Cryosurgery is a relatively new prostate cancer treatment. Also referred to as ‘Prostate Cryotherapy’ or cryoablation’, it is a minimal invasive surgery capable of using controlled freeze and thaw cycle to destroy the diseased/cancer cells.

Cryosurgery’s role in the Treatment of Prostate Cancer:

As cryosurgery is new and lacks survey records of survival, it is not used as often as radiation therapy for primary treatment. It is however effective in treating prostate cancer cases that are radio resistant and recur as a result. Some doctors believe that the use of freezing temperature rather than strong doses of radiation therapy is more effective for radiation resistant prostate cancer.

The Process:

Cryosurgery works with the freezing of cancer cells. This freezing helps in the formation crystals inside and around them. The freezing and thawing process destroys cancer cells through dehydration, drastic changes in pH levels or prevention of the flow of red blood cells. Subjecting the prostate gland to freezing temperatures, specifically negative 40 degree Celsius, also activates an anti-tumor response in the body. The anti-tumor response begins with the production of antibodies that work to eradicate the tumor.

History of Cryosurgery:

Cryablation which literally means “destruction of tissue by cold” dates back to the 19th century when mixtures of ice and salt were applied to the breast and cervix for the treatment of cancer. Modern Cryosurgery began in 1966 when doctors used liquid nitrogen in place of ice. A perineal incision was made through which an instrument called cryoprobe was placed. Liquid nitrogen was circulated through the probe to freeze the gland. In 1974 doctors started using a transperineal approach.

Today, 3rd generation needles are used more effectively through the guidance of the transrectal ultrasound. The use of argon and helium gas and cryoneedles help the doctors to carefully place and form an ice ball that will destroy the prostate cancer tissue.

Advantages and Disadvantages of Cryosurgery:

Cryosurgery is an effective primary treatment for those who are in the early stage of prostate cancer with low risk of tumor extension. It may be an excellent alternative for those patients who are not fit for prostatectomy. Cryosurgery may be used if EBRT fails and the cancerous cells are radio resistant. The patient experiences only minimal blood loss. The patient has to spend just a day or overnight stay in the hospital.

Chemotherapy is the use of certain drugs that act throughout the body to kill the rapidly dividing cells. As cancer cells are always more rapidly dividing than normal cells, chemotherapy kills cancer cells at a higher rate than normal cells.

Chemotherapy has two important properties to be aware of:

  • Chemotherapy is systemic. This means it works throughout the body and does not target specific area such as the prostate.
  • Chemotherapy is toxic. This means is causes all rapidly dividing cells in the body to die.

Therefore chemotherapy not only kills rapidly dividing cancer cells in the body but also kills the rapidly dividing normal cells.

Skin, hair follicles, bone marrow cells and cells of gastrointestinal tract are all normal cells that divide rapidly and are therefore affected by the chemotherapy. This is reason why patients undergoing chemotherapy lose their hair, have gastrointestinal issues such as nausea, vomiting and diarrhea and sometimes have low blood count.

When is chemotherapy used in prostate cancer?

Chemotherapy is not used often in prostate cancer. Rather it is the last option for treatment. However there are two sets of specific circumstances where it is employed.

  • Prostate cancer that has stopped responding to hormone therapy is said to be “hormone refractory”. Once the prostate cancer reaches this point, hormone therapy will have only minimal benefit in controlling the growth of prostate cancer cells. Therefore systemic therapy such as chemotherapy is used.
  • For advanced prostate cancer that has metastasized (spread) to other parts of the body distant from prostate gland.

Prostate cancer that has reached an advanced stage a has spread far from the prostate to other parts of the body and that which is not easily curable through other treatments like surgery, radiation and other standard treatment chemotherapy has be the last life saving option. In order to treat the cancer wherever it has spread in the body a systemic treatment such as chemotherapy is needed.

Disadvantages of Chemotherapy:

Chemotherapy has more disadvantages than advantages.  After each spell of treatment the patient becomes weaker as the whole system of the body is affected. Anemia, gastrointestinal ailments become a part of the patients life.  Patients who have reached such a stage of life where potency is not important but just want to live go for chemotherapy.

Prostate cancer can also be treated through radiation. The treatment is called as ‘Radiation Therapy’.

Radiation Therapy, also called X-ray therapy, uses high levels of radiation to kill prostate cancer cells or keep them from growing and dividing, while minimizing damage to healthy cells.

Radiation can be produced from a machine outside the body (external radiation) and directed right at the prostate or by putting radioactive elements known as radioisotopes through thin plastic tubes into the cancer infected area(internal radiation or brachytherapy).

