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<div align = "justify"> There Consists in aplicaciСn of the suitable treatment segЗn age of the patient, life expectancy, associate illnesses, Gleason, level of PSA, TNM, sМntomas, side effects of terapИuticas and elecciСn informed on the part of the proper patient. it Is necessary to depart from the base of which, in general, cАncer of prСstata is an illness of long evoluciСn, almost crСnica. For it, it is necessary to take in consideraciСn many factors. Except exceptions, her decisiСn of the treatment in cАncer of prСstata is not one cuestiСn urgently. Nothing of that one so tМpico of "venga on Monday that him operaremos". First of all, it is necessary to insure itself that has everything her informaciСn and that has understood all his content. The age is a factor of big importance, since, in persons of advanced age, the aggressive treatments are not convenient and better the least aggressive, with atenciСn specially to fight the possible ones sМntomas. MАs aЗn that the proper age cronolСgica, to think the life expectancy that depends on the age, but, tambiИn, on the general state of health and of the presence or not of other associate illnesses (diabetes, hipertensiСn, cardiopatМa, respiratory insufficiency, etc). The Gleason grade allows to know the aggressiveness of the tumor, siИndose mАs conservatives in the treatments when the Gleason is low. The level of the PSA is an approximate indicative of the quantity of cИlulas you activate of cАncer of prСstata. The TNM is fundamental to value the need or not of an immediate treatment or of the deferred one. The treatments, especially cirugМa and hormonoterapia, can alter severely the quality of life of the fond person for the illness. Powerlessness and incontinence of urine, feminizaciСn, etc, there are topics it sufficiently important as so that them mИdicos they explain them in detail and his incidence segЗn the treatment that should be chosen. Finally, with everything her informaciСn available it is convenient often to request a second opiniСn, to contrast pareceres. And, if it needs, the third one opiniСn. The treatments bАsicos that we have in cАncer of prСstata located in glАndula are cirugМa (prostatectomМa) and radiotherapy. The hormonoterapia estА indicated in the cases recidivantes (the illness repeats despuИs of the curative initial attempt) and in metastАsicos. TambiИn sometimes it is used before the radiotherapy, to diminish the tumor mass and to facilitate it irradiaciСn. HabrА patients that, when they consider it informaciСn on his illness that has given them mИdico, querrАn to choose his future having mАs in account the following priorities: a) Treatment: Some men not querrАn to run the risk of losing control on the urine or of remaining impotent, to have one dominated cАncer potentially (not always) mortally, enclosed without treatment. b) Incontinence of urine and/or sexual powerlessness they are of the biggest risk factors at the time of deciding on the treatment, bearing in mind that they affect seriously the quality of life of the person. c) Quality of life: Many men do not resist the idea of having one cАncer in prСstata and he prefers that they are extirpated while others do not want to risk suffering from urinal incontinence and/or sexual powerlessness and choose a treatment not quirЗrgico. TO WAIT AND TO SEE Is her situaciСn in that, after diagnСstico of cАncer of prСstata, it is decided to abstain from treating the patient and happening to his observaciСn, to see as the events develop. ŠO be that, observaciСn it means....? to Choose not to treat cАncer of prСstata. But is not this done in others cАnceres, Šno is it true? PrАcticamente never. CАncer of prСstata, for his slightly aggressive growth, it allows her observaciСn without treatment to be one elecciСn legМtima in certain circumstances. ŠEn cuАles? When it is mАs probably that you die for other causes before his cАncer you could start growing and to cause problems or to kill him. to establish this, there are considered to be many factors: age (all that mАs age mАs possibilities that one cАncer of slow growth does not go so far as to develop); individual life expectancy (it depends on the age cronolСgica, of course, but tambiИn of the general state of health of the person and of the associate illnesses that it has; to minor life expectancy, less possibilities that cАncer of prСstata it could be lethal). Taking in consideraciСn exclusively age and life expectancy, the best candidates for observaciСn are, men of mАs of 75 aЯos, with limited life expectancy; or, men between 60 and 75 aЯos, with associate illnesses that threaten his existence. But it is necessary to value very much factors of the proper one cАncer: patients with T initials, of T1a to T2b, ═Gleason down - the tumors with low Gleason develop mАs slowly that those with tall Gleason and low PSA, which they predict a tumor growth so slow that it is possible that the active treatment does not improve the life expectancy of the patient. Her excepciСn the patients constitute it with sМntomas, an expectation of life of mАs of 20 aЯos, one major Gleason of 6 and one PSAcreciente (in these cases local treatment is preferred with radiotherapy or prostatectomМa). it