Can I Have Radiation First And Then Surgery
With 3D conformal radiotherapy, intensity modulated radiation therapy , and brachytherapy, local tissue damage is often kept at a minimum, and surgeons at some of the larger cancer centers have been seeing improved results with salvage prostatectomy performed after radiation. But even under the best of circumstances, post-radiation surgery is a very difficult operation to perform, and few surgeons across the country perform it regularly.
What Happens To The Prostate After Radiation
The entire prostate gland is radiated when we treat the cancer. The prostate normally produces some of the fluid in the ejaculation. Radiation therapy has the side effect of damaging the glands in the prostate, so a lot less fluid is produced. The ejaculation may be dry or nearly dry. In addition, you will probably be sterile after radiation, but this is not 100% guaranteed and should not be relied upon as a form of birth control. You can still usually have erections because the nerves and blood vessels that go to the penis are not as damaged as the prostate gland.
The prostate gland will end up having a lot of scar tissue. It will shrink in size to about half its original weight within a couple years after finishing radiation. The urethra passes through the canter of the prostate gland like the hole of a doughnut. Sometimes this passage can widen, other times it can shrink after radiation. In summary, the prostate gland is heavily damaged from radiation and does not work normally afterwards.
Percentage Of Men Obtaining Full Erections 2 Years After Open Prostatectomy
As one can see, the chance of regaining potency diminishes with age and with the number of nerves damaged. Even though it is usually technically possible to spare the nerves, sometimes the nerves themselves are cancerous and must be removed since the primary goal of the surgeon is to remove the prostate cancer. If the cancer has not reached the nerves controlling erection, the da Vinci Robot has the visual capabilities and the precision necessary to spare these nerves in most cases, thus it is possible that using the robot may add to the chances of being potent after surgery. However, there is no way to guarantee this due to variability in patient anatomy and condition. It is important to realize that some men never regain the ability to maintain an erection after robotic prostatectomy.
As mentioned above, medical therapy may aid in return to erections, but this has not as of yet been fully substantiated. Usage of sildenafil and newer erectile medications may potentially increase the potency percentages in the table above but this has not been proven. A recently presented study found that daily doses of 50mg or 100mg sildenafil for 9 months increased full erections by 7 fold when compared with a group who did not receive any medication.
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What Happens Between Appointments
Contact your doctor or nurse if you have any concerns or get any new symptoms or side effects between your follow-up appointments.
Its important to speak to them if youre concerned about anything dont worry about them being too busy.
You can get support or advice over the telephone, or they might bring forward the date of your nextfollow-up appointment.
How Long Does It Take For Nerves To Heal After Prostatectomy
How long does nerve regeneration take? Recovery of potency may be very rapid in younger patients and is sometimes immediate. However, for most patients the recovery is gradual and can take up to 3 years to plateau, although typically a patient sees a return to erectile function after about 12 months .
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Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
Doctor Visits And Tests
Your doctor visits will usually include PSA blood tests, possibly with digital rectal exams if your prostate hasnt been removed. These will probably begin within a few months of finishing treatment. How often you need follow-up visits and tests might depend to some extent on the stage of your cancer and the chance of it coming back. Most doctors recommend PSA tests about every 6 months or so for the first 5 years after treatment, and at least yearly after that. Bone scans or other imaging tests might also be done, depending on your medical situation and symptoms.
Prostate cancer can recur even many years after treatment, which is why its important to keep regular doctor visits and report any new symptoms .
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Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery
Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.
Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.
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Can I Lower My Risk Of Getting A Second Cancer
There are steps you can take to lower your risk and stay as healthy as possible. For example, prostate cancer survivors should do their best to stay away from all tobacco products and tobacco smoke. Smoking can increase the risk of bladder cancer, as well as increase the risk of many other cancers.
To help maintain good health, prostate cancer survivors should also:
- Get to and stay at a healthy weight
- Keep physically active and limit the time you spend sitting or lying down
- Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
- Not drink alcohol. If you do drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some other health problems.
See Second Cancers in Adults to learn a lot more about the causes of second cancers.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Bostrom PJ, Soloway MS. Secondary cancer after radiotherapy for prostate cancer: Should we be more aware of the risk? Eur Urol. 2007 52:973-982.
Moon K, Stukenborg GJ, Keim J, Theodorescu D. Cancer incidence after localized therapy for prostate cancer. Cancer. 2006 107:991-998.
Last Revised: June 9, 2020
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What Does Rising Psa Mean
When the PSA is rising or cancer spreading despite a low level of testosterone, prostate cancer is called castration-resistant, or hormone-refractory. Despite this name, some hormonal therapies may still work. But prostate cancer in this setting will inevitably progress and become more aggressive and resistant, and you should be prepared to discuss more aggressive treatment strategies with your doctor. This is the time when a medical oncologist, if not already involved in your care, gets involved. These doctors specialize in systemic treatments for prostate cancer, which is useful at this time given that your disease is typically systemic, meaning that it is not confined to only one location. Cancer cells in this situation have typically spread through the blood stream or lymphatics to other places in the body, and localized treatments are rarely helpful except in circumstances where urination becomes difficult. You should talk to your doctor about these systemic therapies, when to start chemotherapy, and clinical trials that may be available.
