatment to 25% after 2 years.

Modern methods of external beam radiation therapy can achieve a significant reduction in these side effects of intensity-modulated radiation therapy and three-dimensional conformal radiation therapy. At the same time, in patients who underwent intensive modulated radiation therapy, after two years, the incidence of bowel dysfunction remained low and amounted to 5%. With brachytherapy, the incidence of this complication is also low.

If this complication occurs, you should consult a doctor, and not self-medicate.

The treatment for this complication is to use a diet that does not irritate the intestines. The fact is that this complication is due to the fact that as a result of exposure to radiation on the rectal mucosa, inflammation occurs, which can be of varying severity: from simple inflammation to the formation of ulcers and erosions (as a result of bleeding).

To treat this complication, sea buckthorn oil enema, vitamins A and E and other drugs are used that promote healing of the affected rectal mucosa.

IMPOTENCE (ERECTILE DYSFUNCTION)

Impotence, or as it is also called now, erectile dysfunction, is the absence of an erection or the appearance of an erection that is insufficient for sexual intercourse.

While prostate cancer itself does not cause impotence, erectile dysfunction can be caused by treatment with prostate cancer.

When undergoing nerve-sparing surgery or fine-tuned brachytherapy, in the treatment of prostate cancer, during the first months of treatment, almost all men experience impotence in varying degrees of severity. The nerves and blood vessels responsible for erection are very delicate and sensitive to any slightest injury, this is the cause of impotence.

With the integrity of nerve fibers during the year in men, there is a gradual improvement. The same erection as before treatment is observed after a year in half of the patients who underwent surgery using the nerve-sparing technique, and after two years in 75% of patients.

These indicators are better in patients who have undergone radiation therapy, but at the same time, a longer period for the restoration of lost function is characteristic. After remote radiation therapy, impotence occurs in 50% of men, and after brachytherapy in 25%.

If the patient has undergone treatment that was not aimed at preserving the integrity of the nerves, the situation with erection worsens significantly.

Also, if the patient suffers from diseases such as diabetes mellitus, atherosclerosis, in which there is a violation of blood flow in the vessels, this also significantly impairs erection recovery.

With hormone therapy, Erectile dysfunction may occur approximately 2-4 weeks after the start of treatment. There may also be a decrease in libido (sexual desire), which is associated with a decrease in the level of male sex hormone in the blood.

A lot of methods have been proposed for the treatment of impotence. These are surgical methods, drug treatment and special mechanical devices.

The best-known medications for treating impotence are sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These drugs relax the muscles of the penis and allow blood through the blood vessels to fill the corpora cavernosa. These drugs begin their action one hour after ingestion.The effect of Viagra and Levitra lasts about 8 hours, and Cialis 36 hours. 75% of men who have undergone nerve-sparing prostatectomy or selective radiotherapy report the effectiveness of these drugs.

These drugs are not suitable for all patients. These three drugs change the mechanism of action of drugs that are used in the treatment of angina pectoris. As a result, the patient's blood pressure may drop sharply. In addition, these drugs affect the mechanism of action of alpha-blockers of drugs used to treat prostate adenoma.

If oral drugs for the treatment of impotence (Viagra and others) are ineffective, injections into the genitals may be an effective treatment for men after radical prostatectomy or radiation therapy. Injection therapy achieves erection in 60-80% of men with erectile dysfunction after prostate cancer treatment

Penal suppositories. This drug is in the form of a suppository (candle) for injection into the urethra using a plastic applicator. The suppository in its composition contains the drug alprostadil, which is absorbed into the cavernous bodies of the penis. Alprostadil relaxes the muscles in these bodies and allows blood to flow into the penis. This method is effective on average in 30% of men.

In the case when the patient cannot or does not want to use these drugs, he has the opportunity to use some mechanical devices.

Vacuum device. A special cylinder is put on the penis, which is tightly fixed on it. Further, air is pumped out of it, that is, a vacuum is created. As a result of this, blood tends to the penis, filling its cavernous bodies, which is manifested in the onset of an erection. Further, a cuff is left on the base of the penis, which maintains an erection for a certain time. On average, this is enough for half an hour. Although these devices are effective in achieving an erection, patients after prostate cancer surgery are not very fond of such restoration of an erection. Many patients do not like to use the cuff on the base of the penis and find it uncomfortable.

Surgical treatments

Surgical treatments for impotence are used when all other methods fail.