Is necessary to value this series of factors and, in many cases, the patient podrА to choose not to talk each other. On the other hand, it is known that there are many persons with cАncer of prСstata that at least they go so far as to know it during his lives (one knows for autopsies in dead aged persons for accidents of trАfico; in the autopsy one finds to them often cАncer of prСstata that never manifestС). If I choose "esperar and ver", Šque do I have to do? In fact "esperar and ver" it demands the control mИdico periСdico, to detect sМntomas, problems or increases of the PSA that were going to conclusiСn of that cАncer estА growing too quickly. Therefore, during perМodo of observaciСn the PSA must be practised regularly (every four or six months). With his determinaciСn, mИdico valorarА the possible ones sМntomas and, if he considers it to be precise, practicarА a rectal tact. And if cАncer it begins growing? If it does it slowly, it is possible to wait a little mАs the PSA continuing. If it does it rАpido (for example, the PSA increases very much and/or mИdico it appreciates increase of the tumor in prСstata with sМntomas urinal), there can begin the treatment (by it sometimes it is named "esperar and ver", "tratamiento diferido") . A good norm for constara the importance of the increase of the PSA is, from that a significant increase is detected, to repeat it monthly two or three times. he is growth suspects when it increases clearly month after month. ŠSon now different the treatments that if it had chosen to talk each other from the beginning? Probably, not and the possibilities of treatment serАn the initials, segЗn the TNM. ═ Although is demonstrated that the tumor estА growing, Špuedo to continue in observaciСn since it has been said that cАncer of prСstata it grows very slowly? If, it is possible sometimes. The possibilities of dying because of it cАncer are low, although irМan increasing with the step of aЯos. PROSTATECTOMмA Her prostatectomМa radical consists in extirpaciСn of everything her glАndula prostАtica.para the treatment of cАncer of prСstata is used, with attempt curativo═cuando cАncer estА located in prСstata. it is realized or with general anesthesia completely asleep (patient) or with anesthesia epidural (in that the low part of the body is anesthetized). There Are two forms of prostatectomМa: *ProstatectomМa retropЗbica, her mАs used. It is practised incisiСn abdominal low. He allows to explore the ganglions linfАticos. If estАn affected, it is not extirpated prСstata and there are considered to be other treatments; if not estАn affected, it is extirpated prСstata. A form of prostatectomМa retropЗbica is that in that one tries to avoid it secciСn of the nerves placed on both sides of prСstata. since these nerves are fundamental for erecciСn, to leave them diminishes (although not always) the powerlessness risk, recuperАndose, in the favorable cases, her erecciСn 12 or 18 months after prostatectomМa. *ProstatectomМa perineal, in that her extirpaciСn of prСstata it is done to travИs of one incisiСn between year and scrotum. It does not allow to extirpate the ganglions. To do it, it is necessary to proceed ademАs to one pequeЯa incisiСn in the abdomen or to use a laparoscopio. it does not also facilitate it preservaciСn of the nerves that intervene in erecciСn. On the other hand, her prostectomМa perineal it is less traumАtica for the organism, it allows one recuperaciСn of the patient mАs rАpida and with less pains. ŠCЗal do they prefer them urСlogos? they Usually prefer it prostatectomМa retropЗbica, for the described advantages. ŠCuanto does time last one prostatectomМa? Her intervenciСn it lasts between 2 and 4 hours, since her prСstata estА placed very deeply and the hemorrhage risk is big. ŠEs dangerous for my life her prostatectomМa? The consequences of prostatectomМa have been minimized. The blood transfusions are not usually very necessary and the mortality is lower than 0.05 % in the hospitals with enough experience and tecnologМa. The stay in the hospital usually ranges between 3 and 6 dМas, with one perМodo of recuperaciСn in the domicile between 4 and 8 weeks. It Facilitates it very much recuperaciСn tackling exercise fМsico, of that mАs appropriate walking is, increasing progressively the distances. If in a given moment, one is tired, sweating excessively and nauseatingly, the fact is that exercise has been demanded too much and must be moderated, increasing again gradually. It is advisable to distribute the walks in approximately 4 to 6 times to dМa. Even the whole recuperaciСn must avoid the bicycle, to avoid any type of presiСn on the area perineal, Аrea where urinal bladder and urethra have got connected. When this sport is allowed again, it is necessary to do it step by step. It is recommended sillМn not to be hard and narrow, but soft and wide. it is not convenient to raise heavy things even her recuperaciСn. Neither to lead a car up to at least three weeks despuИs of cirugМa. And although one goes of passenger, it is necessary to avoid long trips for some weeks. The persons who were practising before intervenciСn other exercises fМsicos (golf, tennis, skittles, nataciСn, etc), must consult to mИdico to be advised on the progressive one prАctica of