Thursday, 16 February 2017


Prostate Cancer Treatments


Prostate Cancer Treatments: Which is Best for Treating your Cancer?

Which of the Prostate Cancer Treatments Is Best For You?
The treatment of prostate cancer depends upon many factors. The type of cancer, whether or not the cancer has spread (metastasized), a patient’s age, general health status, and prior prostate treatments the patient may have undergone. There are three standard therapies for men with organ-confined prostate cancer: Active Surveillance, Surgery and Radiation Therapy.

Watchful Waiting or Active Surveillance?

In select patients with prostate cancer, the best choice may be active surveillance. Active surveillance also is called “watchful waiting.” Of the Prostate Cancer Treatments, Active surveillance may be recommended only if a cancer is not causing any symptoms and is expected to grow very slowly. This approach is sometimes suited for men who are older or have other serious health problems. Because some prostate cancers spread very slowly, older men who have the disease may never require treatment. Other men choose active surveillance because they feel the side effects of treatment outweigh the benefits. The cancer is regularly and carefully monitored with PSA, clinical evaluation and intermittent prostate biopsies to ensure that the cancer is not becoming more aggressive. If progression of the cancer is evident, active treatment can be started.


Surgical treatment for prostate cancer involves removing the entire prostate as well as the seminal vesicles, a procedure called radical prostatectomy. There are two prostate cancer treatments classified as radical prostatectomy, open radical retropubic prostatectomy and laparoscopic radical prostatectomy.

Prostate Cancer Prostatectomy: RRP or RALP?
Radical Retropubic Prostatectomy (RRP)The surgeon makes a skin incision in the lower abdomen. The prostate is removed from both the bladder and the urethra. After the prostate is removed, the bladder is connected to the urethra with suture. Takes 2-3 hours to perform with a hospital stay of 2-3 days.

Prostate Cancer Treatments: Prostatectomy DaVinci Surgical System
Robotic Assisted Laparoscopic Radical Prostatectomy (RALP)Minimally invasive surgical technique to remove the prostate and seminal vesicles. The surgeon performs the procedure through five 1-cm incisions spread in the shape of a fan across the lower abdomen. The surgeon performs the procedure using a robotic surgical assist device called the daVinci® Surgical System. Takes 2.5-3.5 hours to perform with a hospital stay of 24-48 hours.

Radiation Therapy ?

Radiation therapy is either a non-invasive, or minimally invasive treatment for prostate cancer that uses x-rays or gamma-rays to eradicate prostate cancer cells. Prostate cancer treatments have several forms of radiation therapy that may be recommended. Each patient receives a customized treatment plan depending on the nature of the cancer, the patient’s unique symptoms and overall health.

External Beam RadiationDelivered using an x-ray machine called a linear accelerator. Treatment is delivered on a daily basis, 5 days per week, for up to 8 or 9 weeks. Listed below are the four primary techniques.
o Intensity Modulated Radiation Therapy (IMRT)
o Volumetric Arc Therapy (VMAT)
o Image Guided Radiation Therapy (IGRT)
o Proton Beam Radiation Therapy – Proton beam radiation therapy utilizes particle radiation (protons) instead of electromagnetic (photon or x-ray) radiation to destroy tumor cells

Prostate Cancer Treatments: Prostate Cancer External Beam Radiation
Prostate Seed BrachytherapyThe implantation of small radioactive pellets, or “seeds,” into the prostate. The radioactive seeds deliver high doses of radiation to a very confined region, making it possible to deliver a higher dose of radiation to tumor cells within the prostate. Seed placement is determined, by use of previous ultrasound to map, or use of ultrasound image during the actual procedure to place radioactive seeds.

High Dose Rate RadiationHigh dose rate (HDR) brachytherapy is a procedure similar to seed brachytherapy, but instead of permanently placing radioactive seeds into the prostate, catheters are attached to empty needles placed into the prostate and a highly radioactive source is placed temporarily (for approximately 5-15 minutes) into the needles to deliver radiation to the prostate.

