| What
Treatments are Available in your own area of Scotland |
Treatment
across Scotland
(Information correct as at March 2006)
Choice
exists because of the long natural history of prostate cancer -
not all patients will require treatment at all. There are no comparative
studies yet that tell us if any one treatment is better than another,
with curative intent. The choices available are:
•
Active Monitoring - which should be accompanied by a regular
check of PSA and a Digital Rectal Examination.
•
Radical radiotherapy - external beam, brachytherapy
Published cure rates for disease free survival after external beam
radiotherapy 85% at 10 years.
Cure
rates for brachytherapy 80% at 10 years. Attractive to many because
it involves two short visits to the hospital for general anaethetic
procedures and there is no short-term risk of incontinence. With
time radiation can cause damage to erectile nerves resulting in
erectile dysfunction. Longer term (20 year) effects of high dose
radiotherapy are not known.
•
Radical
prostatectomy - retropubic, perineal, laparoscopic
Open Radical Prostatectomy has a 15-year survival of up to 90%.
There is some urinary (stress) incontinence (10-15%), 1-2% severe
incontinence, and 40% erectile dysfunction.
Laparoscopic radical prostatectomy improves visualisation of the
anatomy, benefiting surgeons. For patients, smaller incision and
minimal bleeding result in lower transfusion rate, less pain, shorter
hospitalisation. Long-term data is not yet available but short-term
results are comparable to open surgery.
•
Newer
technologies - cryotherapy, HIFU (high intensity focused
ultrasound). These are mostly used in patients with recurrent
disease after radiotherapy and not a recommended primary treatment
for prostate cancer. HIFU is only available in trials currently.
What
are the Treatment Choices for those with Prostate Cancer in Scotland
Aberdeen
Two surgeons performing open radical prostatectomy; radical radiotherapy
- external beam 64 gray in 32 fractions; patients referred to Edinburgh
for brachytherapy.
Ayr
Two surgeons performing open radical prostatectomy, radical radiotherapy
and brachytherapy referred to Glasgow.
Dundee
One surgeon performing open radical prostatectomy; conformal external
beam radiotherapy - 54 Gray in 20 fractions (as at October 2006),
shortly to be increased to 55 Gray in 20 fractions; brachytherapy
referred to Edinburgh.
Edinburgh,
Borders and Dumfries
One surgeon performing open radical prostatectomy; radical radiotherapy
- external beam 55 gray in 20 fractions; brachytherapy; 2 surgeons
performing endoscopic radical prostatectomy (embryonic).
Fife
Two surgeons performing open radical prostatectomy; radical external
beam radiotherapy and brachytherapy referred to Edinburgh.
Forth
Valley
Two surgeons performing radical prostatectomy; radiotherapy and
brachytherapy referred to Glasgow and Edinburgh.
Glasgow
(Beatson)
Two surgeons performing open radical prostatectomy; radical radiotherapy
74 gray in 37 fractions; brachytherapy available.
Intensity modulated radiotherapy introduced in November 2005.
Inverness
One surgeon performing open radical open prostatectomy, radical
external beam radiotherapy 55 gray in 20 fractions; brachytherapy
referred to Edinburgh.
Treatment
and the NHS
All treatments are available on the NHS. Some surgeons also practice
in the private sector. Some patients travel to England and Wales
for private treatment. The provision of services is reasonable.
Patients don't have to wait too long for surgery. With radiotherapy,
you start with hormone treatment so you have a run in. I don't think
there are major waits for brachytherapy in either of the centres.
The above information
was presented by Mr Alan McNeill, Consultant Urological Surgeon,
Western General Hospital, Edinburgh to the First Scotland Prostate
Cancer Forum held in Glasgow on the 2nd March 2006
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ABOUT OTHER TREATMENTS WHICH MAY BE AVAILABLE IN OTHER AREAS
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