Prostate Cancer Therapy

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Prostate Cancer Therapy
Prostate Cancer Therapy
Video: Prostate Cancer Therapy
Video: Prostate Cancer Treatment 2023, February
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Prostate cancer: therapy & aftercare

If prostate cancer is detected early and treated in good time, the prognosis is very good in most cases. About nine out of ten people are doing well five years after diagnosis. The treatment depends on the age or life expectancy of the patient, on the stage and the risk profile of the tumor. Basically, a distinction is made between treatments with the aim of healing (curative therapy) and those with the aim of alleviating symptoms that arise from the disease (palliative therapy).

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  • Curative treatments
  • Palliative treatments
  • Treatment of bone metastases
  • Aftercare & Rehabilitation
  • Whom can I ask?
  • How are the costs going to be covered?

Curative treatments

Treatments with the aim of healing are used when the tumor has not yet metastasized. The aim is to completely destroy or remove the tumor tissue, thereby eliminating the disease. If the tumor belongs to the low-risk group, curative treatment can be delayed until the tumor progresses (active observation). The following curative therapy options are available:

Surgical removal (radical prostatectomy)

Most of the tumors are operated on. The prostate and thus the tumor are completely removed. This option is recommended for all localized tumors, ie tumors limited to the prostate. The operation can be performed either through a skin incision in the abdominal wall, purely laparoscopically, laparoscopically with the aid of a robot or, less often, through an access to the perineum. Sometimes the pelvic lymph nodes must also be removed. Possible side effects are incontinence and loss of potency (erectile dysfunction). The nerves that cause an erection run along the prostate. If the tumor is still small, these nerves can be spared during the operation, but sometimes this is not possible.

Irradiation

High-energy radiation is directed onto the tumor tissue. The cells are so damaged that they can no longer divide and die. A distinction is made between two methods:

  • External radiation through the skin (percutaneous radiation therapy): The radiation source is directed from the outside onto the prostate. In advance, it is calculated exactly where the rays should work. This largely spares the surrounding tissue. This procedure is recommended for localized prostate cancer. In terms of its effectiveness, it is comparable to surgery.
  • Irradiation from the inside(Brachytherapy): This therapy is carried out either with a low radiation dose over a longer period of time (LDR: “Low dose rate” brachytherapy) or with a high dose over a short period of time (HDR: “High dose rate” brachytherapy). With LDR brachytherapy, low-level radioactive grains ("seeds") are introduced into the prostate, where they emit low levels of radiation over a long period and stay there. It is recommended for prostate cancer with a low risk profile. In HDR brachytherapy, radiation sources are introduced directly into the prostate, where they emit a high dose of radiation for a short period of time and are then removed again. It is recommended in conjunction with subsequent percutaneous radiation therapy for medium and high risk prostate cancer. Side effects of radiation are impotence,Damage to the intestine with fecal incontinence, chronic diarrhea and urinary incontinence.

Supportive hormone therapy

Hormone withdrawal therapy can be used to support radiation therapy. Hormone administration before (neoadjuvant) or during and after (adjuvant) radiation therapy is intended to reduce the number of cancer cells in the prostate and possibly make them smaller. This can increase the effectiveness of the radiation.

Active surveillance ("Active Surveillance")

Many tumors in the low-risk group will probably progress very slowly or not at all and will not cause any symptoms for a long time. For this type of prostate cancer, "active observation" is a sensible option: a tumor that is discovered is not treated immediately, but rather closely monitored. Only when it progresses is healing treatment initiated. In this way, the affected person is spared the side effects of an operation for a certain time or at all. This approach is recommended for certain tumors in the low-risk group.

Palliative treatments

Measures to alleviate the symptoms are useful if the tumor has already metastasized and a cure is no longer possible. Withdrawal of hormones can delay tumor growth. Under certain circumstances, it can also make sense not to treat the tumor itself at all, but only to treat the symptoms it causes (“waiting and observing”). The following palliative treatment options are available:

Hormone withdrawal therapy

The male sex hormone testosterone ensures that prostate cells grow and multiply faster, especially cancer cells. With hormone withdrawal ("hormone-ablative therapy") the testosterone level can be lowered and the tumor growth slowed down. Under certain circumstances, the suppression of testosterone production can already be used for the initial treatment of prostate cancer, especially if a man wants to avoid the risk of radiation or surgery due to his age or his state of health. Hormone withdrawal can take place in two ways with comparable effects:

  • Medicines (chemical or medicinal castration with docetaxel or abiraterone plus prednisone / prednisolone),
  • surgical removal of the testicles (orchiectomy, castration).

Note Possible consequences include weak drive, hot flashes, osteoporosis, loss of sexual interest (libido) and potency, muscle loss, increase in body fat and anemia.

Treatment with antiandrogens

These drugs ensure that the testosterone in the prostate - especially in the tumor cells - cannot take effect. Men who are treated with antiandrogens have normal or slightly elevated testosterone levels. Therefore, many side effects of castration are eliminated. The most common consequence of taking antiandrogens is painful swelling of the mammary glands, which, however, can be prevented with the daily intake of a drug or the mammary gland irradiation.

