Prostate cancer - one of the most frequent cancer among the male population of the planet. In the treatment of prostate cancer in Israel involving different specialists: oncologists, urologists, radiotherapists, chemotherapists.
Given the fact that prostate cancer is often found in older, and men of working age, the treatment regimen is chosen with great care. Full treatment plan is drawn up after a thorough examination of the patient, determining the histological structure, size, tumor invasiveness, and also taking into account the presence or absence of regional and / or distant metastases.
Increased influence is given to the patient and health in general. In the presence of comorbidities is performed, if necessary, simultaneous correction of other disorders.
For treatment in Israel applies all the currently known methods. Preference is given to modern technology, which gives minimal risk of complications and ensure a good result.
Diagnosis of prostate cancer in Israel
There is a certain standard surveys that are carried out in preparation for prostate cancer treatment in clinics in Israel.
The study consists of:
- general clinical blood tests, urinalysis, PSA determination;
- CT pelvis, abdomen, thorax. In complex cases, a MRI;
- tumor biopsy followed by histological examination;
- consulting specialists (oncologist, urologist, radiologist, himioterapevt).
When the results obtained, the development begins tactics patient.
The patient is given the opportunity to familiarize themselves with all acceptable in his case the treatment methods and with the same effectiveness, choose in his opinion the most suitable.
Rates of prostate cancer treatment in Israel
The total cost of the diagnostic program of the disease in the Assuta is about $ 3000.
It includes consultation of the oncologist, general and detailed biochemical blood tests, CT scans, biopsy audit on PSA analysis.
Leading experts in the treatment of prostate cancer in Israel
- Ofer Osipovich - surgeon-urologist, headed by Department of Oncological Urology at Beilinson Hospital, Rabin Medical Center.
- Professon Jack Baniel manages Beilinson Hospital urology department, a deputy director of the Oncology Center of David. Successfully conducts operations such as removal of the prostate while preserving erectile function, surgery robotically "Da Vinci".
- Dr. Andrew I must headed laparoscopic urology department at the Rabin MC. He specializes in laparoscopic surgery.
Prostate Cancer Treatment in Israel
With the patient in a medical complex Assuta interacts group of highly professional doctors: radiation oncologist, himioterapevt specializing in the field of hormone therapy oncologist, physical therapist.
In the development of prostate cancer treatment programs in Israel, doctors are guided by the following factors: - the stage of the disease, the patient's health, the PSA level, the possible adverse effects of therapy.
Often, in spite of diagnosed prostate cancer at an early stage of development, it is impossible to determine whether or not to develop the disease, and whether there will be signs of illness. More information can be identified by using the gradation on Gleason. Often, this type of cancer develops with a very slow speed, small size of the tumor may never cause problems.
Taking a sample of tissue during a biopsy, the doctor examines the cancer cells through a microscope. The most common classification system applied Gleason score. On its basis the optimal variant shown in the treatment of prostate cancer in Israel, it is determined how aggressive tumor. Cancer cells classified as belonging to the primary or secondary level exhibited scores. When scores from two to four - for malignancy characterized by a low risk of aggression, from five to seven - moderate, between eight and ten - high.
Treatment of prostate cancer causes undesirable consequences - erectile dysfunction or urinary incontinence. Oncologists may recommend to stay on active surveillance - wait to see if symptoms of a disease trigger.
Watchful waiting in early stages
Basically, it is recommended in elderly patients where the tumor grows slowly, it is localized within the prostate, surgery and radiation are not a viable alternative. There are cases where treatment is not necessary, extremely slow progression of the disease, the symptoms do not occur.
Produced status monitoring - blood tests for PSA, digital rectal examination. Doctor scans the patient about the signs of the disease. If the amount of PSA increases or there are symptoms, it is recommended hormone treatment for prostate cancer in Israel.
The advantage of this method is the lack of side effects of surgery and radiotherapy. However, there are drawbacks. If the disease progresses, turning to hormone therapy, which can not be cured, only it helps to control the disease. The men can be difficult to accept the fact that they have been diagnosed oncology, but the treatment is not carried out.
Active surveillance in the early stages
The main task - to monitor the pathological process to establish substantial progress.
Nizkoagressivnye malignant tumors of the prostate gland in the early stages can develop a very slow rate, without causing symptoms of the disease. Therefore, before turning to the prostate cancer treatment in Israel, the oncologist may offer to wait and see whether the disease to progress.
Every few months (1-3) is carried out diagnostics - blood tests, rectal examination. If there are signs, performed a biopsy. When the diagnostics shows the growth of the disease, is appointed by surgery or radiotherapy.
technique advantage - the absence of complications after surgery, radiotherapy or hormonal treatment. Disadvantages - heavy expectation and observation, as well as in some cases - the need for future therapy.
Watchful waiting for locally advanced cancer
Sometimes the growth of these tumors can be very slow, so for a while the doctors can wait progression of whether observed. The doctor conducts periodic digital rectal examination queries about symptoms. If there are suspicions, runs diagnostics (blood tests, X-ray, PET-CT).
When diagnostic procedures support the development of the disease is selected treatment program for prostate cancer in Israel, whose mission - to control the cancer and relieve symptoms of the disease.
