Prostate Cancer Treatment

Choosing a treatment plan takes into account the following factors: clinical stage of disease, serum PSA level, the degree of histological differentiation (Gleason score), life expectancy. Depending on these parameters and especially its finality may be a curative treatment or palliative. The patient should be informed beforehand about the benefits and risks of different treatment options.

Localized disease.
Indicated treatment consists of radical prostatectomy or radiotherapy. Long-term survival is very high in both situations. Radical prostatectomy is to remove the prostate and seminal vesicles is recommended for patients with life expectancy greater than ten years. It can be done by retro approach (most used) or the perineum. The intervention begins with lymphadenectomy and pathological examination to decide if extemponareu prostatectomy will be continued or not. Intraoperative complications that can occur are represented by hemorrhage and iatrogenic injuries of the ureters and rectum obturator nerve. Postoperative deep venous thrombosis can register, limfocel pelvis, pulmonary embolism, urinary tract infection. Long-term complications that occur frequently, and urinary incontinence, erectile dysfunction is because of infringement of the striated sphincter and nerve cavernosum. For early detection of relapse, patients should be monitored by periodic measurements of PSA (PSA values above 0, 2 ng / ml).

Radiotherapy is indicated in patients with life expectancy less than ten years and who have contraindications for surgery. shows the problem of inaccurate staging is possible only in cases surgical pathology. Irradiation is done in two ways:
- By the external dose of 60-70 Gy fractionated over 6-7 weeks, with or without concomitant irradiation of the lymph.
- Performed by interstitial implantation of radiation by some nice retro perineal or radioactive iodine, gold, iridium, etc.. This method does not produce radiation than the tumor without damaging nearby anatomical structures.
Rectal stenosis, Radica bladder (urinary frequency, hematuria), rectal bleeding and impotence are possible complications but low incidence. Response assessment is by periodic determination of PSA, the normal prostate cells but due to secretion, it never gets to 0.

Extensive local disease (T3-T4).
For this stage, radiotherapy is the best solution, because surgery can not completely tumor resection and adenoterapia satellites, plus favoring systemic dissemination. Another treatment option is the hormonal treatment alone or in combination with radiotherapy. Endoscopic resection is performed in patients with urine retention.

Metastatic disease (N + M +).
The standard treatment for this stage is hormonal. Favorable response to deprivation comes as a result of destruction endrogenica hormone-sensitive cells of adenocarcinoma. Testosterone from 95% in the testes is converted into dihydrotestosterone which is the biologically active form. In the prostate it favors the proliferation of both normal and neoplastic those. The objective of the hormonal treatment is to decrease serum testosterone levels and implicitly dihidrosteronului. It recorded a transient regression in almost 80 cases, but life expectancy is greatly reduced.

Hormone treatment is done by:
- Especially the administration of estrogen in the form of diethylstilbestrol 3 mg daily dose that lowers the level of pituitary LH and testicular testosterone secretion indirectly. Adverse effects include peripheral edema, painful gynecomastia and thromboembolic accidents almost led to the abandonment of this method.
- Antiaandrogenii act in two ways: inhibiting androgen synthesis or preventing their action in prostate cells by competitive inhibition of androgen receptor. Ketoconazole is the preparation to inhibit the rapid synthesis in testis and adrenal androgens. Receptor inhibition is competitive with medicines such as Flutamide (flucinom) who performs a medical castrating in administering the dose of 250 mg. three times daily alone or in combination with an LHRH agonist. Other drugs that can be used are cyproterone acetate, Bicalutamide 50 mg per day and milutamide (Milandron) 150mg daily.
Inhibition of adrenal secretion of testosterone is achieved through a 'medical adrenalectomy "could be achieved with ketoconazole or aminoglutethimide (cytadren). In these patients required hormone replacement steroid hydrocortisone.
- LHRH analogues. It causes a decrease in testosterone levels similar surgical castration. Side effects are much lower than in extrogenilor consisting flahuri heat, moderate painful gynecomastia, nausea, decreased libido. Medicines used are: goswerelin acetate (Zoladex) subcutaneously in doses of 3, 6 mg once per month, or 10, 8 mg every three months and leuprolide acetate (Lupron) 7, 5 mg sc every month.
- Bilateral orchidectomy consists of surgical removal of the testes subrahieanestezie suppressing such a major source of testosterone. Side effects include hot flushes, mental trauma, impotence, gynecomastia, loss of libido and osteoporosis. Low levels of serum testosterone levels lead to a decrease of estradiol (required to maintain bone density) by reducing peripheral flavoring. Fighting osteoporosis is made by these patients daily administration of vitamin D (4oo-8oo IU) and calcium (1, 2-1, 5 g). Bone densitometry provides information about the presence and severity of osteoporosis. Heat waves can be treated by administration of clonidine (a, 1 mg daily). For reasons of aesthetic reconstruction of testicular can try using different silicone implants.
- Maximum androgen blockade associated with administration of antiandrogen orchidectomy as both sources of testosterone, suppressing both the testicular and the adrenal.

Chemotherapy is usually used in cancer patients with less effective hormonorezistent. Anticancer drugs used are: cyclophosphamide, Adriamycin, 5-fluorouracil, docetaxel, mitoxandrone.
In patients with urine retention urinary release requires endoscopic resection.

Palliative treatment aims to improve quality of life by acting in the direction of diminishing the symptoms caused by metastases (mainly pain). The pain caused by vertebral bone metastases after irradiation gives vertebra in question and the following two upper and two lower vertebrae with a total dose of 3000 cGy split (can not repeat). You can try and manage radioactive isotopes of strontium (metastron) and samarium-153 lexidronam (QUADRAMET) that preferentially localize in the tumor. If spinal compression is neurosurgical removal of the vertebral body.

To treat prostate cancer following scheme dedicated staff recommend treatment based on natural products Calivita:

- Pro-State Power (1-0-1 afternoon, 2-3 months continuously improves the hormonal function of the prostate, reduce inflammation and increased size of the prostate).

- Shark Aid (1-1-1 afternoon, 2-3 months continuously, preventing the antitumor effect of neoplastic cell proliferation and tumor vasculature)

- Resveratrol (1-1-1 afternoon, three months continuously, provides protection against cell degeneration and induces programmed death of cancer cells from prostate cancer).

- Ocean 21 (1-2-1 teaspoons before meals, three months continuously strengthens the immune system and improving your overall body strength, is a good antibacterial agent, preventing urinary tract infections and inflammations).