One of the most common methods is the introduction of implants. The effectiveness of this method reaches 100%, while 70% of men who choose this method remain with these implants even after 10 years.

With surgical treatment or radiation therapy, despite all possible attempts by doctors, a man becomes infertile after treatment. During the operation, the prostate itself is removed, the most important organ involved in the formation of sperm, and the seminal vesicles "storage" of sperm, which are involved in the formation of its composition. Removal of the prostate and seminal vesicles makes it impossible to ejaculate.

Radiotherapy also leads to infertility. Irradiated cells of the prostate and seminal vesicles cannot produce the necessary sperm components responsible for sperm motility.

Solving the problem of infertility

To date, medicine has made great strides in the treatment of infertility in men. However, the results of treatment do not lead to the restoration of fertility. They are just auxiliary methods to help fertilize the egg.

The most acceptable is the use of sperm from a cryopreservation bank. Prior to treatment, the man donates his sperm, which is instantly deep-frozen in liquid nitrogen. In this state, sperm can be stored for quite a long time.

IVF/ICSI is another method that allows you to fertilize an egg. In this case, spermatozoa are taken by biopsy using a syringe directly from the testicle. With the help of special procedures, the most viable spermatozoa are isolated. This is followed by a procedure known as in vitro fertilization (IVF). For this, an egg is taken from the woman's ovary. Fertilization is carried out outside the woman's body (in vitro). After a certain time, the resulting new organism is placed in the woman's uterus.

These methods cannot currently guarantee 100% success, but their effectiveness is gradually improving.

Today, in Israel, breast cancer can be completely cured. According to the Israeli Ministry of Health, Israel currently has a 95% survival rate for this disease. This is the highest rate in the world

Today, the standard of care for clinically localized prostate cancer (i.e., limited to the prostate), and therefore curable, is either various surgical methods or radiation therapy methods (brachytherapy). The cost of diagnosing and treating prostate cancer in Germany will be from 15,000 to 17.000

This type of surgical treatment was developed by the American surgeon Frederick Moss and has been successfully used in Israel for the past 20 years. The definition and criteria for Mohs surgery was developed by the American College of Mohs Surgery (ACMS) in collaboration with the American Academy of Dermatology (AAD).

• Breast cancer
• Oncogynecology
• Lung cancer
• Prostate cancer Risk factors for prostate cancer
• Prostate cancer symptoms
• Classification of prostate cancer
• Prostate cancer diagnosis
• Prostate cancer digital rectal examination
• Prostate cancer - PSA testing
• Prostate cancer - ultrasound
• Prostate cancer - biopsy
• Prostate cancer MRI
• Prostate cancer - computed tomography (CT)
• Prostate cancer - cystoscopy
• Prostate cancer - genetic tests
• Prostate cancer - endolgin tests
• Prostate cancer treatment
• Prostate cancer: expectant management
• Prostate cancer - radical prostatectomy
• Prostate cancer - robotic prostatectomy
• Prostate cancer - complications of surgical treatment
• Prostate cancer - surgical treatment and survival
• Prostate cancer - cryosurgery
• Prostate Cancer - High Intensity Focused Ultrasound (HFU)
• Prostate cancer - lumpectomy
• Prostate cancer lymphadenectomy
• Prostate cancer - chemotherapy
• Prostate cancer - hormone therapy
• Prostate cancer - PSA levels during hormone therapy
• Prostate cancer - hormone therapy and diabetes
• Prostate cancer - radiotherapy
• Prostate cancer - targeted therapy
• Prostate cancer - experimental treatments
• Side effects of prostate cancer treatment
• Prostate cancer and fatigue
• Early stage prostate cancer
• Locally advanced prostate cancer
• Treatment of locally advanced prostate cancer
• Locally advanced prostate cancer - hormone therapy
• Locally advanced prostate cancer - surgical treatment
• Locally advanced prostate cancer cryosurgery
• Local advanced prostate cancer high-intensity focused ultrasound
• Metastatic prostate cancer
• Prostate cancer - bone metastases
• Recurrent prostate cancer
• Prevention of osteoporosis in prostate cancer
• Prevention of prostate cancer
• Prostate cancer vaccination
• Nutrition and prostate cancer
• Prostate cancer vitamins and minerals
• Prostate cancer - fruits and vegetables
• Prostate cancer - dishes from tomatoes in the diet of men
• Prostate cancer - meat and fat
• Prostate cancer - ginseng and flaxseed
• Prostate Cancer - Recommended Diet
• Prostate Cancer - Soy Diet
• Prostate cancer - low carbohydrate diet
• Prostate Cancer - Vegetarian Diet
• Prostate cancer treatment in Germany
• Prostate cancer treatment in Israel

Nano-knife cancer treatment

Nano-Knife is the latest technology for the radical treatment of pancreatic, liver, kidney, lung, prostate, metastases and cancer recurrence. The NanoKnife electrocutes soft tissue tumors, minimizing the risk of damage to nearby organs or blood vessels.

