Why do I need prostate cancer treatment?
If your prostate cancer is aggressive, has the potential to advance into other tissues, is at a later stage or is causing symptoms, treatment is advised. Alternatively, those with benign prostatic hyperplasia with symptoms may also opt for prostate removal surgery. You may discuss all options during your free Remedazo consultation.
How do I prepare for prostate cancer treatment? What can I expect?
Pre-travel prostate cancer preparation
Approximately two to three weeks before a prostate cancer procedure you will be asked to supply the results of your PSA blood tests from a period of 6 months to a year if at all possible. This means we can see how your prostate cancer is progressing and help us to advise the best treatment options. We will also need any information regarding medication use, other illnesses or disorders, and your overall state of health.
You will also need to undergo an MRI or CT scan and possibly a bone scan which will help us to see if cancer has spread to other organs. If prostate cancer has spread or metastasised you may need to consider chemotherapy as a therapy.
Approximately 1 week before your prostate cancer treatment you will need to ask your home doctor to take blood for a preoperative blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. For surgical procedures some blood-thinning medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Prostate cancer treatment in the hospital
Please scroll down to the appropriate section. The given information covers all available treatments for prostate cancer at Remedazo.
Hormone therapy
Androgens or male sex hormones stimulate prostate growth. Where cancer is present, these hormones can speed up the process, especially in the early stages. By preventing the release of androgens, one can slow prostate growth. This type of therapy is known as androgen deprivation therapy or ADT. One can either prevent the production of androgens or block their effect.Â
The majority of male androgens are produced in the testicles, with smaller amounts being made in the adrenal glands. However, prostate cancer cells also produce increasing quantities which is why hormone therapy is usually limited to early prostate cancer, as an adjunct therapy and where prostate cancer recurs after remission. Men with intermediate-risk prostate cancer should take oral hormone therapies for 6 months; those with high-risk prostate cancer should proceed with this therapy for at least 18 months.
ADTs are known for their side effects which range from diarrhoea to loss of libido, fat deposits in the breasts (gynaecomastia), loss of bone density and muscle mass, fatigue, insulin resistance and weight gain. This means that other medications are necessary to counteract these effects.
Hormone therapy for prostate cancer is only recommended for certain types and stages of the disease. You can discuss your eligibility for androgen deprivation therapy with a Remedazo specialist.
Orchiectomy or orchidectomy
As the testicles are the primary source of testosterone, the androgen or male hormone that accelerates prostate growth, their surgical removal is sometimes advised. This outpatient procedure is known as an orchiectomy or orchidectomy. While an orchiectomy is not a curative therapy it is known to cause tumours to shrink and also relieves bone pain in cases of metastasized prostate cancer. It can help relieve prostate cancer symptoms, prevent complications and prolong survival for advanced prostate cancer. Radiation treatment is sometimes required after surgery.
This type of procedure means there is less of a need to take oral or injected hormone-restricting medications. Side effects include loss of libido, infertility, gynaecomastia, fatigue and loss of muscle mass.
It is possible to place reconstructive implants at a later date should you so wish. In some cases, a subcapsular orchiectomy is possible where only the area of the testicle that produces testosterone is removed. Recovery from an orchiectomy is rapid with very few risks. Discomfort is easily relieved with over-the-counter painkillers.Â
Prostatectomy
A prostatectomy is a surgical procedure where the entire prostate gland is removed. This procedure can be done using various methods:
A transurethral radical prostatectomy (TURP) does not remove the entire prostate but any areas, usually around the urethra, that become blocked or narrowed due to excessive prostate tissue. A TURP removes this invasive part of prostate growth. A resectoscope is inserted into the penis and so into the urethra. The surgeon can then cut away any parts of the prostate that are creating pressure within the urethra or at the bladder neck. As the majority of the prostate remains in place after surgery, this is only an advised treatment for benign prostatic hyperplasia with associated and uncomfortable symptoms or to increase comfort in inoperable cases of prostate cancer. A TURP involves no incisions on the skin and can be carried out under spinal or general anaesthetic. Hospital stay is one to two days as a urinary catheter must remain in place, flushing the bladder of any debris and removing urine until you are able to urinate without discomfort.
Laparoscopic radical prostatectomy is the removal of the entire prostate by way of keyhole surgery. This procedure requires a general anaesthetic. The surgeon removes the prostate and seminal vesicles via 5 small incisions in the lower abdomen before reattaching the urethra to the bladder. A simultaneous lymph node biopsy may also be carried out. This procedure requires a 2 to 3-day hospital stay. A urinary catheter will be inserted during the procedure and must remain in place until the urethra to bladder connection heals. Radical prostatectomy surgery can also be done through the lower abdomen with a single, large (15 to 20 cm) incision. This type of procedure is called an open prostatectomy. The open procedure requires more recovery time but not a longer hospital stay. All prostate surgery procedures insert a drain through an incision to remove fluids from the operation site. These will remain in place for 24 to 48 hours after surgery.