the same ones. to facilitate the one that the patient could urinate with facility, one is placed catИter to travИs of the penis that comes up to the bladder of the urine. One supports approximately two or three weeks. For the corporal hygiene, there is not limitaciСn to the corporal showers, being preferable that her baЯera, that forces to positions that can be counter-productive. there are no restrictions in the diet, you can eat for what you long to him, although the best thing there is always the Diet MediterrАnea. But, bearing in mind that during a certain time it can experience, despuИs of cirugМa, a certain tendency to estreЯimiento, it is convenient to eat abundant fibre (cereals, fruits, vegetables, etc) and to drink a lot of water and lМquidos. If estreЯimiento it is important, to consult to mИdico. The scars quirЗrgicas usually recover in approximately six weeks, but the entire process can last up to 1 aЯo. I would Like to know the possible complications of prostatectomМa </or>. Are the following ones: The principal ones are a sexual powerlessness and incontinence. But we will refer first to two possible consequences mАs immediate, hemorrhage and tightening of the neck of the urinal bladder. a) Hemorrhage. It takes place because the structures of about prСstata are rich in mЗltiples and thick glasses sanguМneos (arteries and veins). In extirpaciСn of glАndula glass can be cut algЗn, but it is slightly frequent. b) Tightening of the neck of the urinal bladder. Due to a scar produced in the neck of the bladder. It can endure urinal problems. It can be observed in one of every 20-30 prostatectomМas. it usually solve with a few dilators metАlicos or, if he persists, the scar is extirpated quirЗrgicamente. c) sexual Powerlessness. It is necessary to distinguish between powerlessness (incapability to have and to support one erecciСn that serves for relaciСn sexually) and disfunciСn erИctil (aptitude to have one erecciСn that could not be adapted for relaciСn sexually. For example, because I did not last the sufficient time). it owes to daЯo quirЗrgico caused in extirpaciСn of prСstata. despuИs of prostatectomМa and, up to past one aЯo of the same one, the patients have algЗn problem of erecciСn. Finally, and depending on the age (cuАnto mАs minor young problem), between 65 % and 90 % of produced quedarАn impotent. But what aggravates the problem is that the patient preserves it lМbido. And this one disociaciСn is perceived by the patients like one significativaagravaciСn d ela situaciСn that suffer. The form of prostatectomМa that tries to avoid it secciСn of the nerves of erecciСn, in patients with tumors pequeЯos, 50 % to which before intervenciСn they were powerful sexually, they recover it erecciСn. But the quality of the same ones is not usually just as before intervenciСn. But said 50 % of patients, recovers his sexual potency between the 2 and 24 months of operaciСn. For the treatment of the powerlessness it is necessary to come to specialists in the matter. d) urinal Incontinence. It is her pИrdida or involuntary leakage of urine or incapability to control the urinal current. There Are three forms bАsicas of urinal incontinence: *Por estrИs. The urine escapes on having done efforts, like coughing, to sneeze, reМr or to do exercise. It is her mАs frequently after prostatectomМa. </div> <div align = "justify"> </div> <div align = "justify"> *Por rebosamiento. It owes, in general, to blockade or tightening of the exit of the bladder, for tightening of his neck or exit. that can be caused for cirugМa, for formaciСn of a textile cicatricial. * Of urgency (irresistible need to urinate). It happens when the bladder becomes very sensitive to dilataciСn or stretching of the bladder when va═llenando of urine. ═ The urinal incontinence takes place because cirugМa the called one can affect it esfМnter of the urinal bladder, or vАlvula muscular that it supports the urine inside the urinal bladder. Or daЯan the essential nerves for the functioning of esfМnter. ═ In general, the incontinence despuИs of cirugМa recovers between several weeks until some months despuИs of cirugМa. To aЯo, mayorМa of patients they control his urinal bladder. But it can be supported permanently in 35 % of taken control for cАncer of prСstata (in light form, like incontinence of estrИs). But between 2 and 15 %, they have incontinence for estrИs mАs severe, that can be a perm. A way of preparing the incontinence and of fighting it is practising the Kegel exercises. East exercise is already recommended to begin it before prostatectomМa and to continue it despuИs, even her recuperaciСn of the incontinence. It Consists in to reinforce the musculature of the pelvis, doing an exercise similar to the one that normally we can carry out when we are urinating and stop voluntarily the jet of the urine. Or, pressing closely the buttocks, as if quisiИramos to retain something between both. it is recommended to carry these exercises out before prostatectomМa and despuИs of intervenciСn when it moves back catИter inserted in the penis. it Is adapted to realize 5 minutes every hour, during the day hours. The best exercise is of pressing the musculature of the pelvis hard but without releasing suddenly it, but supporting it a little and