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Oganes E. Dilanyan
Urologist, MD, PhD
+7(499)344-03-03

Prostate Cancer

In this article

Prostate cancer is one of the leading oncology related causes of death among men over 45 years old. In this article I will tell you about early and late stage diagnosis, up to date treatment and ways of controlling this condition.   

Diagnosis: Prostate cancer

Specific features: It’s scary. “This is the end…” is the first thought of the vast majority of patients and their families. In this article we will talk about what to do if you or your loved one have been diagnosed with this condition.  The first advice is: Do not despair. Yes, it is a very frightening illness but there are several effective treatment methods available today such as prostate cancer surgery when diagnosed in the early stages, hormonal therapy, chemotherapy and radiotherapy when surgical treatment is not an option.  It is important to understand that modern methods of prostate cancer treatment are highly effective. And one must not surrender to it under any circumstances. 

Prostate cancer: Surgery

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In cases where surgery is required to treat prostate cancer I offer laparoscopic prostatectomy.

This method, radical laparoscopic prostatectomy, allows us to:

  • Perform the operation without any incisions only with 4 punctures and no pain, scarring or blood loss. 
  • Protect the neurovascular bundles of the prostate preserving erectile function and avoiding urinary incontinence.
  • Due to optic enlargement of the operating area prostate cancer laparoscopic surgery is carried out with minimal blood loss. 

What can one say to a healthy person that suddenly finds themselves a patient with a terminal illness that is threatening their life expectancy. Prostate cancer survival statistics? It all depends on the stage and can be 3 months or 10 years. Or tell them about molecular mechanisms that trigger the growth of malignant tumours? I guess not. The question that really bugs the patient having just been diagnosed with prostate cancer is: “Can anything at all be done? Or is this it?”.

Yes, something can be done. And should be done. And yes, terminal conditions still exist especially when it comes to oncology, and some of them are very difficult to treat or cure. But prostate cancer is not one of them.

“...This disease takes many lives while a simple examination would have detected it in the early stages”.

Causes of prostate cancer

I would like every patient reading this to be able to see the specifics of their condition very clearly. This will help to improve the understanding between myself and the patient and will improve the chances of beating the disease. Yes, beating it, curing it completely. The essence of any tumour formation process is cell division. The essence of malignant tumour formation is inability of the cell to specialise and distribute.
A normal cell once divided starts to develop, acquires so called specialisation. A cancerous tumour cell is different from the normal one and instead of specialising it starts dividing very quickly and after it’s divided it starts metastasising, travelling to other far away organs in the blood stream. And another ability of a malignant tumour is intoxication, in other words, poisoning the body with the substances produced by the tumour cells.

A tumour cell divides uncontrollably, spreads to far away organs and poisons the body.

Prostate cancer diagnosis: signs and symptoms in men

Prostate cancer diagnosis has its own specifics. ет свои особенности. First of all, it is very important that the tumour is detected early. Because in the 1st and 2nd stages of the disease the symptoms are not yet present the only way to diagnose early is a yearly check up with a urologist and a PSA blood test.  A prostate biopsy is necessary to confirm the diagnosis. 
But what does the patient need to do after their diagnosis had been confirmed by the biopsy? Basically, they need to undergo further tests to find out the stage of the disease because the form of treatment, be it surgical treatment or hormonal or radiotherapy directly depends on the stage.

Diagnostic process should answer the following questions: what stage of the tumour in, has it metastasised into the lungs, lymph nodes and the bones, is it possible to operate and if it is then how. 

Lower pelvis MRI

Allows to accurately determine the size of the tumour, how far it has spread beyond the prostate and rule out metastasis (spreading of the cancer into the lymph nodes).

CT scan of the lungs

CT scan with contrast will allow us to rule out remote metastasis in the lungs which will let us surgically remove the cancer of the prostate. 

