Prostate Cancer Care

Posts Tagged ‘prostatectomy’

The prostate is a glandular organ present in males. It surrounds the neck of the bladder & the first side of the urethra plus it contributes to the emission of seminal fluid.

The gland is tapering in form, 3 cm straight down diameter as well as 4 cm in sloping diameter. It has  five lobes: fore, posterior, two lateral as well as a median lobe. Seeing as it is at the initial part of the urethra passage, any lesion in the prostate will raise blockage issues in passing urine.

Diseases of the prostate gland:

• Prostatitis:

This is the inflamation of the prostate gland due to bacterial infection.

• Gentle bulge of the prostate:-

This is a non cancerous tumour of the prostate seen after the age of 50.

• Sarcoma of the prostate 

A  more serious condition which can result ultimately in death

Cancer of the prostate

Cancer of the prostate is asscociated with the male gender hormones(androgens). If the levels of this male sexual  hormone increases the growth rate of malignancy can also increase.It is noted that as soon as the removel of testes takses place there is marked reduction in the appearance of tumors.

Location of tumour

Prostate malignancy is seen predominantly in the following lobe. Non cancerous amplification is seen in supplementary lobes.

Changes in the gland in malignant cells:

The gland goes hard and bumpy along with loss of natural lobulation. Histologically prostate melanoma is an adeno carcinoma (malignancy of the epithelial cells in the gland)

Development :

The advance rate can be very fast in prostate cancer. The tumour presses the urethra in addition to produce problems in urination.

Spread of tumour:

Metastasis in malignant cells of the prostate

• Local spread

Starting with the fore lobe the malignancy cells spread to the side lobes along with determining vesicles.Tumor cells also spread to the collar along with pedestal of the urinary bladder.

• Lymphatic spread

From end to end the lymph vessel sarcoma cells reach the inner and external iliac cluster of lymph nodes. Starting nearby cells go to retroperitonial (Behind the peritonium) as well as mediastinal lymph nodes (in the chest)

• Spread from first to last the blood

Spread of sarcoma cells takes place through the periprostatic venous plexus to the vertebral veins while coughing and sneezing in addition to the vertebral bodies of the lumbar spine.

Signs and symptoms of prostate melanoma

Signs and symptoms depend on the stage of the malignant cells.

The following symptoms are listed

• No symptoms:

Tumour is miniature and only in the subsequent lobe. This is diagnosed accidentally.

• Urination:

Now the tumour is inflated as the urethra is slightly packed in. In a minute there will be a repeated urge for urination through difficult urination.

• The tumour multiplies to all in the vicinity areas as well as the neck of bladder in addition to the urethra and at this stage there will be painful urination and bleeding.

• Retention of urine:

When the urethra is utterly condensed there will be withholding of urine.This may show up as hydronephrosis, renal collapse ect. In this statethe sufferer may get convulsions due to renal failure along with finally coma.

Signs of metastasis:

a) Lumbo sacral – extending of tumor cells to lumbar along with sacral vertebrae.

b) Break of spinal column due to cancerous intensification in the spine.

c) Puffiness, pain as well as fluid collection in the abdomen due to laceration in the stomach.

d) Respiratory complaints due to tumor of mediastinal lymphnodes and lungs.

e) Common limitation due to spread of melanoma

f) Anaemia

Clinical examination :

Includes rectal exam to feel the prostate gland, palpation of tummy to feel the inflammation in kidneys and any tumours. The patient is examined beginning head to foot to search for any lesions.

Investigations

1) Whole blood investigations: RBC,WBC, Platelets, ESR, bleeding time, clotting time etc.

2) Urine analysis: Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.

3) Renal function tests: Blood urea point, serum creatinine level, electrolyte level etc.

4) Serum acid phosphatase: Augmented in sarcoma of prostate.

5) x-ray of the spinal column: To notice any tumour or break.

6) Ultra sonography: Gives idea about prostate, bladder, kidney etc.

7) C T scan: More detailed information about organs in addition to tumour.

MRI of the spine: Gives complete information about spine ,disc and nearby soft tissues.

9) Lymphangiography: Gives idea about lymphatic spread of cancer.

10) Biopsy to back up suspected cancer diagnosis: Biopsy is taken plus histopathological examination of cells beneath the microscope.This will reveal the presence of sarcoma cells.

Treatment:

1) If there is retention of urine, catheterisation is needed.
2) Dialysis, if kidney malfunction.
3) If there is coma, monitoring of all crucial functions together with parentral nutrition along with electrolyte supply.
4) Specific treatment is prostatectomy (removal of prostate)

Partial prostatectomy:

At this juncture only the affected lobe is removed.

Far-reaching prostatectomy :

Total subtraction of prostate along with nearby lymphnodes.

5, Hormone therapy : Stilbestrol is given to moderate tumour escalation.Since this treatment increases the possibility for cardiovascular disease phosphorylated diethyle stilbesterol is used at the moment.