CyberKnife cancer treatment

The CyberKnife technology was developed by a group of doctors, physicists and engineers at Stanford University. This technique was approved by the FDA for the treatment of intracranial tumors in August 1999, and for tumors elsewhere in the body in August 2001. At the beginning of 2011 there were about 250 installations. The system is actively spreading around the world.

Proton therapy for cancer treatment

PROTON THERAPY radiosurgery of a proton beam or heavily charged particles. Freely moving protons are extracted from hydrogen atoms. For this, a special apparatus is used, which separates negatively charged electrons. The remaining positively charged particles are protons. In a particle accelerator (cyclotron), protons in a strong electromagnetic field are accelerated along a spiral trajectory to a tremendous speed equal to 60% of the speed of light 180,000 km/sec.

Side effects of prostate cancer treatment

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SIDE EFFECTS OF PROSTATE CANCER TREATMENT

Methods of treatment of prostate cancer are constantly being improved. This has significantly reduced the severity of side effects. Still, it is important to understand how and why these effects appear. It is equally important to know how best to minimize these effects.

In the treatment of prostate cancer, there are usually six categories of side effects:

Intestinal dysfunction

Erectile dysfunction (impotence)

Infertility (impaired fertility)

Effects associated with decreased testosterone levels

Side effects of chemotherapy

Some symptoms may require immediate medical attention, and some are not so terrible for the patient.

Urination disorders are divided into urinary incontinence, which can be of varying severity, and irritation of the urinary tract, which are manifested by pain and burning during urination, as well as frequent urination. Urinary dysfunction is the most common side effect of prostate cancer treatment. Especially during surgical treatment (prostatectomy).

This complication occurs in approximately 25% of men undergoing surgical treatment for prostate cancer. Within six months after treatment, they are forced to use special absorbent pads. About a year after treatment, the percentage of such men decreases to 10.

With external radiation therapy, there may be irritation of the mucous membrane of the bladder and urethra, or swelling of the prostate. Most of these symptoms improve over time without any medical intervention. In 10% of men, these symptoms may persist. After 2 years, drug treatment is required to eliminate them.

After brachytherapy, urinary symptoms are more pronounced. During the first six months after the implantation of radioactive seeds, these symptoms occur in 70% of cases. This requires medical treatment. After two years, the number of such patients decreases to 25%.

In order to cope with the symptoms of side effects after radiation therapy, drugs that improve urination are usually used. All patients who have undergone radiation therapy for prostate cancer are prescribed alpha-blockers (tamsulosin, terazosin). They are taken for a few weeks and discontinued as symptoms improve.

If medical treatment is not successful, minimally invasive methods are used.

One of these methods is the introduction of collagen into the urethra. After this procedure, the urethra becomes denser, and the lumen narrows. This leads to a reduction in the symptoms of urinary incontinence. More than half of the patients after such a procedure have a positive effect, but it does not last long.

Surgical methods allow you to get a longer effect. The surgical procedure involves inserting a loop of silicone or tissue from the patient under the urethra. This loop is attached to a muscle or bone. The urethra is then released from the pressure exerted on it by the overflowing bladder. This procedure is effective in 70% of men after prostatectomy.

Intestinal dysfunction

Impaired bowel function is diarrhea (frequent loose stools) and fecal incontinence, as well as bleeding during bowel movements. These side effects are most common with external beam radiation therapy. The appropriate selection of the course of radiation therapy and the dose of radiation allows to reduce the risk of this complication.

Impaired bowel function during prostatectomy is rare, and in the first weeks after surgery. This side effect is the result of the "addiction" of the body to the increased volume after the removal of the prostate.

In 10% of men, 2 years after treatment, diarrhea persists up to several times a week, and bleeding from the rectum increases from 5% immediately after treatment to 25% after 2 years.

