Treatment of Prostate Cancer - Coursework Example

Table of Contents INTRODUCTION 2 STAGES OF PRO CANCER AND THE TREATMENT  2 Stage 2 Stage II 4 THE MOST MODERN TREATMENT OF PRO CANCER 5 CONCLUSION 7 REFERENCE 8 INTRODUCTION Prostate is a walnut sized organ that is located in front of the rectum and just below the bladder in the male reproductive system. The prostate surrounds not only a part of the urethra but also surrounds the tube that mainly carries urine from the bladder to the exterior of the body. The main function delivered by this particular organ is in the production of the fluid for semen. The main purpose of this fluid is to not only transport the sperm cells but also to nourish them. In instances when the cells grow at an abnormal rate, that is greater than the natural growth rate, the cells clump together to form a mass. This mass is termed as a tumor. The tumors are classified as being either benign or as being malignant. The former refers to being not life threatening whereas the latter one is a life threatening and cancerous tumor. As a result of several reasons, the prostate cells divide repeatedly to form a cancerous tumor. This cancer is, at many times, localized, confined to the prostate and small. However, there are instances when the cancer is present on both sides of the prostate gland. The mitotically dividing tumor cells spread to the exterior of the gland to the adjacent pelvic organs or the lymph nodes by a process termed as metastasis. Once in the lymph or in the blood, these cells spread to other parts of the body with great ease. The major sites where these cancerous cells migrate are the bones. As stated by the UCSF (2011), in order to determine the treatment of the cancer, it is vital to note down whether the cancerous cells are located within the gland or have spread to other parts of the body. STAGES OF PROSTATE CANCER AND THE TREATMENT  Stage 1 Stage 1 of prostate cancer is characterized by the presence of small cancers that reflect low Gleason scores. This stage of the cancer tends to grow and reproduce at a slower rate. Furthermore, in this stage of the cancer, no particular symptoms are observed. Stage 1 of the prostate cancer refers to the stage in which the tumor is not felt during the digital rectal exam. T1a and T1b demonstrate those cancers that are diagnosed incidentally during the TURP. TURP refers to the transurethral resection of the prostate which is a surgical procedure that is performed in order to relieve symptoms of benign prostatic hyperplasia. The T1c cancers are those tumors that are detected by an elevated level of PSA. This is then diagnosed with a biopsy. In this stage of prostate cancer, the treatment varies considerably on the age of the patient. For elderly men who have not yet demonstrated any signs or symptoms of prostate cancer and have other serious health issues, two major treatment options are present. These include waiting that should be watchful and secondly radiation therapy. For the radiation therapy, either brachytherapy or external beam therapy is a reasonable option. According to an article written by the Cleveland Clinic (2011), in the brachytherapy form of radiation, certain radioactive pellets are implanted into the prostate gland. Each of these pellets is comparable to the size of a grain of rice. One of the reasons for selecting these pellets is that they can be easily removed once the proper dosage has been obtained. Thus, these pellets are temporary. However, at other times, these pellets can also be permanent. In the high dosage brachytherapy, radiation sources with stronger intensity are utilized. These pellets are placed in the cancerous site for duration of only less than 15 minutes. The sources of radiation are put in to catheters that are soft tubes. 3 treatments are usually given over a couple of days after which the catheters are removed from the prostate. The numbers of radiation sources that are implanted in the gland depend entirely on the location and size of the cancerous growth. The entire process of implantation of the pellet takes only an hour and is performed on the outpatient basis. As compared to the external beam procedure, the pellets used in this method of treatment deliver higher dosage of radiation thus the radiation tends to travels only a few millimeters and is successful in limiting itself within the prostate and does not extend beyond the site of the cancer. The other method of treatment is the external beam radiation therapy. In this treatment, the beams of radiation are focused entirely on the prostate gland using a machine that is placed outside the body. The duration of the treatment is only a few minutes but the entire process continues over a time period of 7 to 9 weeks. The treatment process is painless and is non invasive. In the current times, the external beam radiation therapy is used less often in comparison to the other treatment methods. This is because the newer methods allow the doctors to demonstrate greater accuracy and in decreasing the exposure of the radiation to the surrounding healthy tissues (ACS, 2013). Men who have the stage 1 cancer and are younger and are not experiencing any health issues are to consider either a surgical approach to remove the prostate. This is the radical prostatectomy or should opt for the external beam therapy or external beam therapy. As stated by Christopher, John and Stephen (2005), this treatment is of great importance since it corrects any obstruction that imposes to the flow of urine. The radical prostatectomy is the most common urological procedure performed in the UK. This is performed by three