repeating during 5 minutes. But it is solved, it is necessary to consult with specialists. </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> ŠEs true that there is a new form of prostatectomМa assisted by robot and that it is mАs effective and less traumАtica? </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> Her prostatectomМa robСtica or system quirЗrgico of Vinci, it is a form de═prostatectomМa less invasive (aggressive) that the traditional one. it is less aggressive because incisions are realized to travИs of five pequeЯas, with what, as soon as the process was overcome, the scars are mМnimas and minors that with open sea proceeding quirЗrgico. And the time of recuperaciСn is mАs shortly. </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> ŠEn that consists? </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> urСlogo, during intervenciСn, it sees his it prСstata praised in a console that mejorasu visualizaciСn, destrezay precisiСn. They are used cАmaras of high resoluciСn and instruments of cirugМa microscСpica. A computer coordinates it realizaciСn of the micro-movements, guiding with precisiСn the arms robСticos, directed for urСlogo during intervenciСn. </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> your followers and producers say that her intervenciСn robСtica it is very effective and is necessary and that it allows to support the sexual potency and avoid the problems of urinal incontinence. But it is difficult to be resulted very much in percentages on powerlessness and incontienecia with this one tИcnica. Neither are studies randomizados (comparative) between prostatectomМa robСtica and the traditional one. </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> It Is so an interesting advance but that must be quantified objectively since his cost is very top to of prostatectomМa tradicional. </div><div align = "justify"> CRIOTERAPIA ŠEn that the crioterapia consists? </or> It Is her congelaciСn of prСstata to try to treat one cАncer in this one glАndula. this one tИcnica tambiИn knows each other with the name of criocirugМa. The target is of killing them cИlulas cancerous. It Offers the advantages of his simplicity, facility and rapidity with which it is practised asМ like his low cost. Nevertheless, it is even considered to be an experimental treatment, because there are no long-term studies that show his real efficacy. Therefore, it is not known if it is so effective as her cirugМa or the radiotherapy. ŠCСmo it is practised? </or> it is done under anesthesia of the person. Under control by means of ecografМa transrectal, there are placed in prСstata a few special probes for which it becomes circular nitrСgeno lМquido, that freezes the textile of prСstata. to prevent the urethra from freezing, one becomes circular lМquido warm for the same one during the crioterapia. ŠQue secondary problems can it cause? </or> Are temporary declarations produced by irritaciСn of the urethra or of the bladder of the urine. They Consist bАsicamente in sensaciСn of burn on having urinated, frequent urine, often without previous notice, hematuria - to urinate blood - pain on having urinated, similar inconveniences on having defecated and hinchazСn of the penis and/or of the scrotum. Few persons present problems mАs serious, like scars in the urethra and/or difficulties mАs serious on having urinated (that can need it colocaciСn of one catИter). One complicaciСn mАs severe is her formaciСn of one fМstula, by means of comunicaciСn between urethra and rectum. ŠImpotencia and urine incontinence? </or> The powerlessness is the serious one complicaciСn of the crioterapia, which affects 75-80 % of persons. On the other hand, the urine incontinence is very rare. ŠEn they sum up? </or> Is an interesting treatment but that cannot take like the first elecciСn, since his long-term efficacy not estА proved cientМficamente. ═ One indicaciСn, to consider, is his utilizaciСn in cases of relapse (reapariciСn of the illness) despuИs of the radiotherapy. When it has been applied irradiaciСn on prСstata for cАncer of prСstata, it is not possible to apply cirugМa. the radiotherapy believe adhesions between the textiles that prevent disecciСn quirЗrgica. this is one of the reasons that use them urСlogos to convince the patients so that they choose it prostatectomМa since, they say to them "si him the illness reappears and there is elejido radiotherapy as the first treatment then not podrА operar". Well, today in dМa there are alternatives in case of relapse, the said crioterapia and tambiИn the HIFU (vИase mАs below). </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> does HIFU </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> ŠEn quИ consist? </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> HIFU (ultrasСnidos focused of high intensity), is her opciСn less aggressive available today in dМa in the treatment of cАncer of prСstata located or in the relapses of the illness, in the cases in which the radiotherapy fails. To see braquiterapia is realized without punctures, without seeds (), without irradiaciСn. And it has the enormous advantage of which it is possible to repeat when it needs. Her hospitalizaciСn it is very brief. </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> ŠCСmo is it carried out? </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> a beam of ultrasСnidos is used convergent of high intensity, generated by a tranductor of big potency, to produce heat. HIFU necrosa (destroys) the textile prostАtico, without affecting the textiles of around. </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> ŠHay results cientМficos available? </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> </div> <div align = "justify"> SМ, in case of the HIFU they are, thanks to essays long and realized with thousands of patients. In 87 % the biopsies despuИs were negative to HIFU, preserving it erecciСn 47 % of patients and without incontinence severas.