In patients who underwent intensive modulated radiation therapy, after two years, the incidence of bowel dysfunction remained low and amounted to only 5%. The same was observed with brachytherapy, in which the incidence of this complication is low.

If this complication occurs, you should consult a doctor, and not self-medicate.

Treatment for this complication is to use a non-irritating diet.

For the treatment of this complication, enema products with sea buckthorn oil, vitamins A and E and other drugs are used that promote the healing of the affected mucous membrane of the rectum.

Impotence (erectile dysfunction) due to prostate cancer

When undergoing nerve-sparing surgery or fine-tuned brachytherapy, in the treatment of prostate cancer, during the first months of treatment, almost all men experience impotence in varying degrees of severity. The nerves and blood vessels responsible for erection are very delicate and sensitive to any slightest injury, this is the cause of impotence.

With the integrity of nerve fibers during the year in men, there is a gradual improvement. The same erection as before treatment is observed after a year in half of the patients who underwent surgery using the nerve-sparing technique, and after two years in 75% of patients.

These indicators are better in patients who have undergone radiation therapy, but at the same time, a longer period for the restoration of lost function is characteristic. After remote radiation therapy, impotence occurs in 50% of men, and after brachytherapy in 25%.

If the patient has undergone treatment that was not aimed at preserving the integrity of the nerves, the situation with erection worsens significantly.

Also, if the patient suffers from diseases such as diabetes mellitus, atherosclerosis, in which there is a violation of blood flow in the vessels, this also significantly impairs erection recovery.

A lot of methods have been proposed for the treatment of impotence. These are surgical methods, drug treatment and special mechanical devices.

Surgical treatments

Surgical treatments for impotence are used when all other methods fail.

One of the most common methods is the introduction of implants. The effectiveness of this method reaches 100%, while 70% of men who choose this method remain with these implants even after 10 years.

The best-known medications for treating impotence are sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These drugs relax the muscles of the penis and allow blood through the blood vessels to fill the corpora cavernosa. These drugs begin their action one hour after ingestion. The effect of Viagra and Levitra lasts about 8 hours, and Cialis 36 hours. 75% of men who have undergone nerve-sparing prostatectomy or selective radiotherapy report the effectiveness of these drugs.

These drugs are not suitable for all patients. These three drugs change the mechanism of action of drugs that are used in the treatment of angina pectoris. As a result, the patient's blood pressure may drop sharply. In addition, these drugs affect the mechanism of action of alpha-blockers of drugs used to treat prostate adenoma.

In the case when the patient cannot or does not want to use these drugs, he has the opportunity to use some mechanical devices.

One such device is a vacuum device. It creates an erection mechanically, forcing blood into the cavernous bodies of the penis. After that, a special rubber ring is put on the base of the penis, which prevents the reverse flow of blood. The imposition of a rubber ring on the base of the penis leads to a cessation of blood flow to the organ, so it must be removed immediately after intercourse.

Male infertility due to prostate cancer

With surgical treatment or radiation therapy, despite all kinds of attempts by doctors, a man becomes infertile after treatment.

During the operation, the prostate gland itself, the most important organ involved in the formation of sperm, and the seminal vesicles "storage" of sperm, which are involved in the formation of its composition, are removed. Removal of the prostate and seminal vesicles makes it impossible to ejaculate.

Radiotherapy also leads to infertility. Irradiated cells of the prostate and seminal vesicles cannot produce the necessary sperm components responsible for sperm motility.

Solving the problem of infertility

To date, medicine has made great strides in the treatment of infertility in men. However, the results of treatment do not lead to the restoration of fertility. They are just auxiliary methods to help fertilize the egg.

The most acceptable is the use of sperm from a cryopreservation bank. Prior to treatment, the man donates his sperm, which is instantly deep-frozen in liquid nitrogen. In this state, sperm can be stored for quite a long time.

IVF/ICSI is another method that allows you to fertilize an egg. In this case, spermatozoa are taken by biopsy using a syringe directly from the testicle. With the help of special procedures, the most viable spermatozoa are isolated. This is followed by a procedure known as in vitro fertilization (IVF). For this, an egg is taken from the woman's ovary.Fertilization is carried out outside the woman's body (in vitro). After a certain time, the resulting new organism is placed in the woman's uterus.

These methods cannot currently guarantee 100% success, but their effectiveness is gradually improving.