Other Prostate Cancer Treatments: CRYO, HIFU, CHEMO, or Hormone Therapy?

CryotherapyCryotherapy (also called cryoablation or cryosurgery) can be used to treat localized prostate cancer by freezing the cancerous cells. This procedure is performed under general or spinal anesthesia and may be performed as an outpatient or may require an overnight stay. The probes are placed through skin incisions located between the anus and scrotum. Guidance and monitoring of therapy is performed using transrectal ultrasound.
HIFUHIFU or High Intensity Focus Ultrasound procedure may be an option for men diagnosed with organ-confined prostate cancer. During the procedure, precisely focused ultrasound waves raise the temperature of the targeted prostate tissue to 195 degrees Fahrenheit in 2-3 seconds.
ChemotherapyChemotherapy utilizes drugs injected intravenously or by mouth to stop the growth of cancer cells. It is usually used in cases where prostate cancer has spread outside the gland (metastasized) or is resistant to androgen deprivation therapy. Chemotherapy is given in cycles in which the drug is given over a few days to week followed by a rest period to allow the body time to recover. Each cycle typically lasts several weeks to a month.
ADT or Hormone TherapyHormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. Androgens (testosterone and dihydrotestosterone) are produced mainly in the testicles and stimulate prostate cancer cells to grow. While not curing prostate cancer, lowering androgen levels often stops or significantly slows the growth of prostate cancer cells. Reducing androgen levels is accomplished mainly by oral or injected medications, called chemical castration. This can also be achieved by removal of the testicles (castration).


Collected Vaginal Swab

Self-Collected Vaginal Swabs for Gonorrhea and Chlamydia Women who do not need a pelvic exam as part of their clinic evaluation may be screened for chlamydia and gonorrhea by providing a self-collected vaginal swab. Your healthcare provider should give you instructions and make sure you understand what to do before you start. This page explains the procedure.

 (Illustrations courtesy of Gen-Probe Incorporated, San Diego CA) To collect a vaginal swab for gonorrhea/chlamydia testing:
 1. Thoroughly wash your hands before starting. Undress from the waist down.
2. Read the instructions for using the test kit.
 3. Open the kit package and set the tube of liquid to the side (do not open tube).
4. Partially peel open the swab package as directed, exposing the stick end of the swab (see picture 1). IMPORTANT: Do not touch the soft tip of the swab or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, ask for a new test kit.
 5. Remove the swab from the package carefully; do not lay it down.
 6. Hold the swab in the middle of the stick (shaft) with your thumb and forefinger (see picture 2).
7. Carefully insert the soft tip end of the swab into your vagina about 2 inches (5 cm) past the opening of the vagina (see picture 3). Gently rotate the swab for 10 to 30 seconds, making sure the swab touches the walls of the vagina so that moisture is absorbed by the swab.
 8. Withdraw the swab without touching your skin.
 9. While still holding the swab, carefully unscrew the cap from the tube of liquid. Do not spill the contents of the tube. (See picture 4.)
10. Immediately place the swab into the tube so that the soft tip of the swab is visible below the tube label. (See picture 5.)
11. Carefully break the swab shaft at the scoreline (dented line around middle of stick), being careful not to spill the liquid in the tube (picture 6). Leave the soft end of the swab in the tube and throw away the top portion of the swab shaft (picture 7). Tightly screw the cap onto the tube (picture 8).
12. If the contents of the tube are spilled or the tip of the swab touches anything, ask for a new test kit.
13. Return the tube as instructed by the nurse or doctor. NC Sexually Transmitted Diseases Public Health Public Health Program Manual /Laboratory Testing & Standing Orders Self-Collected Swabs April 2011 Page 1 of 1 


Female hormones

We discuss the effects hormones have on women as they mature, fall pregnant and go through the menopause

More from Wellbeing
Painful breasts

The menstrual cycle


One stereotyped view of women 
portrays us all as creatures at the mercy of our hormones. 'Balls (or should it be ovaries?) to that!' I say.
Our hormones undoubtedly have a huge influence on our lives, but there's no reason why we have to become slaves to them.
The more we understand how hormones can affect the female body, mind and emotions – the better able we will be to minimise their negative effects and enhance their positive ones.