</div> <div align = "justify"> </div> <div align = "justify"> RADIOTHERAPY Is one tИcnica curative in cases located (with equal effectiveness that her prostatectomМa) ═para to destroy tumors in the one that there use beams (similar to the RX) or partМculas (electrons or protons), of high energМa. The tumor estА surrounded of cИlulas normal, that irradiaciСn tambiИn it can destroy, which is convenient to avoid in the possible thing. The difference between cИlulas normal and cancerous, as for radiotherapy, is that the first ones have a big aptitude to repair or to correct daЯo that causes them it irradiaciСn. On the other hand, cИlulas cancerous they have theirs minor capacity of reparaciСn great. This way it is possible to destroy very much mАs the tumor that them cИlulas normal. Although some of these die for the effect of irradiaciСn, the organism can replace them by the piece of news development cИlulas normal. ŠDe all the ways the radiotherapy is applied? </or> BАsicamente, there are two forms of radiotherapy that are applied to the treatment of cАncer of prСstata, external radiotherapy and internal radiotherapy or braquiterapia. The external radiotherapy comes from one mАquina (bomb of cobalt, linear gas pedal, etc), placed out of the patient. irradiaciСn the tumor directs it to the Аrea for itself where estА, in this case, her prСstata. The radiotherapy interns or braquiterapia or interstitial radiotherapy is that in that radioactive materials are placed in prСstata, in the shape of pequeЯos "perdigones" or "simientes". For weeks or months they express neither radioactivity not harmful to the patient nor his family. ŠPuede to explain to me mАs on the external radiotherapy? </or> The specialist who applies this treatment knows each other as radioterapeuta or as oncСlogo radioterapeuta. The radiotherapy is a local treatment (for T1 and T2), equivalent to cirugМa, although tambiИn it is Зtil, the radiotherapy, in the treatment of cАnceres located but extended (T3, T4), that cirugМa it cannot tackle it for his excessive one extensiСn. TambiИn estА indicated in the persons who, for other motives, do not want or could not surrender to cirugМa. ŠCСmo it is applied? </or> First of all, it is realized what we know like simulaciСn. By means of a few special X-rays, the treatment is simulated, to determine the dose and the exact area to treat. It does not represent any inconvenience for the patient. once Realized simulaciСn the treatment initiates it autИntico. they have said to Me that it is a very long treatment. ŠEs true? </or> the Whole treatment comes to last between 6 and 7 weeks. Five is applied dМas a week, generally from Monday until Friday. The rest of two dМas is done to facilitate it recuperaciСn of cИlulas normal of the surroundings of the tumor. ŠCuanto does time last one sesiСn? </or> About 10 minute. ═ The dose of irradiaciСn estАndar is to 70 Gy. ŠTiene advantages the radiotherapy with regard to prostatectomМa? </or> First of all, anesthesia is avoided and hospitalizaciСn and the side effects of cirugМa. there is hemorrhage risk not neither of pain, nor problems cardМacos or of embolisms for coАgulos of blood. Then, ŠcuАles are the possible side effects of the radiotherapy? </or> the weariness Is very frequent, towards the end of the treatment. AdemАs, about 15 % of patients develops cystitis (irritaciСn on having urinated) and/or rectitis (inconveniences on having defecated, pain, urgent need to defecate). ŠSon perms these inconveniences? </or> In mayorМa of persons, they disappear on having finished the radiotherapy, mАximo in approximately two or three months despuИs. In a few patients, they can prolong and need treatment. ŠProduce urine incontinence the radiotherapy? </or> SСlo in 5 % of patients. ŽImpotencia? The radiotherapy can cause powerlessness, if daЯa the glasses sanguМneos and nerves necessary for erecciСn. For it, between the third one and half of men treated with radiotherapy experimentarАn algЗn grade of disminuciСn of erecciСn. Of presenting before itself, it does not do it immediately, but it is late like mМnimo 1 or mАs aЯos in being evident. ŠEs curative the radiotherapy? </or> Just as her prostatectomМa. The efficacy is similar. DespuИs of the radiotherapy, Šcuando podrИ to work again? </or> Except those persons who have fatigue (which recuperaciСn despuИs of the treatment it can last a few weeks), them demАs can continue with his activities fМsicas (for example, deport) during and despuИs of the treatment. ŠPuede to explain mАs on the internal radiotherapy? </or> The radiotherapy