What Can Be Done
If your prostate cancer has recurred, your doctor will likely order some imaging tests to better determine where in your body the cancer has returned. Bone scans, CT scans, and MRIs are the most common tests ordered to find where in the body prostate cancer has recurred.
Many treatment options are available for prostate cancer that has returned. The one that you and your physician choose depends on individual factors such as what treatment you have already received, where in the body your prostate cancer has returned, how your cancer has spread, your general health, and your age.
If your prostate cancer is thought to have recurred in only a small area and has not spread to other areas of the body, then radiation therapy to that area may be an option.
If your prostate cancer has most likely spread to multiple areas of the body, then hormonal therapy would likely be an option. Chemotherapy can also be used when the cancer has spread to multiple sites.
Geller J. Basis for Hormonal Management of Advanced Prostate Cancer. Cancer. 1993 Feb 1;71:1039-45.
Kupelian PA, Buchsbaum JC, Elshaikh M, et al. Factors Affecting Recurrence Rates After Prostatectomy or Radiotherapy in Localized Prostate Carcinoma Patients With Biopsy Gleason Score 8 or Above. Cancer. 2002 Dec 1;95:2302-7.
Vickers AJ, Bianco FJ Jr, Boorjian S, et al. Does a Delay Between Diagnosis and Radical Prostatectomy Increase the Risk of Disease Recurrence? Cancer. 2006 Feb 1;106:576-80.
Prostate Specific Antigen Blood Tests
- Have a PSA blood test done at the following times:
- 6 to 8 weeks after surgery
- 3 to 6 months after surgery
- 12 months after surgery
If you can, have your PSA blood test done at a MSK location. If you cant have it done at a MSK location, you can go to a medical office closer to where you live. Have the results faxed to your MSK doctors office.
MSK doctor: ___________________________
Treatment Of Rising Psa
If PSA levels are rising slowly or by a small amount, a person may not need treatment. A doctor usually considers an individuals overall health, medical history, and age when giving advice on treatment.
Doctors often use active surveillance if PSA levels are rising. Active surveillance is a series of regular tests and health checks, with treatment only if necessary. Prostate cancer often progresses very slowly, so it may be many years before a person needs treatment.
If a person has had a prostatectomy, a doctor may also recommend radiation therapy, which kills cancer cells using high-energy particles.
Radiation therapy is not suitable for everyone who has had a prostatectomy. If a person had radiation therapy before surgery, they cannot usually have this treatment again. Having radiation therapy a second time can cause side effects.
Doctors may also use hormone therapy to shrink a persons tumors. This can make other treatments such as radiation therapy more effective.
It is not always possible to prevent PSA levels from rising. The best way to safeguard health after having a prostatectomy is by undergoing regular medical checks.
- stopping smoking or using tobacco products
- exercising regularly
- eating a healthful diet, with plenty of fruits and vegetables
- limiting alcohol intake to a moderate amount
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What Are The Side Effects Of Cryotherapy
Most men have blood in their urine for a day or two after the procedure, as well as soreness in the area where the needles were placed. Other side effects may include loss of urinary control, injury to the rectum and loss of sexual function. Freezing damages nerves near the prostate and causes impotence in up to four out of five men who have cryosurgery. Erectile dysfunction is more common after cryosurgery than after radical prostatectomy.
The freezing may also affect the bladder and intestines, which can lead to pain, burning sensations, and the need to empty the bladder and bowels often. Most men recover normal bowel and bladder function over time.
The side effects from cryosurgery tend to be worse when treatment is done in men who already had radiation therapy, as opposed to men who have it as the first form of treatment.
Cancer Treatments And Erectile Dysfunction
Following surgery, many men experience erectile dysfunction , but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy;may reduce the chances of nerve damage. Another factor is the surgeons skill level for performing the nerve-sparing technique, which if done correctly, may improve patients likelihood of retaining erectile function, says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapybrachytherapy, external beam radiation;or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
When you compare surgery with radiation, both may affect erections, says Dr. Shelfo. Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over timemonths or, sometimes, yearssexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.
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Enlarged Prostate Surgery: The Real Risks And Side Effects
Enlarged prostate surgery unfortunately has real risks and side effects that are often downplayed or minimized by urologists making you the guinea pig with very possible impotence and incontinence as a result.
