Schmerzen beim Wasserlassen und im Bauch? Prostataentzündung rechtzeitig erkennen - Urologie am Ring
Treatment for prostate cancer may involve active surveillancesurgeryradiation therapy - including brachytherapy prostate brachytherapy and external-beam radiation therapyproton therapy, high-intensity focused ultrasound HIFUcryosurgeryhormonal therapy, chemotherapyor some combination.
Treatments also extend to survivorship based interventions  [ circular reference ]. These interventions are focused on five domains including: physical Blockade in der Prostata, psychological symptoms, surveillance, health promotion and care coordination.
However, a published review has found only high levels of evidence for interventions that target physical and psychological Blockade in der Prostata management and health promotion, with no reviews of interventions for either Blockade in der Prostata coordination or surveillance. The favored treatment option depends on the stage of the disease, the Gleason scoreand the PSA level. Other important factors include the man's age, his general health, and his feelings about potential treatments and their possible side-effects.
Because all treatments can have significant side-effectssuch as erectile dysfunction and urinary incontinencetreatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
The selection of treatment options may involve complex decisions with many factors. For example, radical prostatectomy after primary radiation failure, a very technically challenging surgical operation, may not be an option. If the cancer has spread beyond the prostate, treatment options change significantly, so most doctors who treat prostate cancer use a variety of nomograms to Blockade in der Prostata the probability of spread.
Clinicians may reserve hormonal therapy and chemotherapy for disease that has spread beyond the prostate. However, there are exceptions: radiation therapy can treat some advanced tumors, and hormonal therapy some early-stage tumors. Doctors may also propose cryotherapy the process of freezing the tumorhormonal therapy, or chemotherapy if initial treatment fails and the cancer progresses.
Active surveillance is observation and regular monitoring without invasive treatment. In the context of prostate disease this usually comprises regular PSA blood tests and prostate biopsies. Active surveillance is often used when an early stage, slow-growing prostate cancer is suspected.
However, watchful waiting may also be suggested when the risks of surgery, radiation therapy, or hormonal therapy outweigh the Blockade in der Prostata benefits.
Other treatments can be started if symptoms develop, or if there are signs that the cancer growth is accelerating. Approximately one-third of men who choose active surveillance for early stage tumors eventually have signs of tumor progression, and they may need to begin treatment within three years.
The risk of disease progression and metastasis spread of the cancer may be increased, but this increase risk appears to be small if the program of surveillance is followed closely, generally including serial PSA assessments and repeat prostate biopsies every 1—2 years depending on the PSA trends. Study results in suggest active surveillance is the best choice for older 'low-risk' patients. Surgical removal of the prostate, or prostatectomyis a common treatment either for early stage prostate cancer or for cancer that has failed to respond to radiation therapy.
The most common type is radical retropubic prostatectomywhen the surgeon removes the prostate through an abdominal incision. Another type is radical perineal prostatectomywhen the surgeon removes the prostate through an incision in the perineumthe skin between the scrotum and anus. Radical prostatectomy is effective for tumors that have not spread beyond the prostate;  cure rates depend on risk factors such as PSA level Blockade in der Prostata Gleason grade.
However, it may cause nerve damage that may significantly alter the quality of life of the prostate cancer survivor. Radical prostatectomy has been associated with a greater decrease in sexual function Blockade in der Prostata increased urinary incontinence than external beam radiotherapy, an alternative treatment. Radical prostatectomy has traditionally been used alone when the cancer is localized to the prostate.
In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has higher risks of complications. Laparoscopic radical prostatectomy, LRP, is a new way to approach the prostate surgically with intent to cure.
Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy requires a smaller incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment but is technically demanding and seldom done [ citation needed ] in the USA.
Transurethral resection of Blockade in der Prostata prostatecommonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis urethra is blocked by Blockade in der Prostata enlargement. In general, TURP is for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small instrument cystoscope is placed into the penis and the blocking prostate is cut away. Cryosurgery is another method of treating prostate cancer in which the prostate gland is exposed to freezing temperatures.
Under ultrasound guidance, a method invented by Dr. Gary Onik metal rods are inserted through the skin of the perineum into the prostate. As the water within the prostate cells freezes, the cells die.
The urethra is protected from freezing by a catheter filled with warm liquid. Impotence occurs up to ninety percent of the time. In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles called orchiectomy may be done to decrease testosterone levels and control cancer growth.
See hormonal therapy, below. The most common serious complications of surgery are loss of urinary control and impotence.
Reported rates of both complications vary widely depending on how they are assessed, by whom, and how long after surgery, as well as the setting e. Although penile sensation and the ability to achieve orgasm usually remain intact, erection and ejaculation Blockade in der Prostata often Blockade in der Prostata. Medications such as sildenafil Viagratadalafil Cialisor vardenafil Levitra may restore some degree of potency.
For most men with organ-confined disease, a more limited "nerve-sparing" technique may help reduce urinary Blockade in der Prostata and impotence. Although pelvic floor muscle training has been prescribed to improve urinary continence, the evidence for efficacy in men after radical prostatectomy has come into question recently. According to information from the Men After Prostate Surgery MAPS randomised control trial, pelvic floor muscle training was not shown to be therapeutic or Blockade in der Prostata effective in improving urinary continence.
Of the patients in the intervention group, of the patients reported some form of incontinence at the month mark. Radiation therapyBlockade in der Prostata known as radiotherapy, is often used to treat all stages of prostate cancer.