Internal radiation therapy places radioactive implants directly into the tumor. These radioactive sources can be temporary (removed after the proper dose is reached) or permanent.

What happens while the treatment?

External radiation therapy requires regular sessions (generally five days a week) during a period of eight to nine weeks. During each treatment the therapist puts the patient in proper position on the treatment table and leaves the room and starts the treatment.

The patient is under constant observation during the treatment; cameras and intercom are in the treatment room so that the therapist can constantly watch and also hear the patient. The patient has to remain still and relaxed throughout the treatment and has to inform the therapist in case of any problem or discomfort.

The therapist has to keep coming into the room time to time to reposition the machine and the patient. The machine actually does not touch the patient and the patient feels nothing during the treatment. On completion of the treatment the therapist help’s the patient out of the treatment table.

The therapist has to take an X-ray or port film every week to verify that the patient is positioned accurately during the treatment as well as helps him to make sure that the radiation is delivered in the precise area.

After effect of treatment:

After the treatment small marks resembling freckles is marked by the therapist on the skin along the treatment area. The marks provide an outline of the treatment which has to be left untouched by the patient.

Will diet affect treatment?

Good nutrition is important for recovering from the side effects of radiation therapy. Eating well helps the body to heal fast and fight infections and it also gives a sense of well being. The best way is to consult a dietician who can help in framing a diet chart.

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system.

What causes prostate cancer?

Male hormone called androgen causes the growth of the prostate gland. There are several types of cells in the prostate gland and nearly all types of prostate cancer begin in the gland. As a result the gland starts growing in size and infection may spread to other parts of the body too. Invariable the gland increases in size because of large amount of hormone (androgen) secretion.

There are a number of ways to treat and prevent prostate cancer of which ‘Hormone therapy treatment’ is one. Hormone therapy also known as ‘androgen deprivation therapy’ is one of the primary treatment options for prostate cancer.

How does it work?

Androgen is produced at a much higher level in men. It is primarily produced in the testicles, but the adrenal gland situated at the top of the kidney also produces small amount of it. The basic principal behind this treatment is to block the production or effect of androgen in the body and thus slow the growth of the prostate cancer cells. Thus there are two groups of drugs that are administered to block the production of androgen in the testicles.

Luteinizing Hormone-Releasing Hormone (LHRH) Agonists and Antagonists

These two group of drugs work by blocking the hormones that cause the production of androgen. It also lowers the level of testosterone (the most well known androgen) in the body.

They are administered via implant under the skin or as injections. Common drugs in this category include ‘leuprolide, goserelin, triptorelin and abarelix’.

However these drugs are expensive and require frequent visit to the physician.

How can androgen be blocked from working in the body?

Anti- androgen medication also exists that do not block the production of the hormone but stops their function in the body. They are used while LHRH agonists and antagonists are being used. They are rarely used alone.

Anti-androgen blocks the function of androgens throughout the body regardless whether they are produced in the testicles or adrenal gland. They are usually given as pills that are to be taken every day.

Common medication in this category include ‘flutamide (Eulexin) and bicalutamide (Casodex)’

Due to the invention of hormone treatment most patients avoid surgery (Orchiectomy).

Fatigue is often confused with tiredness. A person can get over his tiredness after a good night’s sleep. On the other hand fatigue is a fall in energy level that cannot be regained even after sleep. It gets in the way of a person’s daily routine.

Cancer related fatigue is one of the side effects of cancer treatment. It comes suddenly after treatment and is often described as paralyzing.

What causes cancer related fatigue?

The exact reason is unknown. It may be related to the disease itself or treatment. The following cancer treatments are commonly associated with fatigue:

Chemotherapy:

Any chemotherapy drug may lead to fatigue, but it may be the side effect of drugs like ‘vincristine’ and ‘cisplatin’. The patient experiences fatigue even months after chemotherapy, but it varies with patient.

Radiation Therapy

Radiation therapy can cause fatigue that increases over time. This can last from three to four week and can continue for three months or a year after treatment.

Combination Therapy:

More than one kind of treatment at the same time may increase fatigue in the patient.