routes. These include Perineal, Laparoscopic and Retro pubic. Stage II The stage II cancer in comparison to the stage I cancers are not treated with high dosage of radiation or surgically. These cancers are considered to spread from the prostate gland beyond and also tend to show several symptoms. Similar to the Stage I cancer, the current treatment approach for elderly patients is radiation therapy and radical prostatectomy. For younger and healthier patients, the options include External beam radiation only, Cryosurgery which is the surgery that freezes diseased tissue, Brachytherapy and external beam radiation combined Brachytherapy only or the Radical prostatectomy, often with removal of the pelvic lymph nodes and sometimes proceeded by hormone therapy. While comparing the treatment approaches, the radiation therapy or surgery are more widely studied and used in the recent times as compared to the cryosurgery. Talking about the next stage of cancer, the Stage III prostate cancer is that stage in which the cancerous cells have spread to the outside of the prostate gland but has not yet invaded the lymph nodes, rectum, bladder or the distant organs. The third stage cancer refers to that cancer in which the cells have extended beyond the capsule of the prostate and to the seminal vesicles. This spread of the cancer is indicated by the imaging studies as well as by the biopsy. In cases when the cancer is felt during a DRE and extends to the outer sides of the prostate but not to the seminal vesicles, this is termed as T3a. In other instances, when the cancer also spreads to the seminal vesicle, that is termed as T3b (WebMD, 2014). Recently, the radiation therapy and surgical approach are less likely to provide successful results. In the current times, the most widely used approaches are the Hormone therapy only, External beam radiation plus hormone therapy, in certain selected cases radical prostatectomy and watchful waiting for the older patients. Apart from these treatment options, the radical prostatectomy at this stage is not nerve-sparing and is often done with removal of the pelvic lymph nodes. As stated by The Prostate Cancer Charity (2012), the hormone therapy for the Stage III prostate cancer acts by preventing the testosterone from reaching the prostate cancer cells. Testosterone acts as a source of amplifying the growth of the cancer cells. Even if the cancerous cells are localized in the prostate or if they have metastasized to other parts of the body, testosterone feeds the cells. By taking the cells away, the cancerous cells shrink. Some of the hormone therapy include GnRH antagonist, Oestrogens, LHRH therapy etc. Albeit this method is widely used, there are certain issues associated with it. These include treating early stage cancer, Early versus delayed treatment, intermittent versus continuous hormone therapy as well as combined androgen blockade. As mentioned by the PCT (2012), metastatic Prostate cancer is responsive to androgen deprivation therapy. The androgen deprivation therapy involves either pharmacologic therapy which makes use of anti- androgens or LHRH analogues or involves bilateral orchiectomy (castration). These treatments can be used in two ways. Firstly, they can be utilized sequentially or secondly in combination. Records suggest that the use of androgen deprivation therapy is successful in controlling the metastatic prostate cancer for several years. There is present certain limited evidence on the combination as well as optimal sequencing of these treatments. Furthermore, with the passage of time, new anti-androgens are being trailed in studies which will hopefully prove to be useful in the treatment of metastatic prostate cancer. In the final stage of the prostate cancer, that is Stage IV, the cancerous cells have grown out of the prostate gland. The cancer has spread to only the bladder, lymph nodes but also to the bones and rectum. As stated by Jay (2013), this stage of cancer is not considered as a curable cancer however, it is very treatment. Whatever treatment is opted for this stage, it can not only prolong the life of the patient but also reduce the symptoms associated with the cancer for considerably long periods of time. THE MOST MODERN TREATMENT OF PROSTATE CANCER The treatment of prostate cancer acts as an excellent area for research. At the same time not only current methods are being improved and enhanced but also newer treatment approaches are being developed. In surgical approaches, doctors are working on new methods to repair the nerves that are responsible for causing erection. For early stages of cancer, newer treatments are being explored and researchers are studying for newer and modernized forms. One of the treatments approaches is known as HIFU, high- intensity frequency ultrasound. These highly focused ultrasonic beams destroy the cancer cells by heating. Recently, computers special software including the Trans rectal ultrasound device and monitoring of the HIFU treatment allows a real time therapy control for patients with prostate cancer. Treatment with HIFU can be easily extended to several different surgical areas. It is used as an extracorporeal method which permits the non-invasive as well as coagulative destruction without the use of any surgical procedure. Another treatment approach that is currently in use includes the use of Tumor markers (Chaussy, Thüroff, 2010). They not only aid in the detection of several types of cancer but also in the diagnosis as well as management of the cancers. The levels of these tumor markers in the body depict the presence of cancer in the prostate gland. One of the most