6) Chemotherapy: Drugs like cyclophosphamide, cisoplatim etc are specified.

7) Radiotherapy is also prepared for several cases.

Homoeopathy: Homoeopathic drugs akin to carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur etc can be given according to symptoms. Constitutional homoeopathic medicine can offer  relief.

9) Yoga plus reflection and meditation is also helpful.

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Cancer prostate incidence rates are much more advanced in the  African American male than in Caucasian men. Cancer of the prostate is a leading cause of cancer-related deaths in men, with an estimated 28,660 in 2008.

>>  Don’t  Be Just Another statistic. Stay Well With This Cancer Remedy

According to specialist doctors cancer of the prostate appears without any obvious symptoms. Prostate cancer can distribute to the bones, which causes pain to the hips, spine, ribs and other areas.

Approximately 65% of all cancer prostate cases are diagnosed in men of 65 years of age or older. Various evidence shows that the danger of dying from prostate cancer may perhaps rise with fatness.

Taking the PSA blood test is maybe fine for American Society to detect the protein made by the prostate and digital rectal examination. More than 90% of all cancer prostates are discovered generally at the regional stages.

Cancer of the prostate is a male disease connected with men’s gland, which is part of the mans reproductive system. Cancer prostate remedy options depend on how complicated the cancer is. Cancer prostate might possibly cause pain, problems urinating and erectile dysfunction, although in the early stages time there may perhaps be no symptoms at all.

A Doctor might want to confirm by taking a biopsy. If the cancer is restricted within the prostate gland there are two usage options.

One of radical prostatectomy surgery. The lymph nodes are subsequently checked to ensure if the cancer has spread or, as metastasized. If the cancer has metastasized beyond the prostate gland hormone medication can be given. Male hormones, called androgens, can be associated with accelerated growth of the tumor.

 >>  Beat cancer. Prostate Cancer Survivor Tells How Click here

The final remedial used for cancer prostate is called watchful waiting . With all these types of medication  and treatments the patient may wish to weigh up the pros and cons and discuss the side effects of the various treatments with his doctor before decising upon his options

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A major study of patient satisfaction and regret following open prostatectomy and robot-assisted laparoscopic prostatectomy provides some important lessons for surgeons …

… and opens up the debate about  alternative prostate cancer care

The research, recently published in the European Journal of Urology, shows 19 per cent of patients regretted their treatment choice and patients who had robot-assisted surgery were most likely to be dissatisfied.

The authors suggest the regret is “possibly because of higher expectation of an ‘innovative procedure’”.

Their conclusion is one for all urological surgeons to note.

“We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counselling to minimise regret and maximise satisfaction.”

In recent years, the treatment of prostate cancer has been a rapidly developing field, providing patients with a  wide range of different cancer care choices .

Brachytherapy and HIFU offer non-surgical options and for those who want surgery, there are open, laparoscopic and nerve-sparring options, depending upon your diagnosis and treatment provider.

At the same time, patients are becoming increasingly proactive, using the internet to research and consider the different  prostate cancer treatment options themselves, as well as the traditional consultation with the urologist.

Increased choice is without doubt a positive benefit for patients, but as urology centres – both private and NHS – seek to attract patients, we have a responsibility to carefully counsel them about the advantages and disadvantages of treatments.
There is a distinctive risk when a procedure is perceived to be new and especially “innovative”. The media will always be interested in the next “pioneering operation”, particularly one which involves robots.

A newspaper article will tend to portray the new procedure as an immaculate solution, which corrects all the risk and disadvantages of other procedures.
As surgeons, we have a responsibility to provide patients with a more sober and informative picture, acknowledging limitations as well as benefits.

The patient satisfaction study was based on the responses of 400 men who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy between 2000 and 2007 in the US.

The report’s authors also examined patients urinary domain scores, hormonal domain scores and found scores were independently linked with regret.

It is still early days for robotic surgery in the UK. In prostate cancer surgery, there are currently six Da Vinci robotic machines in the UK, compared with 350 in America.

There is no current evidence that robotic surgery provides better outcomes for patients, in terms of urinary symptoms, post operative sexual function or post-operative risks and complications. It seems certain that robotic surgery will increase within the UK during the next decade, with NHS and private centres purchasing the Da Vinci machines.

This will provide even more choice for patients, which is in principle, a positive development.

It is however vital that patients are given accurate and comprehensive information to enable them to make an informed choice, rather than simply being over-sold on a new product.

By: Alan Doherty

Article Directory: http://www.articledashboard.com

Alan Doherty is a Consultant Urologist and Medical Director of The Birmingham Prostate Clinic. A centre of excellence for Prostate Cancer Treatment.

Here are some related posts about prostate cancer treatment options

Prostate Cancer – Causes And Treatment

The treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery, radiation therapy , hormonal therapy, cryotherapy, combinations of some of these treatments, and watchful waiting. 