Furthermore, you will often have to repeat the operation later on as your prostate continues to grow because the real causes of this prostate disease have not been addressed by radical surgeries.
Also known as a TURP surgery or BPH surgery, this is the gold standard of prostate surgeries for enlarged prostate symptoms.
TURP stands for Transurethral Resection of the Prostate. The surgery consists of passing a flexible instrument up your penis and into the prostate gland to shave off pieces of the prostate.
The bloody pieces are removed allowing more space for the urethra tube to pass urine from your bladder.
The operation is done under anesthesiaâ¦ and you will usually spend a couple of days recovering. You will have to wear a catheter for some time while you heal, and then it can be removed.
It would be great if that was all there was to it. Yet, itâs not so simpleâ¦
Is There A Role For Intra
Intraoperative frozen section biopsy has been recommended in radical prostatectomy. The problem with most +SMs is that they are microscopic and hence the surgeon has no real feeling or worry of the presence of a +SM. Most surgeons will check a frozen section if they are concerned or unsure of how the tissue looks or feels. In this case the abnormal tissue is usually obvious. So if the surgeon is concerned that there maybe residual tissue or cancer the frozen section is very useful in converting a possible +SM to a SM . However, routine use of frozen section on all cases to be sure of getting negative margins although enticing has not fulfilled its dream.
Figure 3a. Reported rates of percent pT2 +SM rates in robotic-assisted prostatectomy for the years 2003-2007.
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Immediately After A Prostatectomy
- You will stay in hospital for two to five days.
- Nurses will monitor your vital signs.
- Your pain will be managed with medication.
- You may be given antibiotics to reduce the risk of infection.
- You may have a drip inserted into your arm or hand for a few days.
- You will most likely have a drain tube out of your abdomen that will be removed in the first day or two after the surgery.
- You will be fitted with a small tube in your penis. The catheter drains urine into an attached bottle or bag. This catheter will be removed about one to three weeks after the operation. Your surgeon will tell you when it can be removed.
- In most cases, you will have to go home still wearing the catheter. You will be taught how to care for it.
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What Is Hormone Therapy For Prostate Cancer
Androgen deprivation therapy is a key treatment strategy for prostate cancer that has recurred following local treatment. The goal of all hormone therapies is to stop the production and/or interfere with the effects of testosterone, which fuels the growth of prostate cancer cells. However, because not all prostate cancer cells are sensitive to increases or decreases in testosterone levels, hormone therapy is a treatment for prostate cancer but does not cure the disease. The decision on starting testosterone lowering or blocking therapies is individualized, based on your PSA, the PSA doubling time, whether the cancer has spread visibly or caused symptoms, and the potential risks involved with this type of therapy.
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Changes In The Prostate As You Age
Since the prostate gland tends to become bigger as you age, it might crush the urethra and cause issues in passing urine. At times, men in their 30s and 40s may start to have these urinary manifestations and need medical consideration. For other people, indications are not observable until much later in life. A tumor or an infection can likewise make the prostate bigger. Make sure to inform your doctor if you have any urinary issues listed below.
- Fewer urine flows
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What Are The Types Of Radiation Therapy Used For Prostate Cancer
Radiationtherapy for prostate cancer can be divided into two main categories.
Externalbeam radiation :Using a machine outside the body, beams of radiation are focused on theprostate gland. This can help relieve symptoms such as pain while limiting thedamage to the tissues surrounding the prostate.
The 4methods of external beam radiation are:
- Three-dimensional conformal radiation therapy
- Stereotactic body radiation therapy
- Proton beam radiation therapy
Brachytherapy:Small radioactive pellets are inserted into the prostate, each one about thesize of a grain of rice. About 100 pellets are used to limit the damage tosurrounding tissues and organs. Brachytherapy is most often used forearly-stage cases and is sometimes combined with EBRT. The pellets can eitherbe inserted for a couple of days for high dosages or a few months for lowdosage depending on the patients overall status.
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Getting Ready For Your Surgery
You and your care team will work together to get ready for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you arent sure.
- I take a blood thinner, such as:
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these complications, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling .
