2024-04-11 13:01:46
Stories of three men with prostate cancer
71-year-old Mr. Arvydas got prostate cancer 7 years ago. The man from Vilnius was diagnosed with local cancer, without metastases. The man had already been treated for this disease some time ago, but recently found out that the cancer has returned. Mr. Arvydas received cryotherapy, which is a minimally invasive ablative treatment method that destroys tumor tissue by freezing it with compressed argon gas.
“I found out I was sick 7 years ago – my PSA started to rise. One time the indicator was higher than 6, six months later it was already 7. Then I went to the doctor. I was offered to remove the prostate, then for some reason I was very afraid, apparently I did not trust the doctor. There was also the option of radiation therapy, which I chose. That was exactly 6 years ago.
And now the PSA has started to rise again. I have known about cryotherapy for a long time, I was interested in this treatment. I wondered if such a treatment could be applied in my case, it turns out that it is. I didn’t hesitate, I trusted the doctor of the National Cancer Institute, Alvydus Vēželius, who performed cryotherapy on me,” says Mr. Arvydas. Today, the man says he feels well. True, you will need to visit the doctor every few months – the PSA level in the blood will be monitored.
68 MP Vytautas, who hails from the Merkina area, says he is feeling well. The man’s story is similar – cryotherapy was used to treat relapsed prostate cancer.
“I got prostate cancer about 15 years ago. I had various inflammations, so I visited doctors often, and I took medicine for a long time. Then the PSA started to rise. I received a referral from the doctors in Varėna to the National Cancer Institute, where I was diagnosed with prostate cancer. This was the beginning of the disease. I had 37 sessions of radiation treatment. Since only 3 months had passed since the kidney operation, I refused to operate on prostate cancer, I chose radiation treatment.
At that time I was living with my brother in Vilnius. At that time, the PSA indicators decreased, I was checked every year. But after a while, the PSA started to rise again. Dr. Alvydas Vēželis said that there is a method to treat prostate cancer – cryotherapy. He asked if I would agree. I said that I would agree to anything, just to make it better and easier.
I had this procedure done in September and now I have a PSA test every three months and all is well. It’s a lot of fun, and the mood is different. Many thanks to the doctors at the National Cancer Institute. There is nothing to be afraid of. Maybe on the third day after cryotherapy I was discharged home. Gave a catheter. My wife is a nurse, it fixed everything,” says Mr. optimistically about his illness. Vytautas.
A similar story happened to 63 mp Rimantas from Panevėžys. He was diagnosed with prostate cancer 12 years ago at the age of 50. the man went for a preventive check-up according to the program that belongs to him. Later the disease recurred. As for other interlocutors, Mr. Rimant’s relapsed prostate cancer was also treated with cryotherapy.
“When I turned 50, my GP said it was up to me to get checked by the prostate cancer screening programme. It turned out that PSA indicators do not drink. I wouldn’t have checked, and I wouldn’t have known that I was sick. Everything turned out very well. I was treated with brachytherapy for prostate cancer 12 years ago. After 12 years, I had a blood test, it turned out that the PSA had risen. I contacted doctor Alvydas Vēželis, he offered me cryotherapy treatment, everything was done in December. Now my PSA levels are good, I will check again in 3 months. Now the mood is good, the doctors are very polite and kind,” says Mr. Rimant.
How is a relapsed prostate cancer treated and what are the benefits of cryotherapy applied to the mentioned patients, we talk to the urologist of the National Cancer Institute, doctor of medical sciences Alvydus Vēželius.
– Doctor, what are the main methods of treating early prostate cancer?
– In developed countries, prostate cancer is one of the most common malignant diseases in men. Lithuania is no exception – prostate cancer is the most common oncological disease in men. The choice of treatment for prostate cancer takes into account the spread of the disease, ie stage, morphological verification, radiological examination results, patient age, PSA level, etc. Doctors’ conclusions regarding treatment methods are considered and coordinated with the patient.
When prostate cancer is in the early stages and is free of metastases, the goal is to completely remove or destroy the cancer, that is, to cure the patient. The main treatments for early prostate cancer are radical prostatectomy, which involves the complete (radical) surgical removal of the prostate, or prostate radiotherapy, which destroys the cancer using ionizing radiation.
Radiation therapy can be: external beam radiation therapy, stereotaxic radiation therapy, or brachytherapy (given as monotherapy or in combination with external beam radiation therapy). In certain cases of early prostate cancer, when there is a small probability of activation of its course, another tactic is possible – active monitoring of the disease, when treatment is applied only after detection of its activation. Minimally invasive treatment methods, such as cryotherapy, focused ultrasound, thermoablation, etc., are increasingly being used.
