Prostate Cancer Recurrence After Prostatectomy: Why Does It Happen And How Do We Treat It
Filed in Life After Treatment
The concept of prostate cancer recurrence after prostatectomy puzzles many patients. A frequently asked question is how can the cancer come back if the prostate has been removed? The explanation is that, as with any cancer, if cancerous cells migrate out of the organ in which they arose before the organ is removed , they can settle and grow elsewhere. These migrating cells are called metastases, secondary deposits or secondaries.
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists
We offer affordable appointment prices with or without insurance.;;We offer weekday, weekend, and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist and specialist in the treatment of urinary problems in men.; He is one of the few urologists who offers a full range of treatment options for BPH .; He specializes in all aspects of care for men with an enlarged prostate and urinary problems, including frequent urination at night, difficulty emptying the bladder, urinary urgency, and incontinence.; He has successfully treated thousands of men with urinary problems, including urinary retention, painful urination, and frequent urination.
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Prostate Size And Blockage Of The Urethra
If the inner part of the prostate gland obstructs the urethra during urination, this will irritate the bladder and cause urinary symptoms.Urinary symptoms may include:
- frequent urination, particularly at night
- urgency and possible urgency incontinence
- passing drops of urine involuntarily after you think you’ve finished
- blood in the urine although this can never be assumed to be due to the prostate until other causes have been excluded.
The actual size of the prostate does not appear to determine whether or not there is a blockage. Some men with large prostates never develop obstruction, but some men with small prostates can have severe bladder obstruction, which causes difficulty with urinating.Around one in three Victorian men over the age of 50 years have some urinary symptoms. In most cases, these symptoms are due to a blockage caused by an enlarged prostate, but they may be due to other causes.;
How Do You Know If Prostate Cancer Has Returned
The PSA level should be followed closely after initial treatment. If the PSA starts to rise again after it has gone down to zero or close to zero, this may signal that the prostate cancer has returned . It usually takes more than one elevated PSA test to determine that prostate cancer has returned .
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Home Care After Surgery
Removing extra prostate tissue should help you urinate more easily and less frequently. Still, it may take a few weeks for you to recover fully. Most men who have this surgery are back to their regular activities in six to eight weeks.
While you recover, you may have:
- an urgent need to urinate
- trouble controlling urination
- problems getting and keeping an erection
- small amounts of blood in your urine
These surgery side effects should subside in time. Tell your doctor if youre still having problems several weeks after surgery.
What Factors Determine The Likelihood Of Recurrence
Several signs can point to a prostate cancer that has come back or spread, including:
- Lymph node involvement. Men who have cancer cells in the lymph nodes in the pelvic region may be more likely to have a recurrence.
- Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
- Gleason score. The higher the grade, the greater the chance of recurrence. Your doctor can tell you your score when the biopsy results come back from the laboratory.
- Stage. The stage of a cancer is one of the most important factors for selecting treatment options, as well as for predicting future outlook of the cancer.
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How Effective Is Turp And What Consequences Can It Have
Studies have shown that TURP can permanently reduce prostate-related problems. Nine months after having TURP, about 75 out of 100 men only have mild symptoms. For example, at night they only need to get up to go to the bathroom once, or not at all. The other men usually still benefit from TURP, but the effect is smaller. Side effects are common, though.
The most common side effect of TURP is dry orgasm” or “dry climax” . This is where no semen, or much less than usual, leaves the penis during ejaculation. Instead, the semen flows into the bladder. This can happen if the muscles that normally close the entrance of the bladder during ejaculation are damaged during surgery. About 65 out of 100 men have this side effect after TURP.; Although dry orgasms arent harmful and usually dont affect mens sexual pleasure during orgasm, they do reduce .
Some men are afraid that they will have erection problems after surgery. Although there is no guarantee that this wont happen, research has shown that permanent erection problems are rare. Some men even feel more comfortable with their sexuality after surgery because they no longer have bothersome symptoms such as having to go to the bathroom a lot.
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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Do Laser Treatments Have Any Advantages Over Turp
As well as the standard approaches such as TURP, there are a number of other surgical techniques. They mainly differ in terms of the instruments and sources of energy used to remove or destroy the prostate tissue. Most of the other techniques are carried out using laser beams. Like in TURP, the instruments are inserted into the urethra and guided to the prostate.