The advantage of this watchful waiting - the absence of adverse effects of hormone therapy or radiotherapy. Disadvantages - in heavy anticipation, and for some patients - in need of further treatment.
Surgery in the treatment of prostate cancer in Israel in the clinic Assuta
Surgical intervention is one of the main treatments for cancer of the prostate. Selection operations is largely determined by the stage of disease.
In the early stages of the disease, Israeli doctors have successfully used prostatectomy in various modifications.
Radical prostatectomy is performed in the clinic Assuta surgeon urologist. During the operation, he removes the prostate gland and the adjacent tissue (pelvic lymph nodes, bladder neck, seminal vesicles, extending through the prostate urethra) through an incision:
- in the peritoneal cavity - retropubic prostatectomy;
- between the anus and the scrotum - perineal prostatectomy (but it is not appropriate to remove the lymph nodes).
Radical prostatectomy is performed in the following situations:
- 1 or 2 stages, when the tumor is localized within the prostate.
- 3 stage if the cancer - locally advanced.
Prostatectomy is mainly recommended to young men (under 75 years) and have a good health condition. But every case of the disease is evaluated individually.
Disadvantages associated with prostatectomy impotence, infertility, urinary incontinence. Israeli hospitals have successfully carried out the so-called nerve-sparing prostatectomy.
Nevrosberegayuschaya radical prostatectomy
Radical prostatectomy often causes erectile dysfunction. On both sides of the prostate are nerve fibers that are responsible for erections. During the removal of the tumor they can damage or delete that leads to erectile dysfunction. The advantage of nerve-sparing prostatectomy is to preserve the nerve bundles. If the tissue around the nerves are not affected by the tumor process, they are left. The decision to delete the surgeon receives during the operation. The best results of the surgical treatment of note in the early stages of prostate cancer, when the men are young and sexually active.
The advantage of radical prostatectomy is the complete removal of the tumor process and recovery. If the cancer is aggressive, such an operation increases survival. A disadvantage associated with the overall risk, as well as the probability of erectile dysfunction and incontinence.
In some cases the use of organ techniques - laparoscopic and robot-assisted approaches:
- During laparoscopic surgery, the surgeon makes several incisions about one centimeter in size using special surgical instruments. To improve the visibility of the abdominal cavity is filled with carbon dioxide, the camera transmits the image on the screen. During this surgery the patient loses less blood, experience less pain, faster restores.
- Robot-assisted surgery is an even more advanced embodiment of surgical treatment performed by the robot "Da Vinci". The process of removing tumor Assuta clinics fully automated minimized trauma to surrounding tissues, the operating hemorrhage practically reduced to zero. Rehabilitation after such an operation requires only a few days. The only drawback of such operations is rather high price. However, it pays off fast restoration of health and good prospects.
According to studies, minimally invasive surgery is also effective as abdominal surgery. But there is no information in the required amount of long-term undesirable effects - incontinence and erectile dysfunction.
In the male group of steroid hormones - androgens - are responsible for sexual maturity. The most famous of them - testosterone and dihydrotestosterone - stimulate the development of not only healthy cells but also cancer. In addition, they can contribute to the development of specific genes, which provoke the development of malignant prostate tumor.
This type of prostate cancer is called androgenozavisimogo, the primary goal of therapy - to reduce the levels of these hormones or prevent their activity.
In the treatment of prostate cancer in Israel, Assuta Hospital successfully used several techniques, the choice is due to several factors.
Reduced synthesis of androgens in the testes
These procedures are turning more often. Let us examine them in detail.
- Orchiectomy - an operation in which one or both testicles removed. Number of testosterone is reduced by ninety - ninety-five percent. It is also used subcapsular orchiectomy when resected tissue only, synthesizing hormones.
- Hormone Agonists Luteinizing hormone-releasing hormone (LHRH) - drugs that prevent the production of LHRH. This so-called drug or chemical castration when drugs reduce androgen levels as during surgical intervention. But such an effect is reversible, the synthesis is restored after the hormonal treatment of prostate cancer in Israel. LHRH agonists are implanted subcutaneously or administered by injection. These drugs include buserelin (Buserelin), leuprolide (Leuprolide), goserelin (Goserelin). In the primary introduction sometimes experience a temporary increase in testosterone.
- LHRH antagonists - another form adrogennoy blockade. Drugs blocking compound LHRH receptors in the pituitary gland, preventing the generation lyuteotropina, reducing the amount of steroid hormones. This type of drug does not increase testosterone. In metastatic malignancy used degarelix (Degarelix) (injection).
- Estrogens - necessary for the female body hormones. Currently, the treatment of prostate cancer rarely refer to them, since there are serious unintended consequences reception.
Suppression of the action of androgens in the treatment of prostate cancer in Israel
This technique uses drugs - anti-androgens. They become competitors of androgens during binding to the receptors, thus reducing their effect. Separately, this technique is rarely used, often combined with LHRH agonists or surgical castration. The clinic Assuta used
- Nilutamide * (Nilutamide *)
- Flutamide * (Flutamide *)
- Bicalutamide (BICALUTAMID)
- Enzalutamid (Kstandi / Xtandi)
Stop production of androgen in the body
These drugs are called androgen synthesis inhibitors, as under the influence of testosterone is reduced as much as possible. A small amount of hormone produced by the adrenal glands or abnormal cells, it is sufficient that the neoplastic process has continued to evolve.
