Laser Surgery For An Enlarged Prostate Is No More Effective Than Standard Surgery
This is a plain English summary of an original research article
Two procedures to treat men with enlarged prostates are both effective, new research has shown.
A benign enlarged prostate is not cancer and is not usually a serious threat to health. But it is common in men over 50 and some need surgery to treat troublesome urinary symptoms caused by the growing prostate. The most common procedure is transurethral resection of the prostate which is usually successful but can lead to complications such as bleeding in some men.
The UNBLOCS trial compared the effectiveness of TURP to a new laser procedure which might reduce a patients hospital stay and cause fewer side effects. The thulium laser, ThuVARP, vaporises excess prostate. Men who needed a prostate operation were asked to consent to either procedure without knowing which one they would receive.
One year later, men in both groups were satisfied with their surgery. They reported similar improvements in their urinary symptoms and quality of life. There was no difference between the two procedures in terms of hospital stay or complications. However, men in the TURP group achieved a faster urinary flow rate . TURP was also slightly more cost-effective and faster to perform than the laser procedure.
External Beam Radiation For Prostate Cancer
When most patients think of radiation therapy, they think of external beam radiation therapy , in which a beam of radiation is directed at cancerous tissue from outside the body. Technological advances, such as intensity-modulated radiation therapy and image-guided radiation therapy , allow radiation oncologists to use computer-controlled devices and image-guidance technology to see and target a three-dimensional image of the tumor, making the treatment more precise than ever before.
In the past, EBRT required 40-45 daily treatments. Now, 25-28 treatments are the norm. This type of protracted, fractionated radiation therapy, however, is now generally considered to be less appropriate for low-risk and favorable intermediate-risk patients. Instead, hypofractionated techniques and brachytherapy techniques are generally more advisable for many patients.
Surgery To Remove Your Prostate Gland
You might have surgery to remove your prostate gland if:
- your cancer hasnât spread outside the prostate gland
- you are younger and have a fast growing tumour
- as part of treatment for locally advanced or high risk localised prostate cancer
The aim of a radical prostatectomy operation is to cure prostate cancer. It is major surgery with some possible side effects. If youâre an older man with a slow growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer might grow so slowly that youâre more likely to die of old age or other causes than from prostate cancer.
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The Prostate Cancer Outcomes Study
This study involved 1,291 men ages 3979 who filled out questionnaires asking about specific changes in urinary and sexual functioning following radical prostatectomy. When questioned 18 months or longer after treatment, 8.4% of men reported being incontinent, and 59.9% reported being impotent. These percentages indicate incontinence and impotence may be more common than other studies, which relied on patients volunteering specific information, have found.
Source: Stanford JL, Feng Z, Hamilton AS, et al. Urinary and Sexual Function after Radical Prostatectomy for Clinically Localized Prostate Cancer: The Prostate Cancer Outcomes Study. Journal of the American Medical Association 2000 283:354-60. PMID: 10647798.
And what did the radiation oncologists advise?
I was really impressed with both men. They talked about the implantation of radioactive seeds . I said to one of them, You know, Im getting all this information and Im in overload here. So if you were in my position, what would you do?
And he said, Well, Im 20 years younger than you. So if I had prostate cancer, I would have surgery. Because Im most concerned about living a long life.
And I said to myself, Look, pal, I want to live a long life too!
Did he provide evidence that surgery would make an individual patient live longer?
Did either of the radiation oncologists mention external beam radiation?
So then what happened?
Have you talked with him since then? Has there been any improvement?
What impressed you?
Radiation Therapy For Prostate Cancer
If your care team is considering radiation therapy as part of your treatment regimen, youll work directly with a radiation oncologist. He or she will explain the specific type of radiation therapy recommended for your cancer and answer any questions you have.
Some prostate cancer patients wonder about the safety of this treatment. Thanks to scientific advances, radiation therapy techniques have improved over the years. More precise radiation delivery techniques are designed to help spare normal tissue from exposure and reduce the severity of side effects. In addition to the external delivery of radiation, we now also have internal delivery options. In some cases, courses of radiation treatment may be more intense and shorter in duration.
The development and use of hydrogel spacersgel thats inserted between the prostate and the rectummay also reduce damage to tissue surrounding the prostate during radiation, which in turn helps to reduce treatment-associated side effects.
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Image Guided Radiation Therapy
In this type of radiation therapy, CT scans are taken both during the planning process and just before treatment begins. Comparing the two images allows doctors to adjust treatment as needed, since tumors can move between treatments. This allows precision targeting of the cancer while avoiding nearby healthy tissue.
