Prostate cancer

Prostate cancer - how to diagnose and how to treat?

First, to be treated, oddly enough, sometimes not everyone needs it. In men older than 70, the disease progresses so slowly and "benignly" that any treatment only worsens the quality of life and does not prolong it. But patients aged 50-70 need treatment, moreover, they themselves must participate in the choice of methods, focusing on their wishes and internal preferences. Patients are usually perplexed - how so, it's you, doctor, who should tell me what is better! So, according to the results of numerous studies on many thousands of patients, none of the methods showed priority over others.

Here's what to choose from:

Surgical treatment, or radical prostatectomy. Allows you to solve the problem "once and for all", but has disadvantages - reduced potency and in some patients - urinary incontinence.

Radiation therapy in different options

For example, in low-dose brachytherapy, radioactive iodine grains are implanted through the perineum into the prostate. The advantage of this method is speed. The sources are introduced to you once, and in a few days you are free. True, you will have to wait a bit until the activity of the sources inside you drops to a level that is safe for others. The downside is that this method is fraught with narrowing of the urethra and problems with urination.

With high-dose brachytherapy, the radiation source is introduced into the body for a while and "travels" along the routes specified by the doctor. It requires at least two needle insertions a week apart, and four radiation fractions. That is, you will have to spend the night twice with needles embedded in the perineum.

External radiation therapy is a traditional bloodless and effective method, but rather long. Modern standards call for 27-28 fractions 5 times a week, that is, almost 6 weeks of daily visits to the accelerator.

What is important to remember about radiation therapy? The prostate is a very mobile organ, its position depends on the degree of filling of the bladder and rectum. This is (but not only) why you will be asked to follow a low-gassing diet and empty your rectum before marking and radiation sessions.

What research should be done at the start of treatment?

Let's indicate how much research we need to have at the start of treatment:

1. PSA.
2. MRI of the pelvis (for prostate cancer - better with contrast), with the designation of the volume of the prostate.
3. Ultrasound (preferably CT with contrast) of the abdominal cavity, CT of the lungs. Ideally (and especially when the PSA level is above 20) - scintigraphy of the bones of the skeleton.
4. Multipoint biopsy of the prostate. And it is in this sequence - first an MRI, and then a biopsy.
5. It is better to have such a study as uroflowmetry - urination parameters.

Before making a decision, always try to listen to the views of several parties - be it an operating urologist, a radiation therapist, a general oncologist. Read. Treatment standards are laid out in #RUSSCO recommendations and #NCCN American guidelines. All this is widely available. And, of course, in your particular case, there may be factors that will tip the scales in favor of a particular method. And even your inner preference can be such a factor. This is fine.