Health Update

by Dr. Miriam Joy C. Calaguas, FCR

Men, like women, also have to go through some changes as they reach their prime. Sadly, most men will prefer to go through these changes in silence. They will definitely not brag about how they are beginning to have trouble urinating.

Problems in urination among men are telltale signs of enlargement of the prostate gland. The prostate is a walnut sized gland beside the rectum that secretes fluid that is a component of semen. The prostate surrounds the uretha (the canal that empties urine from the urinary bladder), so when it enlarges, it causes urination problems, such as:

* Frequent urination, especially at night
* Difficulty starting urination
* Weak or interrupted urine flow;
* Feeling that some urine is retained in the bladder.

While prostate enlargement is just a simple inconvenience, one form of prostate enlargement can be deadly: prostate cancer. Fortunately, prostate cancer is compatible with a long, productive life when treated promptly.

Effective treatment starts with early detection. Have a digital rectal examination (wherein the doctor inserts a glove finger into the rectum to feel if the adjacent prostate is enlarged) every year beginning at age 50. Men with a strong family history of cancer should begin testing at age 45. A blood test called Prostate-Specific Antigen (PSA) is also part of screening. Once prostate cancer is suspected, a prostate biopsy is performed.

There are several choices of therapy for prostate cancer, the choice depending on the stage of the disease. Surgical removal of the prostate, or prostatectomy,is a common treatment. The surgeon can make an incision through the abdomen or the perineum, or the surgeon may use a laparoscope that is inserted through a 1-cm incision.

Radiation therapy is an effective non-surgical method wherein radiation kills the cancer cells. Radiation from a linear accelerator is targeted to the cancer to kill cancer cells. Radiotherapy may be used for both early and late prostate cancers, as well as bone spread (metastasis). To make sure that radiation exposure to healthy organs is minimized, a technique called Intensity-Modulated Radiation Therapy (IMRT) may be used. IMRT is a more precise form of 3D conformal radiotherapy that uses a multileaf collimator (MLC) which splits radiation into beamlets. The arrangement and intensify of the beamlets are varied to conform to the size and shape of the tumor. This minimizes bothersome side effects caused by normal organs (the rectum and bladder) being exposed to unnecessary radiation.

Branchytherapy is another form of radiation therapy for prostate cancer that delivers the radioactive source close to the tumor. There are two types of brachytherapy implants used: permanent or temporary. In the first type, small radioactive seeds are placed permanently into the tumor using ultrasound-guided needles through the skin of the perineum.

High-dose rate (HDR) brachytherapy is a temporary type of brachytherapy, which involves placing CT-guided needles into the prostate gland. A series of radioactive substances are then delivered through the needles. Four treatments are usually given over three days. After each treatment, the radioactive pellet is automatically retracted back to the brachytherapy machine. When the complete dose of radiation is delivered, the needles are removed. The short period it takes for every treatment (lasting 15-20 minutes) is possible because of the high radiation dose rate.

The St. Luke’s Department of Radiation Oncology is a part of the St. Luke’s Cancer Institute, which offers a multidisciplinary approach to cancer care. Its state-of-the-art radiotherapy technology is complemented with a caring team of specialists composed of radiation oncologists, medical physicists and radiologic technologists. The department will conducting a postgraduate course for doctors, with the theme, “Gaining the Upper Hand Using Cutting-edge Technology,” on September 15, 2007 at the 2nd Floor Conference Room of St. Luke’s Main Building. The topic is the multidisciplinary approach to the management of tumors of the lung, brain, prostate, nasopharynx and others. Registration is free for the first 50pre registrants.

Source: Philippine Star