What other factors contribute to fatigue:

Several other factors could contribute to fatigue including:

  • Tumor cells competing for nutrients, often at the expense of normal cells.
  • Decreased nutrition from the side effects like nausea, vomiting, taste change, mouth sores etc. can cause fatigue.
  • Chemotherapy leads to anemia which provides the blood cell with less oxygen resulting in fatigue.
  • Medicines used to treat side effects like nausea, pain, depression and anxiety can cause fatigue.
  • Research show chronic or severe pain can lead to fatigue.
  • Stress worsens feelings of fatigue. Stress can result from dealing with the disease and the ‘unknowns’ as well as worrying about the daily task.
  • Fatigue may result when the patient is trying to maintain his daily routine and treatment together. Modifying daily routine can help conserve energy.
  • Depression and fatigue often go hand in hand. It may not be clear which started first. One way to sort this out would be to understand the depressed feelings and how they affect the patient’s life. If the patient is depressed all the time or was depressed before the treatment or diagnosis of cancer, he needs to be treated of depression first. This would help the doctor to do away with his fatigue.

A diabetic patient has increased levels of blood glucose due to lack of sufficient insulin production.

It is a very common disease that affects large number of people in general population.

A diabetic patient has to manage diabetes everyday and it leads to stress. Eventually it may contribute to depression in individuals.

As per recently concluded studies; Diabetes is linked with depression. The diabetic patients are more prone to depression as compared to normal individuals. Also, the severity of diabetic symptoms is more pronounced in depressed patients in comparison to normal diabetic patients.

How depression is related to diabetes?

It is still not clear if diabetes leads to depression or depression increases the possibility of diabetes.

Diabetes can cause worsening of the symptoms in depressed patients. It’s very challenging to manage diabetes on a daily level. Patient has to maintain strict dietary habits and take regular insulin injections/medications.

On other hand, depression cause profound effect on physical and mental health of patients. Thus, depression may lead to worsening of diabetic symptoms and also increases the risk of diabetes.

Depressed patients tend to feel sad and may overlook the restricted diet regimen or medications.

It puts them at risk of facing severe diabetic symptoms.

Diagnostic Tests for Depression in diabetic patients

Psychiatrists may perform complete physical examination of the depressed patients who have diabetes. Patient is asked various questions associated with his/her lifestyle and symptoms to ascertain the exact reason of depression.

  • Physical Assessment
  • Thorough evaluation of symptoms
  • Standardized questionnaires

Some tests are performed for ruling out other diseases.

  • Blood tests
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection

Signs and Symptoms of Depression in diabetic patients

  • Feeling of worthlessness, hopelessness or sadness
  • Difficulty in concentrating or making decisions
  • Feeling irritable or restlessness
  • Sleep disturbances
  • Loss of interest in activities that were once enjoyable
  • Increasing intake of alcohol, drugs, or tobacco
  • Getting tired frequently/Fatigue
  • Loss of appetite or increased appetite
  • Suicidal tendency

Treatment of depression in people who have cancer

The treatment of depression in diabetic patients is multi-fold in approach. In addition to standard treatment (Antidepressant medications and Psychotherapy); psychiatrists uses various other alternative therapies for obtaining the desired results.

Diabetic patients who are treated for depression find it easy to manage their diabetes. With the improvement in the symptoms of depression, patients experience elevated mood levels and better blood glucose control.

There is wide range of antidepressants available in the market. Psychiatrist needs to select the antidepressant cautiously as many antidepressants cause various side effects.

Depending on the condition of the patient, doctors choose antidepressant with maximum benefits and minimum side effects.

Common Treatment Therapies

  • Medications like antidepressants and antipsychotic medication

Selective serotonin reuptake inhibitor (SSRI)

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Tricyclics

Monoamine oxidase inhibitors (MAOIs)

Paroxetine

Mirtazapine

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy
  • Physical exercise
  • Support from families/friends

o wonder even the thought of having cancer can make you depressed. Cancer is a really a life threatening disease. However there is no proof that cancer can lead to depression or vice versa.

Although there is no direct link between depression and cancer, the patients diagnosed with cancer experience high level of stress or sadness. Eventually these feelings result in depression.

Effect of Depression on Cancer

Depression can affect the treatment of cancer in patients who have cancer. Patients find it difficult to take active part in treatment as they are depressed and have negative feelings.

It is essential to treat depression in cancerous patients as it can generate more positive results.

Diagnostic Tests for Depression in patients who have cancer

The diagnosis of the depression in patients who have cancer is performed by trained and well qualified psychiatrists.

Doctors usually perform complete physical examination of the depressed patients who have cancer.  Patient is asked several questions associated with medical history and symptoms.