About sleep apnea
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device for sleep apnea, bring it with you the day of your surgery.
Ask about medications
Prostate Cancer Is Common But Treatable
Recently, there has been a movement within the urological community to not treat prostate cancer. Some cases of prostate cancer may never spread to other parts of the body, so treatment may be unnecessary. The benefits of radical surgery or radiation may not be worth the consequences if the cancer is not developing or moving.
The challenge is in knowing which cancers will not spread. No urologist knows when a prostate cancer should be treated. There is no definite signal that tells us that a prostate cancer has already spread. While PSA monitoring, repeated biopsies and MRI studies are of some benefit, the reality is that many patients, while be being watched can have their cancers spread so that a cure is no longer possible.
Another problem with observation or surveillance is that more than 1/3 of prostate cancers have more aggressive cell types or are more extensive than what is found from a biopsy. Not treating these larger or faster growing cancers increases the risk of cancer spread outside the prostate. This is called metastatic cancer and it is not curable.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT;can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006; 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021; 79:150158.
New Test Can Predict Return Of Prostate Cancer
3 Min Read
CHICAGO – A highly sensitive blood test may be able to predict whether prostate cancer is cured or is likely to come back, giving doctors an early sign of whether treatments are working, U.S. researchers said Wednesday.
They said the nanotechnology-based blood test is far more sensitive than currently available commercial tests for prostate-specific antigen, or PSA, a protein produced by cells in the prostate gland.
Our assay can detect PSA in blood samples 300 times better than the current standard PSA tests, Dr. Shad Thaxton of Northwestern Universitys Feinberg School of Medicine in Chicago said in a telephone interview.
The test is not intended for routine prostate cancer screening, but is meant to look for signs that prostate cancer has spread to other organs in patients who have had their prostate gland removed.
Through the technology, it appears we will be better at determining which patients are cured and which patients are destined for prostate cancer recurrence, said Thaxton, whose study was presented at the American Urological Association meeting in San Francisco.
It may allow physicians to act at the earliest and most sensitive time, which we know will provide the patient with the best chance of long-term survival, he said.
The new test takes advantage of some special properties of gold nanoparticles — which are 1,000 to 100,000 times smaller than the width of a human hair.
Editing by Xavier Briand
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Recurrence Outside The Prostate
If tests show the recurrence is outside the prostate, this means there apparently is no cancer within the prostate and therefore no reason to remove it. It also means that even if the prostate had been removed surgically, there would have been a recurrence.
When there is a recurrence outside the prostate, the most common treatment prescribed is hormonal therapy. There are several different hormones used, and each case is different. Hormones may be used individually or in combinations. They could be used continuously, or intermittently. Intermittent Hormonal Therapy is becoming more common for treating prostate cancer that has recurred after any form of treatment. Many, if not most, respond well to this treatment for extended periods of time.
Keeping Up With Appointments And Screenings
Attending your doctors appointments after youve entered remission is very important. If you need to skip an appointment, you should make another appointment as soon as possible.
Use these appointments as a time to discuss any concerns you may have with your doctor. Your doctor can also conduct tests to check for the cancers return during these appointments.
Two tests to detect recurrent prostate cancer include a digital rectal exam and a PSA blood test. During a DRE, your doctor will insert a finger into your rectum. If your doctor detects something unusual, theyll likely ask for additional follow-up tests. These tests may include bone scans and imaging studies, such as an ultrasound or MRI.
Men often experience side effects from their prostate cancer treatments. Some of these side effects may be immediate and temporary. Others may take several weeks or months to show up and never fully disappear.
Common side effects from prostate cancer treatment include:
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What Type Of Follow
If prostate cancer recurs, follow-up treatment depends on what treatment you have already had, the extent of your cancer, the site of recurrence, other illnesses, your age, and other aspects of your medical situation.
One possible treatment might include hormone therapy. Researchers are working on new drugs to block the effects of male hormones, which can cause prostate cancer to grow, and drugs to prevent prostate cancer growth.
Radiation therapy, ultrasound, extreme cold, electrical current, or medicines may be used to relieve symptoms of bone pain. Chemotherapy or other treatments being medically researched are also options.