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PROSTATE CANCER


FRENULOPLASTY
PROSTATE CANCER

One of the leading cancers and cause of death in men.


SYMPTOMS

Symptom are same as that of non cancerous prostate. Advanced cancers with spread into the bones may present with bone pains though or spontaneous fracture of spine or weakness or paralysis of legs due to spine compression.


RISK FACTORS

Family history of prostate cancers

Obesity

Certain races


PREVENTION

You can reduce chances of prsoate cancer by:


Having diet rich in fruits and vegetables and less of animal proteins

Maintaining a healthy weight and exercise

Awareness and seeking medical advise for urinary symptoms may detect cancer at an early stages with a high chance of cure.

SCREENING OF CANCER

Screening by PSA blood test advised in some clinical setting based on age and family history of prostate cancers.


DIAGNOSIS
  • If PSA is high and other causes of high PSA like urinary or prostate infection have been ruled out then an ultrasound through rectum (Trans rectal Ultrasound) of the prostate may be advised to see for any suspicious nodules.
  • TRUS (Trans Rectal Ultrasound)biopsy of Prostate: Through the ultrasound probe passed in the rectum under local anesthesia, a needle is passed into the prostate under ultrasound guidance to take a few cores of prostate tissues (generally 12, sometimes more).. The tissue sample is analysed in the lab to look for any cancer in the prostate, the results generally available between 3 to 7 days. It’s a day care procedure, done under local anesthesia and antibiotic coverage. Blood thinners are generally stopped 3 to 5 day before the procedure. Side effects include some blood in urine, stool or semen which is self limiting. A urinary infection is the only troublesome side effect which can happen in 1 percent and may rquire hospitalization along with intravenous antibiotics.
  • MRI fusion biopsy: MRI guided biopsy may be considerd in patients where PSA is high but no cancer detected in the TRUS biopsy but there is a high index of clinicl suspicion. It may be used a first step instead of ultrasound guided biopsy.

1-Interpreting the biopsy results:

The aggressiveness of the cancer is based on a grade called as Gleasons grade mentioned in the biopsy report(ranging from 2 to 10). Higher the grade more the aggressiveness. Treatment may vary according to aggressiveness

2-Spread to other Organs

Bones followed by lungs are the commonest site of spread. One or more of following tests may be advised:

  • Bone scan
  • PSMA PET scan
  • MRI


  • TREATMENT

    ACTIVE SURVEILLANCE

    A low grade slow growing cancer may be followed up regularly without any intervention by means of clinical and lab examinations and sometimes repeat biopsies. In case of progression, definitive treatment is started. Risk involved is growth and spread of cancer in between follow up.

    SURGERY: Robotic or laparoscopic removal of prostate

    The robot has arms with instruments attached to its arms which are passed through key holes through the abdominal wall. The movements of arms are controlled and mimicked by the hand movements of the surgeon who sits on a console and controls the movements of these instrument arms inside the abdomen. Advantages of robotic surgery include more precision, faster recovery and less bleeding as compared to open surgery and possibly traditional lap aroscopic surgery.. Some surgeons may offer open surgical removal based on their experience and non availability of a robot or laparscopy in their armamentarium. Side effect of surgery include loss of urine control, erectile dysfunction,residual cancer or recurrence of cancer. Incidence of these varies from patient to patient. These may require additional treatment modalities.

    RADIOTHERAPY

    High powered energy beams focused on prostate to kill cancer cells. Treatment may extend from days to weeks based on the type and protocol followed. It is done by a radiotherapist. Side effects may include blood in urine, frequent urination, frequent stools and erectile dysfunction. Radiotherapy may need to be combined along with surgery or hormonal therapy.

    HORMONAL THERAPY

    Growth of prostate cancer is dependent on male hormone called testosterone.Removing testosterone from the body will cause cancer to shrink. However this may be temporary and sometimes the cancer may start growing again. Testosterone removal can be achived by either surgical removal of both testis(orchidectomy or surgical castration) or giving some drugs to remove testosterone from circulation(medical castration). These are given in the form of injections which are available in monthly, three monthly and six monthly formulations.

    CHEMOTHERAPY AND IMMUNOTHERAPY

    May be required in advanced cancers.which have spread to other organs

    PALLIATIVE TREATMENT.

    Channel TURP: part of prostate is debulked through urinary passage to ease out flow of urine. Stenting of ureters. : prostate cancer may engulf the opening of ureters into the urinary bladder causing blockage of kidneys and compromisisng their function. To overcome this blockage , thin tubes called as Double J (DJ) stents may be placed through the urinary passage using cystoscope into the ureters for a variable duration. Extremely rarely if such access is not possible through the urethra then tubes may need to be placed directly into the kidneys through the back( Nephrostomy) Radiotherapy focused to some bones may be required to reduce pain not responding to conventional drugs.


    Advantages of Robotic surgery for prostate cancer surgery:
  • Shorter hospitalization
  • Reduced pain and discomfort
  • Faster recovery time and return to normal activities
  • Smaller incisions and minimal scars
  • Reduced blood loss and transfusions
  • • Nerve Sparing Prostatectomy gives a better chance at maintaining their sexual function, thus avoiding long term impotency.  Bladder Neck Sparing techniques allows faster recovery of urinary control. 
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