  • Physical Assessment
  • Thorough evaluation of symptoms
  • Standardized questionnaires
  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection

Signs and Symptoms of Depression in patients who have cancer

  • Feeling of sadness
  • Mood Disorders
  • Difficulty in concentrating
  • Difficulty in making decisions
  • Feeling of worthlessness, hopelessness
  • Feeling irritable or restlessness
  • Loss of interest in activities that were once pleasurable
  • Feeling tired frequently
  • Loss of memory
  • Loss of appetite
  • Suicidal tendency

Treatment of depression in people who have cancer

Psychiatrists need to treat depression in cancer patients after careful evaluation. As some of the antidepressants cause various side effects so doctors need to find the drugs that produces maximum benefits with least side effects in patients.

There are various therapies used by psychiatrists for treating depression in cancer patients.

  • Medications like antidepressants and antipsychotic medication

Selective serotonin reuptake inhibitor (SSRI)

Serotonin and norepinephrine reuptake inhibitor (SNRI)

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy that inculcates the positive attitude and behaviours in the patients
  • Physical exercise
  • Support from families/friends

Other therapies for treating depression in cancer patients

  • Psycho education where patients are made to understand their illness and ways of its treatment
  • Stress management training that involves training the patients to cope up with various stressful situations
  • Problem-solving therapy that assist in identifying the problems and learning ways for solving them.
  •  Support group where patients can express their emotions freely
  • Coping Skills for taking care of depression and cancer treatment

Common Tips for treating depression in cancer patients

  • Maintain strict regimen of taking medications
  • Maintain proper sleeping habits
  • Get engage in socialising activities
  • Take interest in pleasurable activities
  • Exercise regularly and remain physical active
  • Minimize use of alcohol and other illegal drugs
  • Eating healthy foods
  • Express feelings to close friends and family
  • Quit smoking

Treatment resistant depression is usually treated by performing electroconvulsive therapy (ECT) in patients with severe depression. However there are certain side effects associated with electric shocks in ECT.

Magnetic Seizure Therapy is an electrical brain stimulation therapy that has emerged as a safer alternative to ECT.

During MST, the seizures are induced by using magnetic fields instead of using electric shocks as in ECT. It involves rapidly alternating strong magnetic fields that allows greater control of intra-cerebral current intensity.

Studies done with MST have proved that it is an effective anti depressive treatment without any side effects. Moreover it promises faster recovery of orientation than ECT.

Magnetic Seizure Therapy Procedure

The magnetic seizure therapy is performed in similar manner as regular ECT treatment. It is a relatively a safe procedure where Magnetic seizures are elicited under general anaesthesia.

  • Patient is administered with general anaesthesia before the procedure
  • During anaesthesia, patient is oxygenated with 100 % oxygen
  • Therapist assess the motor activity of the right foot for tracking the duration of motor seizures
  • An EEG device is used for obtaining the bilateral frontal-mastoid EEG recordings.
  • A magnetic stimulator is used for delivering the treatments by employing highly efficient “Twin Coil”
  • Parameters of stimulation are as follows

Stimulation repetition rate: 100 pps

Number of pulses: 100-600 (duration 1-6s)

Stimulation amplitude: 100%

Patients are administered with two MST sessions every week. MST has proven to offer better acute side effect profile than ECT.

The magnetic fields induced by MST reaches the targeted areas of brain without any hindrance. Moreover, it allows better seizure initiation and improved control over the site of stimulation than ECT.

MST was introduced for minimizing the cognitive side effects of ECT. MST does so by inducing more focal seizure in the area of prefrontal cortex.

Thus, it is more effective in inducing seizures in targeted area without involving other region of brain including hippocampus and deep brain structures.

You are what you think. Your thoughts have the power to make you happy even in worst of situations. Also, you may have everything and yet you can be sad if your thoughts are negative.

Psychiatrists use the power of thoughts to treat the symptoms of depression and other mental disorders in patients. This therapy which elevates the mood of the person by encouraging healthier ways of thinking is called as Cognitive Behavioural Therapy (CBT).

Cognitive Behavioural Therapy is being widely used as an effective treatment for depression. Patients are taught to recognize negative patterns of thought and eventually replace them with positive and happy thoughts.

CBT leads to changes in patient’s behaviour that stem from dysfunctional thinking. By making changes in pattern of thought and behaviour of patients, CBT aims to improve symptoms of depression.

Strategies of CBT

  • Socratic questioning
  • Role playing
  • Imagery
  • Guided discovery
  • Behavioural experiments

Indications of CBT

As per the researchers, CBT is as effective as antidepressants in treatment of mild and moderate cases of depression.