Skeletal Scintigraphy

Is a bone scan that helps to rule out another type of metastasis of prostate cancer cells– their spread into the bones. 

A usual story

...— Doctor, I really don’t understand…Cancer is cancer. I will live for as long as God has given me, why do I need all these tests? 
— God has given you not only ill health, Victor. God has also given us science so we can defeat the disease. These tests are needed to determine the stage of your disease. And to cure you.
— Lung x-ray? Bone scan? What for?
— Look, Victor. Prostate cancer metastasis is most often found in the bones and the lungs. This is why a simple lung x-ray will help rule out metastasis in the lungs and skeletal scintigraphy, also known as bone scan, will allow us to rule out metastasis in the bones.  
— And what do I need a CT scan for?
— To assess the prostate itself and also the lymph nodes.
— Ok, you have assessed all of that, what next?
— Next, we work out the treatment strategy, Victor. If there is even a small chance that radical prostate cancer surgery will cure you I will recommend surgical treatment.
— And what if…you find metastasis? Lie down and die?
— Don’t you even dare think that. Your grandson is only 3 years old, too early to die yet. Prostate cancer even in the presence of metastasis is not a death sentence.

“What a potion won’t cure metal will.
What metal won’t cure fire will…”

Treatment of prostate cancer in men

When discussing prostate cancer to the patient it is paramount that the following three questions are answered: 

  • Is it possible to completely cure it at the current stage?
  • What is the safest treatment option for this specific patient?
  • What can the doctor do to improve the patient’s quality of life? 

Surgery remain the first radical option in treating prostate cancer. If the tumour has not spread beyond the prostate and has not metastasised into the lymph nodes or the bones it surgery can be very successful in treating prostate cancer.

Oncology principle is as follows: small tumour – small surgery, large tumour – big surgery.  

Prostate cancer surgery

Removing an organ, for example the prostate, in the presence of an incurable condition which can be lethal if left untreated, seems like simple and logical solution at first glance.  And it can seem that in the presence of prostate cancer surgical intervention is vital. 
But other questions also arise: is it advisable to operate on this specific patient and what their quality of life is going to be after prostate cancer surgery as well as what surgical method should be chosen.
I would love it if every single of my patients knew the answers to these questions when they come to me to have surgery.
It is possible and advisable to operate on a patient in the first and second stages of prostate cancer, and the surgery will cure it in most cases.

Laparoscopic prostate cancer surgery and its consequences

I offer my patients three types of surgery for prostate cancer: radical removal of the prostate together with the lymph nodes. This usually involves laparoscopic prostatectomy which does not require a large incision. The minimally invasive technique requires four or five tiny incisions for the instruments which are used to remove the prostate. This method has several advantages while avoiding complications such as post-operative pain, inflammation and hernia risks, as well as excellent cosmetic results and a very short hospital stay.    

"Gold standard"

Laparoscopic surgery for prostate cancer, also known as radical laparoscopic prostatectomy is the modern standard for treating prostate cancer.

Accurate vision

10-fold magnification of the operating field allows to remove the prostate avoiding blood loss, as well as preserving neurovascular bundle and maximum urethral length.   

Quality of life

Preserving the neurovascular bundle allows the patient to avoid urinary incontinence and erectile dysfunction. This is the most important component allowing the patient to have good quality of life following prostate cancer surgery.   

Pain free

No incision means the patient will be pain free following the surgery and will avoid the use of strong pain killers.

Minimizing risks

Laparoscopic surgery also excludes the risk of developing post-operative hernias which, unlike standard hernias, are very difficult to treat. 

Fast recovery

Usually the patient is discharged after 3-4 days following laparoscopic surgery and can go back to work a week later.