It is also often used after Blockade in der Prostata if the surgery was not successful at curing the cancer. Radiotherapy uses ionizing radiation to kill prostate cancer cells. When absorbed in tissue, ionizing radiation such as gamma and x-rays damage the DNA in cancer cells, which increases the probability of apoptosis cell death.
Normal cells are able to repair radiation damage, while cancer cells are not. Radiation therapy exploits this fact to treat cancer. Two different kinds of radiation therapy Blockade in der Prostata used in prostate cancer treatment: external beam radiation therapy and brachytherapy specifically prostate brachytherapy. External beam radiation therapy EBRT uses a linear accelerator to produce high-energy x-rays that are directed in a beam towards the prostate.
A technique called Intensity Modulated Radiation Therapy IMRT may be used to adjust the radiation beam to conform with the shape of the tumor, allowing higher doses to be Blockade in der Prostata to the prostate and seminal vesicles with less damage to the bladder and rectum.
External beam radiation therapy is generally given over several weeks, with daily visits to a radiation therapy center. New types of radiation therapy such as IMRT have fewer side effects than traditional treatment. However, in the short term, EBRT has been associated with acute worsening of urinary obstructive and bowel symptoms. These symptoms have been shown to decline over time. Researchers are also studying types of stereotactic body radiotherapy SBRT to treat prostate cancer. Permanent implant brachytherapy is a popular treatment choice for patients with low to intermediate risk features, can be performed on an outpatient basis, and is associated with good year outcomes with relatively low morbidity.
These seeds emit lower-energy X-rays which are only able to travel a short distance. Although the seeds eventually become inert, they remain in the prostate permanently. The risk of exposure to others from men Blockade in der Prostata implanted seeds is generally accepted to be insignificant. Radiation therapy is commonly used in prostate cancer treatment. It may be used instead of surgery or after surgery in early stage prostate cancer adjuvant radiotherapy.
Radiation treatments also can be combined with hormonal therapy for intermediate risk Blockade in der Prostata, when surgery or radiation therapy Blockade in der Prostata is less likely to cure the cancer. Some radiation oncologists combine external beam radiation and brachytherapy for intermediate to high-risk situations. Radiation therapy is often used in conjunction with hormone therapy for high-risk patients. In advanced stages of prostate cancer, radiation is used to treat painful bone metastases or reduce spinal cord compression.
Radiation therapy is also used after radical prostatectomy either for cancer recurrence or if multiple risk factors are found during Blockade in der Prostata. Radiation therapy delivered immediately after surgery when risk factors are present positive surgical margin, extracapsular extension, seminal vessicle involvement has been demonstrated to reduce cancer recurrence, decrease distant metastasis, and increase overall survival in two separate randomized trials.
Side effects of radiation therapy Blockade in der Prostata occur after a few weeks into treatment. Both types of Blockade in der Prostata therapy may cause diarrhea and mild rectal bleeding due to radiation proctitisas well as potential urinary incontinence and impotence.
Symptoms tend to improve over time except erections which typically worsen as time progresses. A new method to reduce rectal radiation injury Blockade in der Prostata prostate cancer patients involves the use of an absorbable spacer placed between the prostate and rectum. Such spacers are commercially available in some regions, and are undergoing clinical trials in others.
Prostate Rectum Spacers Blockade in der Prostata be compatible with all prostate cancer radiotherapy treatments including 3D conformal, IMRT and stereotactic radiation and brachytherapy. Multiple retrospective analyses have demonstrated that overall survival and disease-free survival outcomes are similar between radical prostatectomy, external beam radiation therapy, and brachytherapy.
Radiation has lower rates of incontinence compared with surgery, but has Blockade in der Prostata rates of occasional mild rectal bleeding. Since prostate cancer is generally a multifocal disease, the traditional prostatectomy eliminates all local lesions Blockade in der Prostata removing the entire prostate. However, it has been hypothesized that an "index lesion" might be responsible for disease progression. Therefore, focal therapy targeted towards the index lesion might effectively treat prostate cancer while preserving the remainder of the gland.
Interventional radiologists have started to treat prostate cancer with minimally invasive therapies such as cryoablationHIFUradiofrequency ablationand photodynamic therapy that permit focal therapy by utilizing image guidance. These therapies are still in beginning or experimental stages; however, because they preserve tissue, they can potentially reduce adverse treatment outcomes such as impotence and incontinence. Patients who might particularly benefit from focal therapy with HIFU are men with recurrent cancer after the gland has been removed.
MR imaging improves early detection of cancer, so MR-guided therapies can be applied to treat recurrent disease. Additionally, for men who have already failed salvage radiation treatment and have limited therapeutic options remaining, interventional therapies might offer more chances to potentially cure their disease. While recent studies have demonstrated the feasibility of these treatments, additional Blockade in der Prostata is needed to further evaluate which patients Blockade in der Prostata best suited for these procedures and determine long-term efficacy.
High Blockade in der Prostata focused ultrasound HIFU was first used in the s and s in efforts to destroy tumors in the central nervous system.
Since then, HIFU has been shown to be effective at Blockade in der Prostata malignant tissue in the brain, prostate, spleen, liver, kidney, breast, and bone.
During the HIFU procedure, sound waves are used to heat the prostate tissue, thus destroying the cancerous cells.