interns or braquiterapia it uses some pequeЯas masses, of tamaЯo brought near of a grain of rice, prepared to be radioactive. By means of thin needles they are introduced in prСstata, being planned the treatment so that the radioactivity affects to the whole tumor. ŠCСmo the needles interfere with the seeds in prСstata? </or> The needles interfere to travИs of the skin of perinИ (under the scrotum and opposite the year. your biggest advantage with regard to the external radiotherapy is the felling duraciСn of the treatment, one dМa. ŠQuИ are radioactive elements used? </or> At first radioactive 125 was using mАs iodine. At present, there prefers in general the palladium 109, which is mАs powerfully and seems to assure mАs the death of cИlulas of the tumor. The braquiterapia, Šes so effective as radiotherapy or prostatectomМa? </or> It Is possible, but long studies need, to demonstrate it. up to the date we have long-term studies in patients treated with radiotherapy or cirugМa. The side effects that the braquiterapia produces, Šson like those of the radiotherapy? </or> SМ, the same ones and in the same one proporciСn. ----------------------------------------------------------- HORMONOTERAPIA your target is to diminish the levels of masculine hormones, the principal one of which it is the testosterone. cАncer of prСstata it is sensitive to the effect of the testosterone, which produces his development and growth. , On having eliminated the testosterone, in mayorМa of patients cАncer it stops developing. ŠEn that situations estАn stated the hormones? </or> In five, 1. Her mАs used it is when the illness is widespread (metАstasis). The illness can stop for prolonged perМodos of time, although he does not go so far as to recover. 2. TambiИn it is indicated in patients whose illness has repeated locally, despuИs of having being treated with Иxito, and there are no possibilities of a new local treatment 3. Before cirugМa or radiotherapy, to diminish tamaЯo of the tumor and to facilitate his extirpaciСn or his irradiaciСn. it is a question of the call hormonoterapia neoadyuvante. 4. In some cases, it is applied despuИs of the local treatment, to improve the results of cirugМa or radiotherapy. 5. In persons of advanced age, when the treatment is necessary because it is a question of a progressive illness, but estАn contra-indicated the local treatments 8especialmente cirugМa, for his biggest risks). The hormonoterapia, Šse applies for cirugМa or for medicines? </or> It mАs frequent it is with medicines. But precisely the hormonoterapia empezС being quirЗrgica, for prАctica of orquiectomМa or extirpaciСn of testМculos. orquiectomМa it is part of the call hormonoterapia ablativa. But, Špor quИ they are extirpated or were they extirpating them testМculos? </or> Because testМculos they produce them 95 % of the testosterone. AЗn it are urСlogos that are followers of orquiectomМa in the hormonal treatment of cАncer of prСstata, but it is necessary to bear in mind his enormous impact psicolСgico, with deterioration of the car image and of the proper esteem. It is very effective, since it diminishes suddenly the biggest source of producciСn of testosterone. But the hormonal medicines have placed it in a secondary place of the hormonal treatment. Today in dМa, her orquiectomМa, Štiene aЗn someone indicaciСn? </or> a place Keeps on having in the patients cardiСpatas (problems cardМacos) that, with cАncer of prСstata, need hormonal treatment. In these cases the hormonal treatment is not recommended with medicines because they can aggravate it cardiopatМa. Another advantage of orquiectomМa is that the testosterone levels fall down almost to zero between 3 and 12 hours of realized her intervenciСn. Men with pain Сseo for metАstasis can see as his pain disappears in few ones dМas. On the other hand, orquiectomМa it does not produce these effects for what estА stated this one situaciСn. ŠQue can he say to me of the hormonal medicines? </or> They Are part of what it calls hormonoterapia additive, because aЯaden a few medicines that are going to change the hormonal state of the person. MayorМa of these medicines they are directed to produce one castraciСn of type quМmico, annulling the sources of producciСn of andrСgenos (principally, testosterone). Has he said that 95 % of andrСgenos takes place in testМculo.ŠY 5 % remaining?. </or> In glАndulas adrenal (named asМ for one is placed on every riЯСn). AndrСgenos are not eliminated these not for castraciСn not by the hormonal treatments that cause it castraciСn quМmica. They need, if they want to be eliminated, a special treatment with medicines that are called antiandrСgenos. ExplМqueme the medicines that are used in hormonoterapia additive. First of all, the DES or dietilestilbestrol, that is like one estrСgeno (feminine hormone). ŠSe it uses at present?. </or> PrАcticamente, no. It does aЯos the Зnico was a hormonal treatment. But it was seen that enough was increasing the risk of enduring attacks cardМacos, cerebral hemorrhage and coАgulos of blood mortal. Is a big disadvantage, because it is a very cheap medicine and that takes fАcilmente (a pill to dМa). But he has had to give in. Since, Šque are medicines used at present? </or> The called ones anАlogos of the liberating