The laser treatments include:
- Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995; 332: 75-79.
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Nerve Regeneration After Radical Prostatectomy
Filed in Life After Treatment
Nerve regeneration after radical prostatectomy usually does take some time, assuming that both nerve bundles around the prostate were able to be preserved by the surgeon. This is because the nerves and arteries that control erections need time to recover and heal. This article explains why this is the case, and what can be done to speed up the healing process.
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Other Surgical Procedures For Prostate Disease
Alternative surgical procedures to TURP include:
- open enucleative prostatectomy this involves making a cut in the abdomen to remove a very enlarged prostate. This is the least common form of surgery. The average hospital stay is seven to 10 days
- laser TURP a laser is used to remove prostate tissue from the middle part of the prostate, which has the advantage of less bleeding and therefore safer for people on anti-coagulation therapy for other problems, including coronary stents, heart valve or vascular disease
- transurethral incision of the prostate similar to TURP except that no prostate tissue is taken out. One to three cuts are made in the prostate near the bladder neck to release the ‘ring’ of enlarged tissue and make a larger opening around the urinary tract
- UroLift® this technique is useful for men for whom medication has not been successful but their prostates are not so enlarged that they need a TURP. It involves the transurethral insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.
Enlarged Prostate Surgical Procedures
Here is a list of enlarged prostate surgery procedures:
- TUIP widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
- TURP surgery is the procedure used for 90% of all prostate surgeries for BPHit is the standard operation.
With TURP, an instrument called a resectoscope is inserted through the penis to remove the excess tissue. It is less traumatic than open forms of surgery.
It has a high risk of retrograde ejaculation, which is when semen works its way back into the bladder instead of coming out the tip of the penis when you come.
Other risks: impotence, incontinence, blood loss, and urinary tract infection. This procedure is now available using lasers.
- Simple or Partial Prostatectomy is the removal of the inner portion of the prostate through an incision in the lower abdomen. This is an invasive surgery used for very large prostate glands to remove the enlarged part of the prostate.
This BPH surgery procedure is open surgery performed while the patient is under general anesthesia.
Read more about BPH and medical procedures here:
Read these industry-funded sites that explain all the different procedures in greater depth. Buyer beware as despite the claims to being superior, many of these private state of the art procedures have not been proven over time to be superior to the standard TURP:
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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.
Why Choose New York Urology Specialists For Treatment Of Enlarged Prostate Problems
- All;treatment is performed by a board-certified urologist experienced in treating men with symptoms of frequent urination, urinary urgency, urinary incontinence, and bladder pain using medical therapy, minimally invasive therapies, lasers, and open surgery.
- We are one of the few practices in the region to offer a full range of options for the treatment of urinary problems caused by an enlarged prostate in men.
- We offer treatment options for enlarged prostate, overactive bladder, UTI, and urinary incontinence in our office, which avoids the risks, costs, and recovery from general anesthesia.;;
- Extensive experience: Thousands of men have been treated successfully using medical therapy, surgery, and minimally invasive procedures such as Urolift procedure, Rezum surgery, Botox for overactive bladder, Interstim for frequent urination, and tibial neuromodulation.;;
- We also offer;laser surgery for BPH , Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
- We offer diagnostic testing in our office, which avoids hospital costs.
- Confidential and Understanding Care. We understand that most of our patients desire privacy. ;We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
- We are conveniently located within a 30-60 minute commute to men who are seeking BPH treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.
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Where Does Sperm Go After Prostatectomy
You no longer ejaculate semen if you have had a radical prostatectomy. This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
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.
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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.Â;
When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety
Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.
The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.
For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.
You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, ;usually those who are younger and had full erections prior to surgery.
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What Do We Know About Potency After A Robitic Prostatectomy
Â;The return of potency is dependent on several factors:
- Previous sexual function before surgery.Â; Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery.Â; It will not improve upon what you already had before surgery.
- Age.Â; Theyounger you are, the better your chances.Â; Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
- How many nerves are spared.Â;As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections.Â; However,even men with no nerve sparing can regain erectile function.
Ejaculation will no longer occur in any patient.Â; This is because the seminal vesicles and the vas deferens , are removed and cut during the surgery.Â; This means that you will no longer be able to father children