Chemotherapy  Treating Prostate Cancer

It is really up to the patient and his doctors to decide whether on balance the advantages outweigh the risks. D.Valerian is a freelance writer interested in items such as prostate cancer treatment 

Preventing Prostate Cancer

In addition, this report discusses the strides made in prostate cancer prevention, and why this cancer in particular should be a target for prevention, rather than treatment. 

Prostate Cancer Treatment Options

Radical prostatectomy is one of the most invasive prostate cancer treatment options. This procedure will remove the prostate and the affected lymph nodes. This is to prevent the spread of cancer cells from reaching other parts 

Prostrate Cancer Awareness Campaign

Many people are now agreed on the need for a broader prostate cancer awareness campaign and images that create more consciousness in the fight against the disease and the against the ignorance about the disease.

New Prostate Cancer Treatment Options Prostate Cancer Support

The most common therapies for prostate cancer are surgical removal of the entire prostate gland, radiation treatment, and hormonal therapy.

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There are a few  options for treatment once prostate cancer is diagnosed. One option for localized prostate cancer is surgery and here we look at just what such surgery involves.

The normal approach for surgery in the case of localized prostate cancer is to remove the entire prostate gland and surrounding tissue in an operation known as a radical prostatectomy. The operation is usually performed as a retropubic prostatectomy, in which access is achieved through the lower abdomen, or a perineal prostatectomy, in which access is gained through the perineum which lies between the scrotum and the anus.

During a radical prostatectomy the prostate gland is removed, together with the seminal vesicles, the ampullae (the lower sections of the tubes which carry sperm from the testicles to the prostate gland) and some other adjoining tissue.

In addition, that part of the urethra which passes through the prostate gland, as well as the neck of the bladder and a part of the sphincter muscle that controls urine flow is also removed.

From this you will see that a radical prostatectomy is not minor surgery, but is a demanding procedure which generally lasts anywhere from about 2 to 4 hours. It is also an operation which generally requires a stay in hospital of about 3 days followed by 10 days to 2 weeks at home during which time you will need to use a catheter to drain urine.

In the past a radical prostatectomy almost always resulted in impotence, but today improvements in surgical techniques and the introduction of what is known as ‘nerve sparing’ surgery means that an increasing number of men are now spared from impotence. When nerve sparing surgery is performed the two sets nerves and other vessels that run along the side of the prostate gland are carefully preserved in order to retain the erectile function. This technique is unfortunately not suitable in all cases of prostate cancer.

One of the commonest results of prostate surgery is a degree of incontinence. Almost all patients will experience some loss of control following their operation and this can vary from occasionally dribbling to a complete loss of urinary control. Fortunately, some men are suitable for further surgery to ease this problem and it is sometimes possible to surgically implant an artificial urinary sphincter or to use collagen injections to narrow the opening of the bladder.

Some men will also suffer muscle damage during surgery leading to fecal incontinence, which is essentially a problem caused by a reduction in the elasticity of the rectum. This too can be corrected surgically in some cases. Radiation therapy can also sometimes be used to stiffen the rectal muscles.

Of course surgery is just one of the  treatments available for localized prostate cancer today and, while many men favor it because it involves the immediate and complete removal of cancer cells from the body, you should not automatically assume that this is the best treatment for you. Take some time to look at all of your options and discuss each with your physician before coming to any decision.

Find more information on a range of prostate problems and solutions including the therapeutic practice of milking the prostate.

By Donald Saunders

Answers to Your Prostate Cancer Questions

Outcomes after radical prostatectomy, for example, are better when a surgeon has done 250 procedures and is likely doing more than 50 per year. Experience is important. 

The Commonly Performed Nerve Sparing Total Prostatectomy

The Journal of Urology, Volume 181, Issue 3, Pages 1076-1081, March 2009, Authors:Karl-Dietrich Sievert; Jörg Hennenlotter; Ines A. Laible; Bastian Amend; Udo Nagele; Arnulf Stenzl.

Report Regarding Continence And Erectile Function

There are few published reports on changes in continence and erectile function beyond 2 years after radical prostatectomy. A newly published, prospective study has reported on continence and erectile function between 2 and 4 years after

Artificial Urinary Sphincter Versus Male Sling

Early outcomes of the male sling to correct post-prostatectomy incontinence have been promising in select patients. Long-term data are lacking to determine whether the male sling is as effective as the artificial urinary sphincter.

Trial Needed To Compare Prostatectomy, Radiotherapy

Results of an interactive feature on the web site of the New England Journal of Medicine suggest a need for a large, rigorous, decisive head-to-head clinical trial comparing radiotherapy and surgery for the treatment of prostate cancer. 

Disseminated Tumor Cells In Prostate Cancer Patients After Radical

Purpose: Men with apparently localized prostate cancer often relapse years after radical prostatectomy. We sought to determine if epithelial-like cells identified from bone marrow in patients after radical prostatectomy

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