A robotic-assisted laparoscopic prostatectomy allows the surgeon to sit at a console next to you and operate using tiny instruments. The robotic system perfectly copies the surgeon’s precise and practiced hand movements. This is a minimally invasive procedure but requires a night on a medium-care ward before being moved to a surgical ward. This procedure takes between 90 minutes and 3 hours and requires the patient to lie in a Trendelenburg position, with the head much lower than the incision sites. This positioning can make you feel confused for up to an hour after surgery, cause facial swelling or give you a headache. Your treating anaesthetist and nurses are fully aware of this complication and will do their best to treat these common side effects early on.
For all types of prostate surgery, you will be admitted to your chosen clinic on the day of the procedure. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting.Â
From midnight of the day before the prostatectomy procedure, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during general anaesthesia. Smokers should stop smoking at least 24-hours before an operation as this improves oxygen levels throughout the body. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted.)
Approximately thirty minutes to one hour before the planned procedure time you will be collected from your room and brought to the surgical department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative prostate cancer surgery preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A general or spinal (only for TURP) anaesthesia
An arterial catheter for robotic-assisted radical prostatectomy procedures
At the surgeon’s signal, you will be anaesthetised.Â
H5 What happens after a prostatectomy? What can I expect?Â
You will be woken by the anaesthesiologist immediately after surgery and transported from the operating theatre to the recovery room. Here you will be carefully monitored. Prostatectomy patients remain in the recovery ward until they are fully responsive and any pain is well under control. TURP patients who have opted for spinal anaesthesia will remain in the recovery unit until they are able to move both legs and experience minimum pain.
When the anaesthesiologist is satisfied you are fully awake and comfortable you will be brought to a surgical ward. Robotic-assisted procedures and some patients who Remedazo patients continue to be carefully monitored for a minimum of 24-hours after surgery. Pain medication is given as standard for the first 24-hours and then upon request and according to your personal doctor’s prescription. Arterial lines are usually removed within 12-hours after surgery. Your intravenous catheter will remain in place until you are able to drink and take medication by mouth. The intravenous catheter will continue to administer fluids for 24 to 48 hours and your drain will be removed by a trained nurse or doctor within 2 days. Urinary catheters placed after total prostatectomies can remain in place for up to three weeks to allow the urethra to heal. For TURP procedures, this time is reduced to 24 – 48 hours.
The majority of prostate cancer patients are out of bed within 8 hours of exiting the recovery room, although robotic-assisted procedures require a night in a medium care unit bed. The average hospital stay for radical prostatectomy is 3 days. You will then be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home or have completed further radiology treatment.
Long-term postoperative care includes the removal of stitches after 10 to 14 days. This can be done by your general practitioner at home if you are not attending further treatment sessions. It is advised not to lift heavy objects for at least 6 weeks after surgery. You can return to work after a month unless your job requires heavy lifting or exertion.
Benefits of prostate cancer surgery
A radical prostatectomy removes the source of prostate cancer and so has the potential to be a curative procedure. This surgery is therefore usually limited to localised or locally advanced prostate cancer. Laparoscopic and robotic-assisted surgeries do not require long stays in the hospital and have relatively rapid recovery times. This type of surgery is also considered safe.
It is possible to request nerve-sparing surgery depending on the tumour type and how close it is to the nerve and blood vessel bundles close to the prostate gland. Nerve-sparing surgery takes care to avoid damaging the areas of nerve tissue and blood vessels that play a role in penile erection but this is not always possible. Your urologist or Remedazo specialist will be able to discuss your eligibility for a nerve-sparing procedure after viewing your most recent CT or MRI results.
Disadvantages of prostate cancer surgery
The chance of postoperative infection is relatively low with this type of surgery and patients are administered antibiotics as a preventive measure before surgery commences. However, all surgery carries a risk of infection. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on. Other short-term risks include bleeding, adverse reactions to the anaesthesia, blood clots, an urge to urinate in the presence of a urinary catheter, and breathing problems. Long-term urinary catheter use does increase the risk of urinary tract infection and your follow-ups will include urine tests to enable rapid treatment.
Long-term complications often include erectile dysfunction (impotence) and urine loss. Erectile function is more likely to return in men under 60 years of age and in those eligible for nerve-sparing surgery. The formation of scar tissue may also narrow the urethra or bladder neck and make urination difficult. We recommend you visit your local general practitioner early on so he or she can keep an eye on your progress.
Prostate radiation therapyÂ
Pre-surgical, post-surgical or stand-alone radiation therapy is used to shrink tumours by way of high-energy rays that kill cancer cells. Radiation therapy alone can cure low-grade prostate cancer.
