Артрит – Arthritis

If we were to offer some friendly advice to men who are focusing on this aspect of the surgery, it would be this. Think about what’s really important! The primary goal here isn’t to preserve potency, but to get rid of the cancer in a careful but thorough way. Please keep that in mind. Men can remain potent even if one bundle is removed, and can still have normal sensation, sex drive, and orgasm even if both bundles are removed.

There is no way for the surgeon to know for certain beforehand whether or not the bundles can be spared; only during surgery is it truly possible to see where the cancer is. If the surgeon decides to preserve the nerve bundles, the tiny branches that connect the nerves to the prostate are divided carefully. If, however, one or both bundles must be widely excised, the nerve bundles are cut near the urethra and beside the rectum.

Next, the surgeon goes to work on the prostate, making a cut to separate it at the bladder neck, which links the bladder to the prostate. The seminal vesicles and vas deferens on both sides are also removed. The goal here is to remove as much surrounding tissue as possible along with the prostate. Finally, the surgeon must carefully rebuild the urinary tract, hooking up the bladder once again to the urethra and urethral sphincter, which is responsible for urinary control (this reconnection is called an anastomosis). The surgeon uses sutures, or stitches, to narrow the bladder neck so it matches the size of the urethra. The Foley catheter is left in place after the operation.

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On the other hand, the benefits of watchful waiting aren’t that clear for younger men with localized disease—men who probably could be cured if they act in time. The biggest disadvantage here is patient is being watched. If you are in otherwise good health, have localized prostate cancer, and a life expectancy longer than ten years.

Which form of treatment is best for your There are two good choices – radical prostatectomy and radiation therapy.

Radiation therapy’s great advantage is that not surgery . Therefore, it’s an ideal form of treatment for men who are older, or who have cancer that is too advanced to cure by surgery. The big advantage of radical prostatectomy is that there is no better way to completely eliminate cancer that is curable. The best candidates for radical prostatectomy are men who are young enough and healthy enough to live.

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A better question might be, «Which treatment is right for me?» There are several important considerations here: Your age and overall health, the stage of cancer, the side effects associated with different treatments, and finally—most importantly—your own wishes.

When prostate cancer is localized in men with a life expectancy of 1o years or more, the goal for treatment is cure. This sounds obvious, until we remember that when prostate cancer is advanced, cure is no longer an option. In other words, if we don’t remove the disease or treat it effectively when it’s localized —if the cancer gets outside the prostate—we can’t stop it.

The big advantage of radical prostatectomy is that there is no better way to completely eliminate cancer that is curable (see above). The disadvantages are the side effects—namely, the risks of impotence and incontinence. And radical prostatectomy is not «a walk in the park.» It is major surgery, and the body must be in strong enough shape to handle it.

Radiation therapy’s great advantage is that it isn’t surgery. But its major disadvantage, especially for the younger patient, is that its ability to control the cancer may not last forever. Many studies have suggested that with standard radiation treatment—external-beam therapy—there is a strong likelihood that a prostate biopsy a few years later will be positive. These studies have also suggested that the likelihood that PSA will be in the undetectable range ten years after radiation is only 10 percent. In contrast, a large study at Johns Hopkins showed that the likelihood of PSA remaining in the undetectable range ten years after surgery was 70 percent.

In choosing the treatment that’s best for you, it’s important to try for a balance between effectiveness and side effects. More information on each of these choices follows in this chapter, and the next chapters cover these treatments in significantly greater detail.

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Now is the time for some plain speaking, so here goes: At the top of this list should be men who are too old or too ill either to undergo the rigors of treatment or to live another ten years—long enough for such treatment to be worthwhile. Also in this group should be men who don’t want to experience the side effects associated with «definitive,» or curative treatment; men who are diagnosed with stage T3, T4 or N+ (C or D) disease who don’t yet have symptoms; men whose prostate cancer is truly incidental and not yet something to worry about (some men with stage Tia or Ai cancer, and men with stage Tic disease who have low Gleason scores and low PSA densities.

The advantages of watchful waiting include its initial freedom from side effects and, at first, the financial break—it’s the cheapest option because there’s no expensive treatment to pay for.

Watchful waiting doesn’t mean «do nothing,» and it doesn’t mean your doctor has written you off—it means you get treatment for specific symptoms when you need it. This can mean hormone treatment or spot radiation to ease bone pain; it can mean a TUR or other procedures to bring relief when the prostate cancer becomes large enough to obstruct the urinary tract; it can mean a host of options aimed at tackling specific problems, prolonging life and easing pain.

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How do you know if you have prostate cancer? Don’t wait for symptoms to show up, because for early prostate cancer, there aren’t any. By the time a man has noticeable symptoms of prostate cancer, it’s probably too late to cure it. To make matters worse, all of prostate cancer’s symptoms can be attributed to other causes. That’s why the American Cancer Society recommends that, after age 50, men undergo a yearly digital rectal exam and take a yearly PSA test, a blood test that measures levels of PSA (prostate-specific antigen), a key enzyme made by the prostate. Men at higher risk—men who have a strong family history of prostate cancer or who are of African-American heritage—should begin this testing at age 40.

PSA is prostate-specific, not cancer-specific. You can have prostate cancer and still have a low PSA level; about 25 percent of men with prostate cancer do. And, just because you have a high PSA does not necessarily mean you have prostate cancer; many men with high PSA levels don’t. It just means that you have some sort of prostate trouble— maybe BPH, maybe prostate cancer, maybe an infection—and that you should see a urologist to find out what kind of problem you have.

No treatment decision should be made on a lone PSA reading. PSA’s partner in diagnosis must be a digital rectal exam, and then, if either is abnormal, ultrasound and biopsy should be performed. Together, the rectal exam and PSA can do far more than each tactic alone.

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