Although we tend to think of hormones kicking in at puberty, they affect our bodies even during early childhood.
Newborn babies (boys as well as girls) may have enlargement of one or both breasts, sometimes accompanied by a little milk production.
It has long been thought that this breast development in newborns is due to female hormones (oestrogens) in the mother's body passing through the placenta during pregnancy and stimulating breast development in the baby.
Another suggestion is that the falling level of the mother's oestrogens in the baby's bloodstream cause the baby's brain to produce a hormone called prolactin which can produce some degree of breast enlargement.
This usually disappears after a few weeks, but it may persist for longer if the breast tissue is stimulated, for example by squeezing the breast to try to express the milky discharge.
In baby girls mild breast enlargement may reappear sometime in the first two years, this time due to the child's own hormones affecting breast tissue.
This breast enlargement may wax and wane repeatedly over months or even years, before finally disappearing during childhood.


At puberty, hormones will begin to make major, lasting changes to a girl's body.
Her breasts will get bigger and take on the shape of an adult woman's breasts. She will develop underarm and pubic hair and will get noticeably taller as a significant growth spurt occurs.
Eventually her periods will start, usually as the growth spurt is beginning to slow down. From beginning to end, the process of puberty usually takes at least four years. Not surprisingly, some girls experience difficulties adapting to their changing body, emerging sexuality, the onset of fertility and a degree of emotional turbulence, as they pass from childhood through adolescence.
All the machinery necessary for going through puberty is present at birth, but the body keeps it switched off for many years.
Eventually, the mechanism that prevents puberty winds down, and hormones that previously have been held in check can begin to exert their influence on the body.
A part of the brain called the hypothalamus starts to release increasingly large and frequent pulses of a hormone called gonadotrophin-releasing hormone (GnRH).
This stimulates the pituitary gland (also in the brain) to produce luteinising hormone (LH) and follicle-stimulating hormone (FSH), which in turn cause a girl's ovaries to start producing other hormones.

Female sex hormones

The most important hormones made by the ovaries are known as female sex hormones (sex steroids) – and the two main ones are oestrogen and progesterone. The ovaries also produce some of the male hormone, testosterone.
During puberty, oestrogen stimulates breast development and causes the vagina, uterus (womb) and Fallopian tubes (that carry eggs to the womb) to mature.
It also plays a role in the growth spurt and alters the distribution of fat on a girl's body, typically resulting in more being deposited around the hips, buttocks and thighs. Testosterone helps to promote muscle and bone growth.
From puberty onwards, LH, FSH, oestrogen and progesterone all play a vital part in regulating a woman's menstrual cycle, which results in her periods.
Each individual hormone follows its own pattern, rising and falling at different points in the cycle, but together they produce a predictable chain of events.
One egg (out of several hundred thousands in each ovary) becomes 'ripe' (mature) and is released from the ovary to begin its journey down the Fallopian tube and into the womb.
If that egg isn't fertilised, the levels of oestrogen and progesterone produced by the ovary begin to fall. Without the supporting action of these hormones, the lining of the womb, which is full of blood, is shed, resulting in a period.


If the egg released from the ovary is fertilised and a pregnancy results, a woman's hormones change dramatically.
The usual fall in oestrogen and progesterone at the end of the menstrual cycle doesn't occur, so no period is seen.
A new hormone, HCG (human chorionic gonadotrophin), produced by the developing placenta, stimulates the ovaries to produce the higher levels of oestrogen and progesterone that are needed to sustain a pregnancy.
Most pregnancy testing kits are designed to detect HCG in a woman's urine, and many can pick up even small amounts just a day or so after her first missed period.