In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT to account for organ/tumor motion even if the body is immobilized.
Calypso is another form of IGRT where the prostate can be tracked during the treatment.
If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Help Managing Cancer Treatment Side Effects
The team at Compass Oncology is experienced in helping patients treat prostate cancer and manage the side effects of treatment. If you live in the Portland-Vancouver area, have more questions about the side effects of prostate cancer treatment, or need help managing your side effects, request an appointment at one of our locations that’s convenient for you. We’re here with you every step of the way.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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Facts About Prostate Removal Surgery
Prostate cancer surgery can be extremely concerning for many patients. You may be wondering how your surgery will be performed because of your prostate glands location. Youll probably have questions about pain and the side effects including questions about your sexual life afterward and your ability to control urine.
The good news is that todays technology offers minimally-invasive prostate removal surgery. The method is known as Robotically Assisted Laparoscopic Radical Prostatectomy . RALP is the most often used surgical method for prostate cancer. The da Vinci robotic system allows surgeons to use one or more small incisions for your surgery. Surgeons use a high-magnification 3D camera system to help them operate with accuracy.
How Does New Robotic Technology Assist The Surgeon During Radical Prostatectomy
The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. Because of robotic technology, surgeons are able to perform minimally invasive procedures with more precision. Robotic arms remain steady at all times and robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles â positions surgeons would have difficulty reaching otherwise.
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Equipment For Laparoscopic Radical Prostatectomy
The laparoscopic approach involves 2-dimensional monitors and conventional laparoscopic instruments with a 10-mm 0° and/or 30° telescope. The camera may be operated by a one-armed camera holder or by an assistant. The use of a single voice-operated robotic arm has also been described as an adjunct to the laparoscopic approach. A camera-holding device provides stability and prevents camera shake that can result from holding it by hand .
The Best Method For Measuring Prostate Cancer Treatment Success
Measuring the Prostate Specific Antigen level is the most important, and most common test to measure success of treatment of prostate cancer.
Why? First, regardless of the treatment you receive, it is the test you will have each time you have a medical visit, and it is the test you and your doctor will use to determine if your cancer is controlled or not.
Second, if PSA levels become elevated after treatment, it will mean you need further tests and very likely further treatment. The tests and subsequent procedures following an elevated PSA level after treatment can significantly worsen the quality of your life. Before deciding on an initial treatment, you need to understand how well that treatment does at controlling the cancer. What is the chance that you will need further treatment? PSA progression rates provide a level playing field to compare the different treatments.
Initially, PSA is used as a cancer screening tool. But after treatment, PSA is used to monitor for the recurrence of cancer.
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What To Expect After Radical Prostatectomy
Most men stay in the hospital for 1 to 3 days after radical prostatectomy. Your care team inserts a urinary catheter during the surgery, and some men may need to wear the catheter home for a few days to a few weeks. Another catheter inserted through the skin also may need to stay in place for a few days after returning home.
Pain after radical prostatectomy can generally be controlled with prescription pain medicines. It can take weeks or months for urinary and sexual function to return to their maximum levels.
After radical prostatectomy, itâs important to see your doctor for all your regular follow-up appointments to make sure your prostate cancer doesnât return.
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Who Performs Prostate Surgery
A urologist performs prostate surgery. Some specialists use the term urologic surgeon, but board certification in urology requires extensive training in surgery, including prostate surgery. If you require prostate surgery for cancer, look for a surgeon who specializes in prostate cancer surgery. This doctor may be a urologist, urologic surgeon, or surgical oncologist.
Urologists specialize in surgical procedures in the urinary tract system and the male reproductive system, including the prostate. Surgical oncologists specialize in cancer surgery. All of these providers may specialize further in the surgical approach, such as laparoscopic surgery or robotic prostate surgery.
Regardless of the specialty, be sure your surgeon performs a high volume of surgeries per year of the exact procedure you are having, and at a hospital with a record of high qualitya low rate of complications. This expertise and experience will improve your chances of a successful operation and recovery. Check hospital quality at healthgrades.com.
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What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Caring For The Incision
You will be able to take a shower the second day after your surgery. You may continue to have some discharge at the drain site for three to five days. Once you leave the hospital, the key words on caring for the drain site and incisions are clean and dry. Showering once a day and gently patting the area with a clean towel should be sufficient.
Am I Too Old To Have Prostate Surgery
How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense that is, for the benefits to outweigh the risks you need to be young enough to take advantage of the added survival time that surgery can offer. Thats why I generally dont recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
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