| - Prostate Cancer Treatment Options -
Other Surgical Options
In the early 1990s, roughly 30 percent
of prostate cancer patients in the United States were treated
by surgery, 30 percent by radiation, and 20 percent by watchful
waiting. The remainder were treated with a combination
of therapies and some experimental treatments.
The popularity of surgery in this country
has risen sharply in recent years. A study of Medicare records found that the number of men nationwide
receiving radical prostatectomy by 1990 was six times greater
than the number recorded for 1984, across all affected age groups.
The growth of the popularity of surgery
has corresponded with the advent of minimally invasive surgical
options that reduce side effects and promote faster recovery
times. The two surgical options discussed in this section are
radical prostatectomy and cryosurgery.
Radical
Prostatectomy
Radical prostatectomy
is the complete removal of the prostate and associated structures. Radical
prostatectomy is further described in terms of the surgical approach to reach the gland. Retropubic
prostatectomy is performed through an incision
in the lower abdomen. Perineal prostatectomy is a less common approach, performed through an incision in the perineum, the space between the scrotum and
the anus. Robotic radical prostatectomy is the newest means of accomplishing surgical removal of the entire prostate. This newer means of prostatectomy allows improved visualization, smaller incisions, reduced blood loss, and quicker recovery.
Radical prostatectomy includes removal of the entire prostate gland, along with the seminal
vesicles, and a segment of the vasa deferenta. The segment
of the urethra that runs through the prostate is removed with the gland. Pelvic lymph node dissection is done if there is an indication of higher risk prostate cancer such as Gleason Grade 7 or higher or PSA above 10.
Cryosurgery
Cryosurgery uses extreme cold to freeze and kill prostate
cancer cells. Guided by transrectal ultrasound, hollow needles are placed through the perineum, into the prostate gland. These cryo probes use pressurized argon gas to attain very cold termperatures. As the cells thaw, they
rupture. The procedure takes about 2 hours, requires anesthesia
(either general or spinal), and requires a night in
the hospital.
During prostate cryosurgery, the urethra is protected from injury with a warming catheter, so incontinence is rarely a problem. However, the nerve bundles responsible for erection can not be protected from freezing, so impotence almost always results from this procedure.
After the procedure, there is often bruising and soreness
in the perineum, where the needles were inserted.
The freezing of the prostate is monitored by ultrasound images, to be sure enough prostate tissue
is destroyed without too much damage to nearby tissues.
A suprapubic catheter may be placed through a skin incision
on the abdomen into the bladder so that if the prostate
swells after the procedure, iit won't
cause urinary retentino. The catheter can be removed once the patient is voiding well again, generally 1 to
2 weeks later.
Compared with surgery
and radiation therapy, there is less known about the long-term
effectiveness of cryosurgery.
Current techniques using ultrasound guidance and precise
temperature monitoring have only become available recently. Long-term (10- to 15-year) follow-up
data must still be collected and analyzed. For this reason, many urologists do not consider cryotherapy as a first-line option for initial treatment of localized prostate cancer. Cryotherapy is currently used most commonly for salvage therapy after recurrence in patients who have been treated previously with radiation. |