By the fourth month of pregnancy, the placenta takes over from the ovaries as the main producer of oestrogen and progesterone. These hormones cause the lining of the womb to thicken, increase the volume of blood circulating (in particular the supply to the womb and breasts), and relax the muscles of the womb sufficiently to make room for the growing baby.
Progesterone and another hormone, relaxin, encourage relaxation of ligaments and muscles. Greater joint mobility in the pelvic girdle may increase the capacity of the pelvis in readiness for the baby to pass through it during childbirth.
Around the time of delivery, other hormones come into play that help the womb to contract during and after labour, as well as stimulate the production and release of breast milk.

After childbirth

After childbirth, what then?
Levels of oestrogen, progesterone and other hormones fall sharply, causing a number of physical changes.
The womb shrinks back to its non-pregnant size, pelvic floor muscle tone improves and the volume of blood circulating round the body returns to normal.
The dramatic changes in hormone levels might also play a part in causing postnatal depression, although no real differences have been found in the hormone changes of women who do, and do not, get postnatal depression. It may be that some women are more easily affected by these hormonal fluctuations than others.
Talking of hormonal fluctuations, although they have been the subject of study for many years, we still don't know whether they are responsible for the wide range of physical and psychological symptoms we now call pre-menstrual syndrome or PMS.
No-one doubts that many women experience tender breasts, abdominal bloating, irritability, low mood and other symptoms in the lead up to a period but whether these are due to hormone fluctuations, changes in brain chemicals, social and emotional problems or a combination of all three is a matter of debate.

The menopause

The next significant hormonal change for most women occurs around the time of the last period.
A woman is said to have reached the menopause when she has not had a period for one year.
In the UK, the average age for a woman to reach the menopause is 52. If the menopause occurs under 40 years of age, it's known as premature menopause or premature ovarian failure.
It's estimated that premature menopause affects 1 per cent of women under the age of 40 and 0.1 per cent of women under the age of 30.
Over five to ten years leading up to a woman's last period, the normal functioning of her ovaries begins to deteriorate. This can cause her menstrual cycle to become shorter or longer, and sometimes it becomes quite erratic. Periods may become heavier or lighter.
Eventually, the ovaries produce so little oestrogen that the lining of the womb fails to thicken up and so periods stop altogether.
Although it's rare for a woman to become pregnant after the menopause it can, and does, happen so the usual advice is to carry on using contraception for two years after your last period if you are under 50 and for one year if you are over 50.
For most of a woman's life, oestrogen helps to protect the heart and bones, as well as maintaining the breasts, womb, vagina and bladder in their healthy state.
The marked loss of oestrogen in a woman's body that occurs around, and after, the menopause can, therefore, have detrimental effects on her health; as well as causing uncomfortable symptoms, such as hot flushes and night sweats, lack of oestrogen can increase the risk of heart disease and the bone disorder osteoporosis.
Other problems include vaginal dryness, discomfort during sex, recurrent urine infections and incontinence.
It may also contribute to the depression, irritability and poor concentration which some menopausal women experience.
But the menopause doesn't have to be a disastrous time for women – if reduced hormone levels do cause unpleasant symptoms, treatments such as hormone replacement therapy (HRT) can be very effective.
HRT and other types of medication can also be used to prevent health problems, for example if a woman has a significantly increased risk of developing osteoporosis in the future.
So, from the cradle to the grave, hormones play an important role in every woman's life. They shape our bodies (quite literally) as well as some of the most important events we experience, from pregnancy and childbirth to the menopause.
There may be times when you curse your body's hormones, but console yourself with the thought that life without them would be much less interesting!


The 5-Minute Pediatric Consult, Schwartz MW et al, Lippincott Williams & Wilkins, 2008
The Reproductive System at a Glance, Heffner L, Schust D. Wiley-Blackwell 2010