The story continues

...— Victor, I have two news for you, good and bad. Good news: your prostate cancer is in very early stages and has not metastasised. The bad news is that you need surgery. 
— Well, just as I though. But this is good, isn’t it, doctor. Doesn’t this mean you may be able to cure me from this nasty disease. 
— Well, yes, it is generally speaking. 
— As any other patient I really want to know about the possible risks. What can I expect? 
— Victor, when removing the prostate, the surgeon sometimes simply has to damage the nerves responsible for urine retention and erectile function. This is why the most common complications of prostate cancer surgery are urinary incontinence and erectile dysfunction. But in your case, it is possible to carry out a nerve-preserving operation and I will keep the neurovascular bundles intact.  The risk of these complications in your case is minimal.   
— But…what if still get them? 
— Not a problem. There are methods of corrections available today both surgical and non-surgical that can help correct both urinary incontinence and erectile dysfunction. 
— Ok, how long does the surgery last? 
— Around four hours, sometimes five. 
— Doctor, you mentioned something about removing the lymph nodes. Mine are all clear according to the MRI results. Are you going to remove my lymph nodes? 
— I am afraid so, Victor. It is true that MRI does not show any lymph node enlargement. But the presence of micro metastasis is still possible as your PSA is raised and is over 10ng/mL. So, the removal of the lymph nodes will improve your prognosis and also the histological examination will allow us to choose further treatment options correctly. 
Seven days after the operation I discharged Victor home. Histology report from the lab was good so I just recommended him to get his PSA checked every three months. Minor urinary incontinence resolved itself after five weeks. 

“Therapy is negotiating with the disease,
surgery is attacking it”.

Hormonal treatment for prostate cancer

Among all of the other important information and medical terms relating to cancer in general and to hormonal treatment of this specific cancer in particular it is important for the patient to know the following:
Cancer cells are divided into three types: first is hormone dependent, second is hormone sensitive and the third is not sensitive to hormones.
The first type of cells cannot survive in the absence of the male sex hormone testosterone. The second type of cells cannot divide in the absence of testosterone. And the third type is not affected by testosterone. 
Why is this important? The thing is that in the case of prostate cancer most cells are sensitive to testosterone and can live and multiply only in the presence of this hormone. This is what the therapy is built on by individually selecting and prescribing medication which block testosterone production in the body. This treatment is effective until the time when the cells that are not sensitive to testosterone become active.   
Chemotherapy and radiotherapy are usually used to treat the third type of cells.

Timing is everything

Prostate cancer: 3rd and 4th stages

— Hello Victor! Long-time no see! Come in!
— Good afternoon, doctor, - my patient is smiling, - how are you doing? 
— I am very well thank you, and by the way you are smiling I am guessing you are too. 
— Hmm, as you have said in the past, I have some news, good and bad. 
— Right! — I was starting to get worried, — tell me all. 
— Well, everything is fine with me, my PSA has been at zero for a year. 
— That’s great, and what is the bad news? 
— My brother has been diagnosed with prostate cancer. Late stage and metastasis in the bones. But you will cure him, won’t you? 

Another specific feature of a cancerous tumour is the ability to metastasise into the bones. What can be done in the presence of metastasis? Surgical intervention is not advised as the is already out of control by this stage and is already in the bone and is likely causing quite strong and sometimes unbearable pain. Can anything be done besides pain relief?
It can be. Modern chemotherapy for prostate cancer allows to fight bone metastisis quite effectively. There are medications that literally infuse calcium into the metastatic areas turning them back into bone.

When setting up my clinical centre for oncology and urology, my aim was to combine the efforts of urology surgeons, chemotherapy specialists, oncologists and radiologists to get the best results possible. Every time we see a patient we decide on the treatment plan together and follow it.

Often this is what helps the most: my patient’s brother was given a tailored treatment which led to normalising the condition of the bones and prevented further progression of the disease. And this means not just saving and prolonging someone’s life but also improving the quality of life.

Information for foreign patients:

If you require prostate cancer surgery in Moscow please contact us. We will arrange hospital admission on the day you arrive and carry out the surgery as soon as possible. You will be able to return home a week later.

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