  • Individuals with mild or moderate depression can be treated by stand along CBT without even taking medication
  • Individuals with major depression are treated with combination of antidepressants and CBT
  • In adolescents who have mild and moderate depression
  • In patients who experience frequent relapses after treatment
  • In patients who are responding partially to medications for depression

Salient Features of Cognitive Behavioural Therapy (CBT)

  • CBT focuses on two primary tasks including Cognitive restructuring and Behavioural activation.
  • Cognitive restructuring involves one to one sessions between therapist and patient for changing thinking patterns
  • Behavioural activation that teaches patients to participate in pleasurable activities by overcoming negative thoughts
  • CBT is a time bound therapy that lasts for a time period of 14 to 16 weeks.
  • During CBT, psychiatrists try to analyse the pattern of patient’s thoughts with stress on what and how a person thinks at the moment rather than why a patient thinks that way.
  • The problems related to the patient’s behaviour and thinking are identified, prioritized, and analysed during CBT sessions. The specific problems of the patient are addressed in individual or group sessions.
  • The CBT sessions are goal oriented with short as well as long term goals are defined before the sessions. Some of the long term goals may take weeks to months to achieve.
  • CBT is found to be very effective in patients who are motivated and have ability for introspection
  • The therapist who conducts CBT, uses structured learning experiences for educating patients to monitor and ward off their negative thoughts. The patients learn to identify how negative thoughts affect their behaviour and physical condition.
  • CBT teaches the patients important coping skills for facing the stressful life events, solving their problems and scheduling pleasurable experiences.
  • During the CBT session, patients are encouraged to take active part in their learning.  They are also given homework assignments that are even graded and reviewed.

Changes in the brain chemistry can be achieved by passing electricity through brain. This phenomenon is known as Electroconvulsive therapy. When electric currents are passed through the patient’s brain, it triggers a brief seizure resulting in changes in brain chemistry.

Electroconvulsive therapy is widely practised in treating severe cases of depression as it can immediately reverse symptoms of depression. It is usually administered in those depressed patients who do not respond to other treatments.

Contrary to stigma associated with electroconvulsive therapy (when high dosage of electricity resulted in serious side effects such as memory loss, fractured bones, etc); Electroconvulsive therapy is a very safe procedure nowadays.

Electroconvulsive therapy is performed in a controlled setting that achieves maximum benefits with minimum side effects.

Common Usages of Electroconvulsive therapy (ECT)

  • Electroconvulsive Therapy offers considerable improvements in severe symptoms of mental disorders and that too immediately.
  • Used as an effective treatment therapy in patients who have suicidal tendency or episode of severe mania
  • Used in cases of severe depression with symptoms like psychosis, refusal to eat or desire to commit suicide
  • Recommend in treatment-resistant depression where patients with long-term depression do not respond to other medications or treatments
  • For treating schizophrenia, specifically if accompanied by psychosis or tendency to commit suicide or hurt others
  • For treatment of severe mania episode of bipolar disorder including state of hyperactivity, intense euphoria or agitation
  • Treatment of mania characterised by impulsive or risky behaviour, substance abuse or impaired decision making
  • Treatment of catatonia marked by lack of movement, lack of speech or strange movements

Moreover, Electroconvulsive therapy is used as last-resort treatment for following conditions.

  • Treatment-resistant obsessive compulsive disorder
  • Severe obsessive compulsive disorder
  • Parkinson’s disease
  • Epilepsy
  • Conditions that cause movement problems or seizures
  • Tourette syndrome that doesn’t respond to other medications

ECT is recommended by psychiatrists in cases where patients do not respond to other treatment or medications.

Risks associated with ECT

Although ECT is a safe procedure that is performed in a controlled setting; there are few risks and side effects associated with it.

Memory loss: ECT can lead to drastic changes on the memory of treated patients. Patient may find it difficult to recollect events that occurred before the beginning of treatment (retrograde amnesia).

However, patient may show improvement in memory symptoms within few months after the treatment.

Physical side effects: Patient may suffer from headache, jaw pain, nausea, vomiting, muscle ache or other mild physical symptoms that can be treated with medications.

Medical complications: Patients may report medical complications in some cases like changes in heart rate, blood pressure and other heart conditions.

Confusion: Some patients may report state of confusion after the ECT treatment that may last for

few minutes to even several hours.

Results of ECT

The exact mechanism of ECT action is not known so it cannot be ascertained how ECT treats

patients with severe depression and other mental disorders. However, ECT is supposed to cause changes in chemical aspects of brain function resulting in reduced depression symptoms.

  • Symptomatic Improvement after two or three treatments
  • Full improvement in symptoms may take longer