hormone of the hormone luteinizante (LHRH). BАsicamente are copies of natural hormones produced in our organism and that stimulate it producciСn of testosterone. Them mАs used there are the acetate of leuprolide and the acetate of goserelina. They diminish the levels of testosterone of a way as effective as her castraciСn. They produce so one castraciСn quМmica. ŠCСmo they are applied? </or> In inyecciСn intramuscular deep or in inyecciСn under the skin (subcutАnea) of the abdomen, one a month (in the form Depot) or tambiИn he gets ready now of another form Depot, which applies itself once every three months. ŠCСmo actЗan? </or> Once they have been administered, provoke one estimulaciСn of producciСn of testosterone during fifteen dМas. The body interprets this increase like which it has produced testosterone in excess, therefore it stops it producciСn of the stimulant hormone of producciСn of testosterone. Our organism is "engaŻado" in certain way for anАlogo of the hormone. ŠNo is the testosterone increase dangerous during 15 dМas?. </or> In effect, it is not suitable. To resist it, before initiating the treatment with one anАlogo of the LHRH 15 are indicated dМas with one antiandrСgeno, to neutralize the testosterone increase. ŠPuede to clarify this to me? </or> First, dИjeme that explains to him what is one antiandrСgeno. We have already said that one pequeЯa proporciСn of andrСgenos is made in glАndulas adrenal. to block his acciСn, a few medicines were synthesized, called antiandrСgenos, whose acciСn it consists of blocking it, at level of prСstata, acciСn of andrСgenos. This way two indications are born for antiandrСgenos: *En the treatment of cАncer of prСstata, associates with one anАlogo of the LHRH, inside the strategy that is named an entire hormonal blockade, which we will define despuИs. *Para to provide the testosterone increase fifteen dМas the first of aplicaciСn with one anАlogo of the LHRH. ŠCuАles are they them antiandrСgenos mАs secondhand? </or> They Are flutamida and bicalutamida. ŠCСmo and all that they take? </or> they present before themselves in the shape of tablets for administraciСn for the mouth. The flutamida is prescribed three times to dМa while the bicalutamida, once every 24 hours. ŠEn that the entire hormonal blockade consists? </or> Some authors believe that the best hormonal treatment is based in asociaciСn or combinaciСn of one anАlogo of the LHRH with one antiandrСgeno or entire hormonal blockade. This way controlarМa 100 % of producciСn of andrСgenos. There Is great one polИmica if really eliminaciСn of 5 % of andrСgenos produced by the adrenal ones it increases the benefits as for avoiding defeats of the treatment, when only it is used anАlogo, or if the entire blockade aumentarМa the survival of the patients. there is no definitive information, therefore any of them mИdicos prefer the entire hormonal blockade and others apply only anАlogo. ŠHay algЗn group of patients in whom has already been demonstrated that the entire hormonal blockade is better that anАlogo only? </or> SМ, it is the group formed by patients with cАncer of prСstata, with few illness (metАstasis) in the bones and with sМntomas mМnimos. The hormonal treatment, Šaumenta the survival of the patients with metАstasis?. </or> it has not been demonstrated. What if it does is to improve the quality of life of the patients and it diminishes the complications risk. A patient with metАstasis for cАncer prСstata, Šhasta when it has to take the hormonal treatment? </or> In Medicine there are always tendencies and polИmicas. For some mИdicos, her mayorМa, the hormonal treatment has always to take. it is the called continuous hormonal treatment. They believe that this way they control better the illness. Others, on the other hand, prefer the called intermittent hormonal treatment. it Consists of initiating the hormonal treatment and of following it until the PSA and sМntomas they should have diminished to his mМnimo level and then they should become stable. Then the treatment stops and it is not resumed until it increases, in two or three anАlisis monthly, the PSA again. AsМ treatment is happening or not, segЗn her evoluciСn of the patient. The intermittent treatment studied in animals of experimentaciСn, has showed that it can be better that the continuous one and that does not cause problems. The intermittent treatment is mАs cheaply that the continuous one and there has another additional advantage, which is that of leaving perМodos of rest the patient in whom they eliminate them to him sМntomas unpleasant produced by the hormones. Some studies in human beings show favorable results with the intermittent treatment. are ŠCuАles the effects tСxicos or secondary of these medicines? </or> Her orquiectomМa, already explained like form of hormonal treatment, it causes, in mАs of 90 % of men, disminuciСn of the sexual desire (libido) or absence of the same one and powerlessness. Sometimes, suffocations. These are mitigated usually in the course of time. Them anАlogos of the LHRH they are similar to those of orquiectomМa. QuizАs the effect mАs frequent is her presentaciСn of suffocations (10 to 15 % of men). There are like heat waves and sudoraciСn, that come and go away and return. In general, they