Radiation Therapy Prostate Cancer After Surgery - Removal Prostate

Radiation Therapy Prostate Cancer After Surgery
 For prostate cancer, there are in addition to the surgical removal of the prostate, depending on staging alternative treatment options in radiation therapy, such as external beam radiotherapy or local, so-called brachytherapy, both to be shown in the following. 

External radiation therapy 
External radiation therapy is that irradiation of the prostate from the outside "through" the patient is carried through. Irradiation is carried out from several directions, ie, from the front, back and side on, or "through" the patient is lying down, with the aim to destroy by these changes of direction by the irradiation as many cancer cells in the prostate, the surrounding healthy tissue or organs such as the bladder, however, rectum, bone and skin to charge as little as possible and to protect. The treatment usually lasts 7-8 weeks, during which the patient comes to the daily radiation - except the weekends. This approach aims as evenly as possible harmful influence by the irradiation of the tumor with the least possible damage to healthy tissue. Typical problems or complications in the treatment, which typically occur at times later in the third to sixth week of treatment, disorders the bowel and bladder function. These include, for example, diarrhea, itching, cramps or painful bowel or bladder emptying, beyond the need to urinate. In 14-46% of cases are to be expected with a Impotence -. Compared to surgery, this complication is so rare on from the many years of experience with radiation therapy, we know that, for example, 62% of patients treated with localized tumor survive at diagnosis of 10 years or during this period about 25% of patients develop local recurrences (in comparison, after surgery in the same tumor stage is the 10 year survival rate of 75%, and the 10 year survival rate of a healthy 60-year-olds about 70%). The localized, incidentally detected tumors that are confined to the prostate, the 15-year overall survival is 50%. Nowadays, it is possible through the three-dimensional conformal radiation technique individually adapted a very accurate computerized treatment planning and calculation of radiation therapy and - dose carried out for each individual patient and thus to better focus the radiation to the tumor, so that one expects in the future even better long-term results in less local complications.Therefore, one can assume in the future that the external three-dimensional radiation will continue to gain importance in the treatment of prostate cancer. External radiation therapy can vary depending on the age of the comorbidities and the patient's wishes today with similarly good results in localized prostate cancer used to come as the surgical removal and provides quite an equivalent treatment option Represent can be useful when an operation can not be performed, for example, because of comorbidities too risky or not seems to make sense, or if the patient refuses the operation . Offenders may also be concomitantly after an operation in question, the external radiation therapy, if not as expected the PSA drops below the detection limit or even increases, as can for example be the case with positive surgical margins, ie tumor tissue remained despite surgery in the body is. In this case, however, it should be noted that should not be started immediately after the operation, but at the earliest after three months of radiation therapy to minimize the risk of local problems / complications during or after radiation exposure as low as possible. brachytherapy (implantation radioactive seeds / afterloading) Another form of radiation therapy is called brachytherapy. It stands for a local radiation therapy, in which small radioactive sources are implanted into the prostate, either continuously in the form of so-called Seeds (engl. seeds) with low-energy lamps or temporarily in the range of seconds to minutes of previously calculated positions of the prostate in the so-called afterloading method (English reloading) with high-energy emitters. In this type of therapy, brachytherapy, so the irradiation is carried out "on the spot". During the so-called seed implantation, the prostate is peppered with ultrasound or computerized tomographic control with needles and the small seed-grain-sized implants are the needles inserted into the tissue.These small radioactive implants can contain radioactive radiant palladium-103 or iodine-125, which radiate over time cease, the effect decreases within each 17 or 59 days by half. The implants generally remain in the live long in the prostate. The complication of this type of radiation is about 10 to 20%, which was mainly reported discomfort in the area of the rectum with diarrhea, cramps or bleeding. In addition, frequently passed bladder emptying disorders.Rarely, in about 5% of the cases were reported incontinence and inflammation of the prostate.Compared to surgery or external-beam radiation, the negative effects on the power is low, the rate will be given here with about 7%. Recent studies show that after three years report up to 80% of patients with a preserved erectile function, which is very good even six years after therapy with at least 60%. This form of radiotherapy is today an equivalent treatment alternative for operation is, even if they can not have the curative claim as it has the surgery.The brachytherapy seed implants is well suited to the treatment of small tumors that are localized and low malignancy (malignancy), ie a Gleason score below 7 have (Gleason score is the result of histological assessment of the malignancy of prostate cancer ) with a PSA level of less than 10 ng / ml. In addition, patients should not infected local lymph nodes have, so that the radiation should always be preceded by the removal of local lymph nodes. The removal of the lymph nodes may occur, for example, laparoscopically (through a kind of laparoscopy so).The lymph nodes can then be examined for histological tumor on her freedom back. Because of today's better technology and application options brachytherapy experienced a renaissance and current studies show a good therapeutic efficacy: as can be, for example, an 8-year progression-free from 73% of patients treated as evidence. In another study locally mainly limited tumors with low malignancy demonstrated in patients who were on average 71 years old, (Gleason score of 5) and a mean PSA level of 10 ng / ml had, after all, that after 12 years 70 % of patients were free of disease. During afterloading (reload) the prostate is also controlled peppered eg by means of ultrasound with needles, over the short term then in the range of seconds to minutes, a high-energy radiation source (usually iridium-192) of previously calculated positions is placed in the prostate. This type of radiation may be applied once or repeatedly, and is usually combined with external radiotherapy. The complications virtually indistinguishable from those of external beam radiotherapy. This therapy can be used with good success for locally advanced prostate cancer. principle, in advanced prostate cancer in addition to surgery, external beam radiotherapy and brachytherapy as a treatment option in combination, with or without concomitant hormonal therapy in question. A local progression-free after irradiation could be achieved in 70 to 75% of cases so treated locally advanced prostate cancer. Summary: Set the external beam radiotherapy and brachytherapy both in local and in advanced prostate cancer now one of the operation quite equivalent treatment alternative in that regard local tumor control, ie, the progression-free survival and also the results of the operation are very close today. Unfortunately, there are no comparative studies in terms of a future-oriented clinical study that will definitely allow an assessment in terms of the superiority of one of these treatment options with respect to another. has Nonetheless, and remains the surgical removal of the prostate in localized prostate cancer the only curative (healing) approach and should be pursued, especially by younger patients preferably with a life expectancy of over 10 years. Therapy of prostate cancer is always determined individually and should in addition to the local tumor spread, the malignancy of the tumor and the PSA level nor the age, life expectancy and comorbidities of the patient into account. Other factors such as typical complications of surgery and radiation therapy should be weighed against each other and incorporated into the final treatment decision.