Bladder Cancer

Kidney Cancer

Testicular Cancer

PROSTATE CANCER

Prevalence and overview
Prostate cancer is the number one cancer diagnosed in men in the United States. It is the number two cause of cancer deaths in men in the United States behind lung cancer. Men who are at high risk to develop prostate cancer are those with a primary relative with it. These men have twice the risk than the average male. Those with two primary relatives with prostate cancer histories have five times the risk of the average male.

It is known that 80% of men over 80 years old will have evidence of microscopic prostate cancer based on autopsy studies. There seems to be two different types of prostate cancer. Numerous studies have shown that those prostate cancers that are picked up on physical examination from digital rectal examinations and PSA screenings tend to be much larger and potentially dangerous cancers than those that are picked up on an autopsy. A urologist will recommend different treatments based on factors such as age and general health of the patient and how advanced the cancer is at the time of diagnosis. The following summarizes a review of prostate cancer treatment.

Treatment Options

1. Radical Prostatectomy
   Radical prostatectomy can be done in either the retropubic approach (radical retropubic prostatectomy) or through a perineal approach (radical Perineal prostatectomy). This results in a complete removal of the prostate and seminal vesicles. Since the prostate is located in between the neck of the bladder and the urinary sphincter muscle, the main potential side effect of this surgery is that of urinary incontinence. These surgical risks are very low. The other main potential risk of surgery is impotence. The nerves that are involved in erections run right along the side of the prostate. Even if potency does not return following surgery, there are now a number of ways to restore it. Hospitalization varies from 2 to approximately 5 days and patients are sent home with an indwelling Foley catheter which is removed several days later.

2. Radiation Therapy
   a) External Beam Radiation Therapy. This involves receiving radiation therapy to the prostate 5 days a week for 6 weeks. Using modern radiation therapy techniques, most of the side effects tend to be transient. They mainly consist of urinary and intestinal symptoms which tend to improve after radiation therapy is over. There are still risks of incontinence and impotence, although they are low.

   b) Radioactive Seed Placement. Radioactive seeds are guided into the prostate through ultrasound in an outpatient or 23 hour observation procedure. Instead of radiation being received from an external source over a 6 week period of time, the radioactive seeds provide an internal source of radioactive decaying over a period of a month. Sometimes two treatments may be required. Long term study results are not yet available yet.

3. Hormonal Therapy
   Prostate cancer is dependent on the male hormone testosterone in order for it to grow. By depleting the body of testosterone, prostate cancer will significantly shrink and be well controlled for a long period of time. This can be accomplished through shots as well as through removal of the testicles. The effectiveness and side effects of the treatment are the same for both the medical or surgical approach. These include a loss of interest in sex as well as hot flashes.

4. Cryosurgery
   This involves freezing the prostate also under ultrasound guidance. As with other forms of treatment, potential side effects also include incontinence and impotence.

5. Watchful Waiting
   This is recommended for men who believe to have clinically insignificant cancers that are unlikely to have an impact during their life time. This involves periodic visits to the urologist, coupled with PSA testing to be sure that the prostate cancer continues to remain clinically insignificant.

BLADDER CANCER

Treatment options include:

• Transurethral resection of bladder tumor
• Laser treatment of bladder tumor
• Bladder instillation of bladder cancer fighting agents
• Urinary diversions

For general information about bladder cancer and treatment options, click on this link: Bladder Cancer.

KIDNEY CANCER

Treatment options include:

• Radical nephrectomy
• Partial nephrectomy

For general information about kidney cancer and treatment options, click on this link: Kidney Cancer.

TESTICULAR CANCER

Treatment options include:

• Radical orchiectomy
• Nerve sparing retopertoneal lymph node dissection

For general information about testicular cancer and treatment options, click on this link: Testicular Cancer.