do usually diminish with the time. These medicines tambiИn can produce sensibility in the breasts and, sometimes, increase of his tamaЯo (ginecomastia). In slightly frequent cases, the precise painful sensibility low radiotherapy doses or cirugМa to solve the problem. to Watch the tendency to the weight increase with these medicines. As for antiandrСgenos, the effect mАs pronounced is the diarrhea, especially with flutamida. If they are supported, it is necessary to lower the dose of antiandrСgeno, to suspend it or to replace it. tambiИn they can take place nАuseas and weariness. The continued use of these medicines can harm to hМgado, by what, periСdicamente, control panel must be realized by means of anАlisis to value as it works. TambiИn there is danger of descalcificaciСn (osteoporosis), therefore there are convenient supplements of calcium, vitamin D and to sunbathe. If cАncer with metАstasis it becomes resistant to the hormonal treatment exhibited even aquМ, Šse does he have other medicines tambiИn of hormonal type? A medicine used in cases of resistance to the hormonal therapy is the estramustine. In fact it is a medicine that placed on horseback between hormonoterapia and chemotherapy. In effect, estramustine it combines a feminine hormone, one estrСgeno, with one fАrmaco quimioterАpico, the nitrogenous mustard. The estramustine is used alone or associate to others quimioterАpicos (mitoxantrona, etoposido, vinblastina, paclitaxel). QUIMIOTERAPIA It Is different opciСn for patients resistant to all kinds of hormonal treatment. two types of medicines are used: *citotСxicos, that interfere with the development of cИlula cancerous and produce his death. *citostАticos, that promote the cellular aging and make it difficult multiplicaciСn cell phone. They do not kill cИlulas straight, but they cause little by little his desapariciСn, on having stopped reproducing. Her mayorМa of the used ones they belong to the first group. Her mayorМa of citotСxicos they affect them cИlulas that estАn multiplying at the moment when the medicine is administered. For it, and aЗn when they affect mАs to cИlulas cancerous, they present unwanted side effects. They owe to afectaciСn of cИlulas normally in divisiСn and multiplicaciСn; bАsicamente those of blood, digestive pipe and skin. AdemАs, up to the present. the chemotherapy has not produced good results. The medicines citotСxicos mАs used are, taxotere, etoposido, vinblastina, paclitaxel and mitoxantrona, apart from estramustine, already commented in the paragraph dedicated to resistance to the hormonal therapy. ------------------------------------------------------------- INDICATIONS OF THE TREATMENT SEGзN TNM AND OTHER FACTORS The treatment individualizes them segЗn caracterМsticas personnels (age, the general health the state, life expectancy), of the tumor (Gleason) and of his extensiСn (TNM). let's Consider these situations. T1. It is necessary to consider separately T1a of T1b, T1c, T2aA and T2b: T1a. it is necessary to raise three fundamental aspects, life expectancy, level of PSA despuИs of resecciСn of the tumor and Мndice of Gleason. SITUACIсN TO. *Si the life expectancy is major than 20 aЯos (for example, men jСvenes, of 40 0 50 aЯos), *y/o the PSA keeps on being major than 1 ng/ml and, *el major Gleason of 6, TO CONSIDER TREATMENT WITH RADIOTHERAPY OR PROSTATECTOMмA RADICAL, without discarding completely the deferred treatment. SITUACIсN B. *Esperanza of minor life of 20 aЯos, *PSA minor of 1ng/ml despuИs of extirpaciСn of the tumor, *Gleason of 6 or less, NOT TREATMENT UNTIL THE HAGUE SмNTOMAS (deferred treatment). T1b, T1c, T2a and T2c. They have the following possibilities: 1. Gleason between 2 and 4, Hopefully of minor life of 10 aЯos, NOT TREATMENT UNTIL THEY APPEAR SмNTOMAS OR RADIOTHERAPY. Hopefully of life between 10 and 20 aЯos, NOT TREATMENT UNTIL THE HAGUE SмNTOMAS OR RADIOTHERAPY OR PROSTATECTOMмA RADICAL. Hopefully of life of mАs of 20 aЯos, RADIOTHERAPY OR PROSTATECTOMмA RADICAL. 2. Gleason 5 or 6, Hopefully of minor life of 10 aЯos, NOT TREATMENT UNTIL THEY APPEAR SмNTOMAS OR RADIOTHERAPY. Hopefully of major life of 10 aЯos, RADIOTHERAPY OR PROSTATECTOMмA RADICAL. 3. Gleason 7 to 10, Hopefully of minor life of 5 aЯos, NOT TREATMENT UNTIL THEY APPEAR SмNTOMAS OR RADIOTHERAPY. Hopefully of major life of 5 aЯos, RADIOTHERAPY OR PROSTATECTOMмA RADICAL. --------------------------------------------- T3a. It depends of extensiСn on the tumor to one or to two lСbulos (parts) of prСstata: If the tumor spreads mАs allА of prСstata, but only in a side, RADIOTHERAPY OR HORMONAL TREATMENT OR BOTH (her prostatectomМa can be indicated by it if the Gleason is 6 or less and there is no excessive one extensiСn of the tumor). If the tumor spreads mАs allА of prСstata, but in both parts, RADIOTHERAPY OR HORMONAL TREATMENT OR BOTH. ------------------------------------------- T3b and T4NOMO: RADIOTHERAPY OR HORMONAL TREATMENT OR BOTH ------------------------------------- AfectaciСn of ganglions (N1, N2, N3), the HORMONAL TREATMENT Can be chosen, with or without radiotherapy, or NINGзN TREATMENT UNTIL THEY APPEAR SмNTOMAS --------------------------------------- MetАstasis, HORMONAL TREATMENT. </div> </div>

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