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PROSTATIC DISEASES - PART 9

(2) tuyến tiền liệt cấp tiến: Được nhiều người để tạo thành điều trị tiêu chuẩn vàng, triệt để tuyến tiền liệt liên quan đến việc loại bỏ toàn bộ tuyến tiền liệt, hoặc retropubically, perineally hoặc laparoscopically (135). Cung cấp tất cả các mô ung thư được cắt bỏ (tức là tất cả lợi nhuận phẫu thuật, | TREATMENT OPTIONS Figure 134 Possible chemopreventative action against dutasteride prostate cancer by the dual 5a-reductase inhibitor 2 Radical prostatectomy Considered by many to constitute the gold standard treatment radical prostatectomy involves the removal of the entire prostate either retropubically perineally or laparoscopically Figure 135 . Provided that all cancer tissue is excised i.e. all surgical margins seminal vesicles and lymph nodes are clear then life expectancy is equivalent to that of an age-matched individual who has never suffered cancer. Side-effects include a low risk 2-3 of stress incontinence but a higher 50 risk of erectile dysfunction even when nerve-sparing techniques are employed. However both these problems improve with time and can now be treated reasonably effectively. Provided that the entire prostate including all cancer has been excised the serum PSA will fall to 0.1ng ml postoperatively. This facilitates follow-up and permits early identification of tumor recurrence. Recently laparoscopic radical prostatectomy has been developed Figure 136 with reduced bleeding and shorter hospital stay. Robotic assistance is claimed to enhance potency and continence results76 Figure 137 . 3 External beam radiotherapy External beam radiotherapy EBRT can provide an effective form of therapy for early prostate cancer. Results have been enhanced by the use of neoadjuvant androgen ablation usually with a LHRH analog such as Eligard leuprolide acetate for injectable suspension 77. Sideeffects include proctitis and rectal bleeding due to inclusion of the anterior rectal wall in the treatment field. These can be reduced by the use of conformal technology which focuses treatment more accurately on the prostate. 4 Brachytherapy Brachytherapy involves the transperineal implantation of radioactive seeds into the prostate under light anesthesia Figure 138 . Swelling of the gland in response may cause a worsening of lower urinary tract symptoms for some time.