Maximum androgen block

The combination of hormone withdrawal and antiandrogens means that testosterone can no longer be effective in the prostate. The side effects are more pronounced than with castration alone.

Intermittent (interrupted) hormone therapy

Intermittent androgen deprivation can be used after prior information about the missing long-term data.

chemotherapy

Over time, prostate cancer becomes insensitive (resistant) to hormone withdrawal. Then chemotherapy can alleviate symptoms and extend life. Medicines are used that prevent cell division (cytostatics). They act not only on cancer cells, but on many cells throughout the body and are therefore associated with side effects.

cortisone

If the patient decides against chemotherapy, treatment with cortisone should be considered. It works against pain and tiredness and increases appetite.

Long-term observation

Especially in old age and / or when impaired by other diseases, the expected benefit should be weighed against the risks of a stressful operation or radiation treatment. Long-term observation means that the doctor regularly checks the state of health. There is no irradiation or surgery. Only when the cancer causes symptoms are they treated, not the cancer itself.

Pain management

Prostate cancer can cause severe pain when it is advanced. Different substance groups are used depending on requirements:

  • Medicines that numb a specific area (local anesthetics)
  • anti-inflammatory and non-inflammatory pain medication,
  • Opioid pain relievers (opioids) with different strengths.

Concomitant medications can help the pain relievers work and reduce side effects such as constipation. Pain can have consequences for the body and mind. For example, it can intensify anxiety and depression, which in turn have an effect on the perception of pain. In these cases, psychotropic drugs can be helpful.

Therapy of androgen-independent or castration-resistant prostate cancer

Abiraterone (in combination with prednisone / prednisolone), docetaxel and enzalutamide are available for this purpose. Therapy with these substances should only be carried out at specialized centers.

Measures recommended in studies only

High-intensity focused ultrasound (HIFU) and the use of cold (cryotherapy) or heat (hyperthermia) are newer methods of treating prostate cancer. So far, their effectiveness has not been sufficiently scientifically proven.

For more information, see: Hospice and Palliative Care.

Treatment of bone metastases

Eight out of ten men with metastatic prostate cancer have their bones affected. The metastases initially settle in the bone marrow. Gradually, the bone substance is also attacked. This can lead to severe pain. The smallest force can cause broken bones. When the spine is affected, the collapse of vertebral bodies can crush nerves or the spinal cord. This can lead to paralysis and sensory disturbances.

The following procedures can be used to alleviate symptoms:

  • Irradiation: If there are only a few bone metastases, these can be irradiated in a targeted manner. For most men, targeted percutaneous radiation to bone metastases can relieve pain. Possible side effects are nausea and vomiting.
  • Radionuclides: If numerous bone metastases have already formed, targeted irradiation of individual foci does not make sense. In this case, treatment with radionuclides can relieve pain. To do this, atoms are injected, the nuclei of which decay radioactively, releasing radiation. Possible side effects are damage to the bone marrow and blood formation, and rarely nausea and vomiting.
  • Bisphosphonates / Antibodies: These drugs are also given for osteoporosis to stop bone loss. In the case of bone metastases, the monoclonal antibody denosumab or the bisphosphonate zoledronic acid in combination with vitamin D are recommended to prevent bone fractures. Possible side effects are bone damage to the jaw (jaw necrosis). These can be treated preventively. A dentist should therefore be consulted before starting bisphononate or antibody therapy.

Aftercare & Rehabilitation

After the treatment, regular follow-up examinations should ensure that a possible recurrence of the tumor (relapse) is detected early. In the first two years, examinations should be carried out every three months, in the third and fourth years every six months and from the fifth year onwards annually. The PSA value is determined. As long as this remains stable, a palpation examination is not necessary.

Most often, rehabilitation is recommended after therapy is completed to speed up the recovery and recovery process. Special rehabilitation clinics are responsible for this; they cater to the individual situation of the patient and provide assistance. These include, for example, psychological and social problems or the unavoidable physical consequences of cancer such as impotence or urinary incontinence. You can find more information about rehabilitation under Rehabilitation and Cure. For some patients, it is also helpful to contact a counseling center or self-help group.

Whom can I ask?

The treatment should be carried out in a specialized center. The following centers are established in Austria:

  • AKH Vienna, Clinic for Internal Medicine I, Clinical Department for Oncology, Währinger Gürtel 18–20, 1090 Vienna, Tel. (01) 40400-4445
  • Prostate center in the hospital of the Sisters of Mercy Linz, Seilerstätte 4, 4010 Linz, Tel. (0732) 7677-7947
  • The European Prostate Center, University Clinic for Urology, University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Tel. (0512) 504-24874
  • Special “Prostate Carcinoma” Outpatient Clinic, University Clinic for Urology, Medical University of Graz Auenbruggerplatz 5/6, 8036 Graz, Tel. (0316) 385 124 42

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Medical aids & aids
  • Health Professions AZ
  • and via the online guide to reimbursement of social insurance costs.

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