– In some patients, the disease may recur after previously applied radiation therapy. What is the treatment for relapsed prostate cancer?
– For patients who have received external beam radiation therapy for prostate cancer, even up to 50 percent. in cases after radical treatment, disease recurrence is diagnosed within 10 years. Most often, it is a local recurrence of the disease. Several treatment options are available for these patients, including salvage prostatectomy, salvage brachytherapy, and cryotherapy.
All these methods are characterized by a high complication rate. Salvage brachytherapy and cryotherapy are attractive methods, especially in patients for whom salvage prostatectomy cannot be performed due to medical contraindications or when the patients themselves do not want this method of treatment. Both high-dose-rate brachytherapy and low-dose-rate brachytherapy can be used as salvage brachytherapy to treat locally advanced prostate cancer.
– What is cryotherapy? How is this treatment method performed?
– Cryotherapy is a minimally invasive ablative treatment method that destroys tumor tissue by freezing it with compressed argon gas. During the procedure, 2 heating and cooling cycles are performed. Effective destruction of tissue cells using cold depends on rapid freezing to very low temperatures and gradual thawing.
This method is recommended for urology, oncology, neurology, dermatology, gynecology, general or thoracic surgery and proctology. The cryotherapy procedure may be repeated as a second-line treatment.
– Doctor, in what cases can cryotherapy be used to treat prostate cancer?
– In addition to the main methods of treatment, cryotherapy treatment of prostate cancer has been successfully applied. This method, like other methods of treatment, is used only in certain conditions, that is, it has its own indications. Cryotherapy for primary prostate cancer (when the initial diagnosis of the disease is established) is recommended for patients in the low and medium risk group of prostate cancer.
For some patients, sooner or later after radiation (external or brachytherapy) treatment, the disease may recur, that is, the tumor reoccurs (relapses) in the prostate. When the recurrence of cancer in the prostate is local, that is, it does not go beyond its borders, prostate cryotherapy becomes the treatment method of first choice. Thus, prostate cryotherapy is possible in case of early-stage primary prostate cancer (at the time of first diagnosis) or local tumor recurrence after radiation therapy.
– How does focal cryotherapy differ from whole prostate cryotherapy? In which patients are each method used?
– Prostate cryotherapy is divided into focal (spot), partial and whole prostate cryoablation. In the case of a small cancerous focus, it is recommended to perform focal (point) cryoablation in one lobe. Before the cryotherapy procedure, the patient undergoes a magnetic resonance imaging and adaptive prostate biopsy. If there is more than one cancerous focus in one lobe, a partial (single lobe) cryoablation of the prostate is performed. Due to the high risk of complications, it is recommended to perform partial cryotherapy procedures on the same patient every 4-6 months. time interval.
Cryoablation procedures are performed under general anesthesia.
– What are the advantages and disadvantages of cryotherapy?
Advantages:
– suitable for the treatment of local cancer recurrence that developed after radiation treatment; if the recurrence of prostate cancer in the prostate is local, that is, it does not go beyond its limits, prostate cryotherapy is the treatment method of first choice;
– as an independent alternative treatment method, it is suitable for treating early-stage primary prostate cancer, so in this case there is no need to apply radiation therapy or surgery;
– it is a minimally invasive and safe treatment method;
– can be applied to elderly patients and patients with concomitant diseases;
– observational data show that it is an effective method of treatment;
– the patient quickly returns to the normal rhythm of life;
– lower risk of urinary incontinence than after other rescue treatments;
– pain is minimal or not painful at all after the procedure;
– less damage to the rectum than with radiation therapy.
Disadvantages:
– after cryotherapy, in order to prevent urinary retention, it is necessary to keep a catheter in the urethra for 7 days, which is associated with the risk of infection;
– after removing the catheter, urinary retention is possible;
– after removing the catheter, dysuria may occur, alpha-adrenoblockers should be used;
– sexual dysfunctions are more common after cryotherapy than after external radiation therapy or brachytherapy.
– How long after the procedure is the patient discharged home?
– The procedure is performed in an inpatient setting. During the first day after the procedure, the patient is monitored for the risk of bleeding. On the second day, the patient is discharged with a bladder catheter for outpatient observation, with antibiotic therapy for 5-7 days. The Folley catheter is removed after 5-7 days on an outpatient basis.
– How is the patient monitored after the cryotherapy procedure?
– After the procedure, the patient is monitored on an outpatient basis by a urologist. The PSA blood level is monitored every 3 months for the first year. Magnetic resonance imaging control is performed no earlier than after 6 months. after the procedure. In the case of an increase in PSA, additional radiological tests are performed to assess the spread of the process and, if indicated, to repeat the prostate biopsy.
Thank you for conversation.
2024-04-11 13:01:46