By shrinking a tumour before surgery, the surgeon’s job is often made easier but also gives an indication of how responsive your specific cancerous prostate cells are to radiology treatment. Post-surgical radiation therapy is used if it is unsure whether all cancer cells have been removed and in early locally advanced cases. For advanced cases of prostate cancer, repeated radiation therapy can slow down tumour growth and keep the cancer cells under control for significant periods of time.
Often, radiation therapy is paired with hormone therapy (androgen suppression therapy). Hormone therapy on its own cannot cure prostate cancer but in combination with radiation therapy can improve results. In advanced prostate cancer, hormone therapy often slows progression and relieves symptoms.
This is because prostate cancer cells use male hormones as fuel. By reducing the availability of male hormones, these cells are less likely to thrive. Some patients opt for an orchiectomy or surgical removal of the testicles with testicular implant surgery at a later date, although the psychological effects of this procedure make it unpopular. Most hormone therapies come in the form of drugs (injected or oral) and require regular follow-ups by your doctor. The most common side effects of hormone therapy are impotence, reduced sexual desire, smaller sexual organs, breast tenderness or breast tissue growth, anaemia, fatigue and weight gain. Newer drugs offer lower side effect risks. You will be able to discuss these options with your urologist at home or with a Remedazo specialist.
Radiotherapy therapy for prostate cancer is composed of two main types – external beam radiation therapy (EBTR) and brachytherapy (internal radiation therapy). If prostate cancer has spread to the bone tissue (bone metastasis), patients may be offered radiopharmaceuticals. These are drugs that contain radioactive substances that are injected and settle in areas of damaged bone. Here, they emit radiation that kills cancer cells. These drugs also relieve bone pain caused by metastasis and can extend life in advanced prostate cancer.
External beam radiation therapy focuses beams of radiation into the prostate gland and requires short (10 to 30 minute) visits to the hospital 5 times a week for several weeks. Long-term stays with all transportation, support, accommodation and meals can be seamlessly arranged by the Remedazo team. EBRT is a painless treatment and recent technology now enables oncologists to be even more precise with dosage and range. Additional options such as three-dimensional conformal radiation therapy or 3D-CRT use computers to map the prostate and shape the radiation beams to avoid damaging non-cancerous tissues. The even more advanced intensity modulated radiation therapy (IMRT) machine moves around the patient, shapes the beams and adjusts radiation intensities. This may be done with built-in scanners (image guided radiation therapy or IGRT) or using a more rapid but not necessarily more effective technique called volumetric modulated arc therapy or VMAT.Â
Internal radiation therapy for prostate cancer is available in the form of brachytherapy. Brachytherapy involves the insertion of small radioactive pellets directly into the prostate under spinal or general anaesthetic in an operating theatre. This treatment is used for low-grade early-stage prostate cancer or in combination with external radiotherapy for those who are more at risk of developing locally advanced prostate cancer. If a prostate gland is very large, this is not the best option. If that prostate responds well to hormonal or radiation therapies and shrinks, brachytherapy then becomes an option. Brachytherapy is an out-patient procedure; some hospitals may prefer you to stay overnight.
Brachytherapy is used either to treat the prostate over the course of weeks or months with low doses of radiation or, less commonly, with one or more treatments of higher doses that remain in place for up to 24 hours before being (surgically) removed. Low doses that remain in the body for a period of time require you to keep your distance from pregnant women and children; a doctor’s note is necessary when traveling by air.
The side effects of radiation therapy often depend on its effects upon healthy tissues that are found close to the prostate such as the rectum and the bladder. In addition, radiation treatments can make you feel tired for weeks to months. Sometimes lymph nodes close to the prostate are damaged, allowing fluid to collect in the legs or genital area. This is called lymphedema and can usually be successfully treated with physical therapy. Brachytherapy pellets can move position and you will have to strain your urine for the first week as these radioactive pellets or seeds must be disposed of in the correct way. At Remedazo, all associated information will be given upon or shortly after your consultation; you can then make an informed decision regarding the types of radiotherapy available to you.
Prostate cryotherapy
Cryotherapy uses cold temperatures to freeze and so kill all prostate cells, including cancerous ones. This is not a first-line treatment unless the patient is unable to undergo surgery or radiation treatment; it is more often used when cancer cells return after radiation therapy. This procedure is usually done under a spinal anaesthetic or a general anaesthetic. Using a rectal ultrasound probe, the doctor locates the prostate and inserts hollow needles into it through which an extremely cold gas is passed. The urethra is protected by warm fluids passing through a urinary catheter which must remain in place for several weeks. Cryotherapy is an out-patient procedure and an option for small, slow-growing prostate cancers.
 Prostate cancer alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The accepted prostate cancer treatment alternatives have been described in the necessary detail above. Complementary and alternative prostate cancer remedies are unproven and should not take the place of accepted treatment courses.Â
Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist urologists and oncologists to determine the best treatment type for you. You can discuss all prostate cancer and BPH treatment alternatives with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.
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