Inhibitors inhibit CYP17 enzyme which has in tumor tissues, testis, prostate and adrenal glands. Thanks to him, the body synthesizes cholesterol to testosterone-based. The following preparations used Assuta - aminoglutethimide (Aminoglutethimide) and ketoconazole (Ketoconazolum) as a secondary therapy. Abiraterone acetate prescribed for metastatic tumors.
Indications for hormone replacement therapy in the treatment of cancer of the prostate in Israel
- After the treatment in order to reduce the likelihood of relapse. For example, following prostatectomy or radiation therapy for early stage prostate cancer. To estimate the probability of relapse is used Gleason score was evaluated lesion surrounding tissues, lymph nodes.
- Hormone therapy is involved and how to neoadjuvant therapy. For example, prior to or in combination with radiation in the early stages of the disease. Thus, increasing the length of life of the patient.
- For hormone treated at later stages of cancer in palliative purposes, to control the symptoms of localized tumors or severe comorbidity, when there is no opportunity to appeal to surgery or radiotherapy.
In the increasingly applied remote radiotherapy - conformal (CRT) or with a modulated intensity (IMRT), also sometimes refer to brachytherapy.
It is carried out five times a week - on weekdays, the duration of the full course - 1-2 months.
Treatment at the clinic Assuta carefully planned clinical oncology, which ensures its effectiveness.
Conformal radiotherapy is able to generate beams of radiation, respectively, contours and shape of the tumor, which reduces the impact on a number of healthy organs are located - on the rectum and the bladder, and also allows you to increase the radiation dose.
IMRT - an advanced type of conformal radiation therapy, allows you to change the dose of radiation with respect to the different segments of the tumor and adjacent tissues. As a result, reduced negative impact on healthy tissue.
Side effects of external radiotherapy are divided into short and long term. Most of them pass, when the treatment ends. Among the short-term notice fatigue, irritated colon, irritation of the anus, diarrhea, cystitis.
Pre-oncologist notify the patient, what side effects to expect. It is important to inform doctors about the occurrence of any signs, to facilitate their use various techniques.
Among the potential long-term consequences note the following:
- Erectile dysfunction - occurs in three to five out of ten. The risk increases if the hormone was conducted. However, there are techniques that can help.
- Infertility - a consequence of the treatment. Doctors suggest, if necessary, to preserve sperm before radiotherapy.
- Disturbance to the functioning of the bladder and bowel occur under irradiation. Blood vessels become fragility, blood may appear in the stool or urine. In very rare cases there is fecal incontinence. Sometimes exposure provokes incontinence due to damage to nerve fibers which regulate the operation of the bladder.
Overall, external irradiation in the initial stages is able to completely get rid of the disease. Pre-hormone therapy or held together with radiotherapy can improve efficiency. Disadvantages associated with possible side effects mentioned above.
Brachytherapy in the treatment of cancer of the prostate in Israel
This is an internal radiation therapy, is a simpler procedure than the remote. In the treatment of this disease may be used:
- Low-dose brachytherapy, when placed inside malignancy radioactive "seeds" of the metal from which the radiation is gradually released. Completely disappears after about 6 months.
- High-dose brachytherapy, when placed inside the prostate miniature catheters, through which the radioactive substance is administered at a time. Used in the treatment of prostate cancer in Israel in the early stages of the disease, when the tumor is localized within the boundaries of the prostate gland.
Treatment is preceded by a study, as determined by the size and location of tumors. The diagnosis process using local anesthesia. Brachytherapy is not carried out, if the prostate is very large. To reduce it, may recommend hormonal treatment of prostate cancer in Israel.
Implanted radioactive substance using general anesthesia for approximately one hour. In order to control use ultrasound. Corn is placed in the space between the anus and prostate, directing the tumor. Implantation sometimes causes swelling of the prostate by blocking the urethra.
In order to prevent infections a patient may be prescribed antibiotics for normalizing urinary - type formulations Flomax®.
Most patients do not need hospitalization. It is recommended for 2-3 days to avoid heavy physical exertion.
Among the potential adverse effects of brachytherapy note:
- moderate pain (analgesic appointed);
- blood in the urine and semen;
- problems with erection in thirty - fifty percent of men after a few years;
- difficulty in urination (marked narrowing of the urethra);
- urinary incontinence in a 1: 1000 (1%).
Advantage of brachytherapy is as follows - in the early stages of the disease, this method is able to heal. Disadvantages associated with possible complications - cystitis, problems in bowel habits, erectile dysfunction, narrowing of the urethra.
Prostate Cancer Chemotherapy in Israel
Suppression of malignant growth in the prostate tissue by chemical agents used in the treatment of prostate cancer in Israel is rare. Destination indications for chemotherapy are several histologic tumor variants, as well as stage 4 disease. Often appointed in the complex therapy.