widely used approaches is that of the targeted therapy. In this method, a drug is utilized that tends to locate as well as attack certain specific cells without damaging the normal body cells. A type of targeted theory is the Monoclonal antibody therapy. Monoclonal antibody therapy is the type of treatment in which antibodies are being utilized in the laboratory from one single type of an immune system cell. The most vital action of these antibodies is that they can easily identify several substances on the cancer cells or those located on any cells that help in the growth of the cancer cells. According to the NCI (2013), by attaching to the respective cells, they antibodies not only kill the cancer cells but also bock their growth and prevent them from spreading. These antibodies are given by infusion and can be used not only alone but also with other drugs, toxins or radioactive material. One type of this antibody is Denosumab. This antibody slowdowns the damage to the bone from cancer and reduces the bone issues and pain. In the recent times, there have been several changing approaches for the management of the metastatic prostate cancer in men during the prechemotherapy time duration. The currently used options include abiraterone acetate and sipuleucel-T. Apart from these two drugs, enzalutamide is also approved after chemotherapy. With these growing number of drug options for patients, the patients tend to experience major challenge. It becomes difficult for the patients to decide as to which drug they should choose for their treatment course. Also, they fail to understand the importance and significance of the drugs. Talking about the drug sipuleucel-T, albeit this drug has resulted in a significant amount of improvements in the survival of patients with the prostate cancer, the drug has failed to provide any objectable betterment or improvement in men who opt for this treatment. This means that the doctors fail to figure out whether the drug is providing a benefit to the cancer patient or is causing harm to him (Chodak, 2014). According to Dr. Robert (2013), it has been observed in recent times that a drug exists which is capable of permanently killing and abolishing the cancerous cells. This drug does not kill the cancer cells but diminishes the cell proliferation capability of the metastatic cells. This drug has been observed to be highly active against all types of cancer cells and possesses the capability of invading the cells at a rapid rate. Furthermore, the drug is retained locally and is poorly absorbed into the blood stream or the lymph. In several clinical trials, this drug has been tested as an intravenous anticancer agent. CONCLUSION Thus, prostate cancer is considered to have a wide range of clinical presentations. The cancerous tumor varies not only in its aggressiveness but also in its extent. Also, the patients suffering from this cancer also vary from very young and fit to elderly and finally to those that have a limited life expectancy. All patients who are diagnosed with prostate cancer and are at significant risk of metastatic disease opt for the best suited treatment approach. The treatment approaches include the expectant management which is also termed as active surveillance, cryosurgery, hormone therapy as well as surgery or radiation therapy. In the recent years many new developments have been made in this aspect of prostate cancer. However, with each new invention come a great number of issues and considerations. The new researches being carried out in the field of the treatment of prostate cancer, include not only advances in the genetics which help the scientists in understanding how the cancerous cells spread, the treatment involving HIFU, advances in hormone therapy and many more. REFERENCE UCSF, (2011), Prostate Cancer & Its Treatment, UCSF Medical Center Your Health Matters, Find a Doctor: (800) 444-2559 • Patient Education Library: www.ucsfhealth.org/education, Cleveland Clinic, (2011), Treatment Guide Prostate Cancer, ©The Cleveland Clinic Foundation 2011. American Cancer Society (2014), Prostate Cancer Overview ,2013 Copyright American Cancer Society. WebMD (2014), Prostate Cancer Health Center,Prostate Cancer: Treatments by Stage,© 2005-2014 WebMD, LLC. All rights reserved, accessed on 23rd March 2014, accessed through: http://www.webmd.com/prostate-cancer/guide/treatments-by-stage Jay B. Zatzkin, MD, FACP (2013), Stages of Prostate Cancer, © 2013 WebMD, LLC. All rights reserved Christopher. E, John. D and Stephen. L, (2005), A Patient’s Guide to Radical Prostatectomy for Prostate Cancer, The Prostate Cancer Centre Stirling Road, Guildford, Surrey GU2 7RF, www.prostatecancercentre.com, Tel: 0845 370 7000 (local rate) EHC, (2008), Treating Prostate Cancer, A Guide for Men With Localized Prostate Cancer, AHRQ Pub. No. 08-EHC010-2A , July 2008 National Cancer Institute (2013), Prostate Cancer Treatment (PDQ®), NIH -Turning Discovery In to Health® Chodak.G, (2014), New Options in Advanced Prostate Cancer Raise Questions Dr. Robert Eyre, (2013), Prostate Research, Bedford Stem Cell Reserc Foundation, E:info@bedfordresearch.org Prostate Cancer Taskforce, (2012), Diagnosis and Management of Prostate Cancer in New Zealand Men,Recommendations from the Prostate Cancer Taskforce, Published in May 2013 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand ISBN 978-0-478-40264-3 (online) HP 5647, This document is available at www.health.govt.nz C. G. Chaussy, S. Thüroff, (2010), TRANSRECTAL HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCAL TREATMENT OF PROSTATE CANCER: CURRENT ROLE, Special Article, Special Article Read More