MEN'S HEALTH MATTERS:Along with surgery, radiation therapy is one of the main curative options for men with prostate cancer, writes Thomas Lynch.
Q I am 65 years old and have recently been diagnosed with prostate cancer. I have been advised that radiotherapy is the best treatment for my particular cancer. What does this treatment entail?
A Radiation therapy is one of the most effective means of treating many forms of cancer. It relies on the fact that cancer cells in the body are more susceptible than normal body cells to the damaging effects of ionizing radiation. This property of cancer cells allows them in many cases to be effectively eliminated. Prostate cancer is one such cancer, and the cure rates with radiation are very high. It can be administered in two ways: external beam (EB) radiation, and brachytherapy (BT).
EB is administered as an outpatient, over approximately a two-month course. It takes 10-15 minutes per day, five days per week, over seven to eight weeks.
BT refers to the direct insertion (single-day treatment) of radioactive sources into the prostate gland itself, to treat the prostate cancer. The sources can be temporarily implanted or, more commonly, permanently implanted. The latter is often called 'prostate seed implantation'. This is a minimally invasive procedure, performed under general or spinal anaesthesia.
Whatever way the radiation is administered temporary symptoms may be present during and after the treatment. These symptoms include fatigue, and a short-term effect on urination and bowel function. These usually resolve within three to six months and rarely persist into the long term. Along with surgery, radiation therapy is one of the main curative options for men with localised prostate cancer. It can also be a highly effective way of treating men in the later stages of this disease.
Q I am 34 years of age and have a tight foreskin, which is giving me some trouble. My GP has advised that I may need a circumcision but a friend of mine mentioned that there are alternative surgical procedures.
A A circumcision is the most definitive treatment for a tight foreskin and is the procedure of choice where there is evidence of scarring or infection of the foreskin. It is often thought that it is an operation performed only in children but it is also commonly performed in adults. This operation involves removal of the foreskin or loose sleeve of skin covering the end of the penis so as to permanently expose the glans (head) and can be performed with either a general or local anaesthetic.
Alternatives to a formal circumcision are possible in selected cases if you want to preserve your foreskin. A frenuloplasty involves the division of the frenulum (under surface of the foreskin) without any removal of foreskin. To recommend this the foreskin must be fully retractile without any evidence of inflammation.
A partial circumcision involves the removal of the constricting skin. Many men who opt for this are dissatisfied with the amount of redundant foreskin remaining and often opt for a full circumcision at a later date.
A dorsal slit (ie, cutting a slit along the top of the foreskin) is sometimes suggested. If the slit is kept short then similar problems to partial circumcision may be encountered.
A preputioplasty may be effective in some cases of phimosis when there are no other problems with the foreskin evident such as inflammation.
This consists of dividing any glandular adhesions (areas where the foreskin is adherent to the glans penis) and making a short slit longitudinally on the tight foreskin and then re-stitching the edges transversely. A small T-shaped scar remains on the tip of the foreskin and, like all scars, is less elastic than the surrounding skin but the opening in the end of the foreskin is enlarged slightly.
If you are keen to preserve your foreskin, it is very important to discuss these issues with your surgeon before you make any decision.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with contributions from Frank Sullivan, consultant radiation oncologist, University College Hospital, Galway and Richard Power, consultant urological surgeon, Beaumont Hospital, Dublin.
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