Castration Resistant Or Hormone
Treatment of prostate cancer with ADT may control the growth of the cancer for several years. Eventually, however, most prostate cancers stop responding to ADT and begin to grow again. Cancers that grow in spite of ADT are called hormone-refractory and if widespread are referred to as metastatic castration resistant prostate cancer . Treatment options for CRPC may include additional ADT, precision cancer medicines, chemotherapy, immunotherapy or local radiation therapy for the purpose of alleviating symptoms, or participation in clinical studies evaluating new treatments. The choice of treatment is influenced by the types of previous therapy received, the overall health of the individual and the goals of therapy.
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Ed And Prostate Surgery
The most common side effect of prostate surgery is erectile dysfunction : research has shown that as many as 85% of men whove had radical prostatectomy have problems with erections following the surgery .
There are two tiny nerve bundles running along the side of the prostate that control erections. For some men, their surgeon may be able to use a nerve-sparing approach during the procedure to avoid injuring these nerves. But for some people with cancer that has grown very close to these nerves, a nerve-sparing approach isnt an option. If both of these nerves have to be cut, you will no longer be able to have spontaneous erections. But some men are able to have erections again with the help of certain treatment strategies . If you only have to have the nerves on one side of the prostate removed, you may still be able to get spontaneous erections, but its less likely than if neither nerve bundle was cut .
Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
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Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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How Common Is Recurrence Of Prostate Cancer
According to the American Cancer Society, nearly 100% of men with low- to intermediate-grade prostate cancer can expect to live at least five years after the initial diagnosis. Since many men who get prostate cancer are already elderly, they are more likely to die from causes other than the cancer.
More than 90% of the time prostate cancer is discovered while it is either confined to the prostate gland or has spread beyond the prostate only to a small degree, referred to as regional spread.
Among the less than 10% of men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis, about 30% are expected to survive at least five years.
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When To Call Your Doctor Or Nurse
Its important to tell your doctor or nurse if:
- your bladder feels full or your catheter isnt draining urine
- your catheter leaks or falls out
- your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
- your wound area or the tip of your penis becomes red, swollen or painful
- you have a fever
- you feel sick or vomit
- you get cramps in your stomach area that will not go away
- you get pain or swelling in the muscles in your lower legs.
Your doctor or nurse will let you know if you should go to the hospital.
On Sex After Prostate Surgery Confusing Data
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For men having prostate cancer surgery, one of the biggest fears is that they will be left impotent. Unfortunately, the research that might help address that question is likely only to confuse.
A notable study in 2005 showed that a year after surgery, 97 percent of patients were able to achieve an erection adequate for intercourse. But last month, researchers from George Washington University and New York University reviewed interim data from their own study showing that fewer than half of the men who had surgery felt their sex lives had returned to normal within a year.
So which of the studies is right? Surprisingly, they both are.
The results depend on several crucial variables the type of patient studied, sex life before surgery and, most important, the definitions doctors use to define potency.
Of the 219,000 men a year who receive diagnoses of prostate cancer, nearly half undergo surgical removal of the gland, according to the National Cancer Institute. Most top surgeons report that an overwhelming majority of their patients can achieve erections adequate for intercourse after the operation.
Under that definition, a man who had regular sex after surgery, a man who managed to have sex only once and a man who struggled mightily each time he had sex would all be considered success stories.
Although he could cite statistics to give men a more hopeful view, he said that did not help the patient.
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What Happens If Prostate Cancer Comes Back
The prostate is a small gland about the size of a walnut that helps make seminal fluid. Its intertwined with your urinary tract system, resting below your bladder and surrounding the urethra. As you age, this gland continues to grow, sometimes resulting in benign prostatic hyperplasia. While this growth is normal, cancerous growth is not. Cancer occurs when the cells in your prostate gland begin to grow out of control.
While prostate cancer is common, especially among older men, its got a fairly positive outcome. When caught early and treated, most men survive and continue on with remission after five years. Unfortunately, for a small percentage of men, the cancer returns. To give you some clarity on this situation, heres what happens if prostate cancer comes back.
Common Side Effects Of Turp
Common side effects after surgery include:
- bleeding after the operation this usually reduces over time and should stop after four weeks
- retrograde ejaculation most men are able to have erections and orgasms after surgery to treat an enlarged prostate. However, they may not ejaculate because the bladder neck is removed along with prostate tissue. This causes the ejaculate to collect with urine and pass out of the body in the next urination.
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Studies Of Prostate Cancer Recurrence
At the University of California, San Francisco, investigators reported that 15 percent of 1,439 men who underwent prostatectomy experienced recurrence. Prostate cancer recurrence was defined as:
- a PSA level of 0.2 ng/mL or greater on two consecutive tests, or
- the patient needed a second cancer treatment at least six months after surgery
Anotherstudy extended that 15 percent figure to 40 percent, noting that this was the number of men who will experience prostate cancer recurrence within 5 years.
If you want to improve your chances of survival after prostatectomy, a course of radiation therapy may be in order, as already mentioned. The potential benefit of radiation therapy after prostate removal was explored in a study published in the Journal of the American Medical Association.The researchers evaluated 635 men who had a prostatectomy between 1982 and 2004 and then followed up through 2007, evaluating the number of men who had a recurrence of prostate cancer and received no treatment , radiation treatment , or radiation plus hormone therapy .
At a median of six years after prostate cancer recurrence and nine years post prostatectomy, a total of 116 men had died of prostate cancer. They included the following:
- 89 men who were not treated after cancer recurrence
- 18 men who underwent radiation treatment only
- 9 men who received both radiation and hormone therapy
Also notable in this study are the following findings: