How Is Prostate Cancer Treated
For many men with prostate cancer, treatment is not immediately necessary.
If the cancer is at an early stage and not causing symptoms, your doctor may suggest either “watchful waiting” or “active surveillance”.
The best option depends on your age and overall health. Both options involve carefully monitoring your condition.
Some cases of prostate cancer can be cured if treated in the early stages.
- radiotherapy either on its own or alongside hormone therapy
Some cases are only diagnosed at a later stage, when the cancer has spread.
If the cancer spreads to other parts of the body and cannot be cured, treatment is focused on prolonging life and relieving symptoms.
All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary symptoms, such as needing to use the toilet more urgently or more often.
For this reason, some men choose to delay treatment until there’s a risk the cancer might spread.
Newer treatments, such as high-intensity focused ultrasound and cryotherapy, aim to reduce these side effects.
Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy.
But the long-term effectiveness of these treatments is not known yet.
What Do The Dre Results Mean
A digital rectal examination is a test used to see if you might have a prostate problem or prostate cancer.
Your prostate may feel:
- normal a normal size for your age with a smooth surface
- larger than expected for your age this could be a sign of an enlarged prostate
- hard or lumpy this could be a sign of prostate cancer.
The DRE is not a completely accurate test. Your doctor or nurse cant feel the whole prostate. And a man with prostate cancer might have a prostate that feels normal.
Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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What Every Guy Needs To Know About Prostate Cancer
Prostate cancer is the second most common cancer among men in America, with about one in eight men diagnosed during their lifetime. It usually occurs in men 65 and older. Generally, doctors suggest that patients begin screenings in their mid-fifties. But if youre predisposed to the illnessprostate cancer is more likely for Black men and anyone with a family history of the diseasethen you should talk to a medical professional about potentially being screened earlier.
According to Dr. Mark Pomerantz, a medical oncologist with Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, many people are hesitant to get screened because of the assumption that it entails a digital rectal examination. While checking your prostate that way can be helpful, it hasnt been the primary method doctors use since the mid-nineties. Your doctor is likely to start with a PSA blood test. Additional screening will be necessary if youre levels are high.
Screening is important because many people diagnosed with prostate cancer show no symptoms. Common symptoms including changes in urination, difficulty with erections, and bone aches can also happen to men as they age for reasons that have nothing to do with cancer. By getting screened specifically, youre putting yourself in the best position to catch things early.
How serious is a prostate cancer diagnosis?
What type of treatment will you need?
How likely is remission?
Psa Tests And Screening
Testing for cancer when you have no symptoms is called screening. There is no national screening programme in Ireland, as theres little evidence that screening would reduce deaths from prostate cancer. It also could mean men having unnecessary treatment for very slow-growing prostate cancer, which could cause side-effects that affect their lives more than the cancer would.
If youre worried
Talk to your GP about:
- Your risk of prostate cancer eg if you have close family members with prostate cancer
- The pros and cons of prostate cancer screening
- What the tests involve
- The decisions you might have to make if your PSA was raised
- How these decisions might affect your life. Eg having treatment and getting side-effects
Should I use a home PSA test kit?
Prostate problems are best diagnosed by your GP, who can take your medical history and carry out a physical examination, as well as doing the PSA test.
Remember – your PSA level can be raised for other reasons it doesnt mean you have prostate cancer. Its also possible to have cancer and a normal PSA level. Read more about understanding PSA test results.
Diagnosing prostate cancer
Your family doctor will talk to you about your symptoms. He or she may do some tests. For example:
Digital rectal examination Inserting a gloved finger into your back passage to see if your prostate feels normal. It can be a little uncomfortable but it doesnt take long.
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How Will Treatment Affect My Libido
Prostate cancer may dampen your sex drive. Knowing that you have cancer and going through treatment can both cause you to feel too anxious to have sex.
Hormone therapy used to treat prostate cancer can also affect your libido. This treatment slows prostate cancer growth by lowering testosterone levels in your body. You need testosterone to have a healthy sex drive. Hormone therapy can also affect your self-esteem and sex drive by making you gain weight or causing your breast tissue to enlarge. If your hormone levels are low, your doctor may be able to prescribe testosterone replacement therapy to bring them back up to normal. This depends on your overall cancer treatment plan.
2013 study , about 3 percent of participants reported that they had a reduced penis size after radical prostatectomy or radiation plus hormone therapy. The men said their smaller penis affected their relationships and their satisfaction with life.
For men who do experience this, the change in size is generally half an inch or less. This decrease in size may be due to tissues shrinking in the penis. These tissues may shrink because of nerve and blood vessel damage.
If youre concerned about this side effect, ask your doctor about taking a drug for an erectile dysfunction , such as Cialis or Viagra. The increased blood flow from these drugs may help prevent your penis from getting smaller. Theyll also help with acquiring and maintaining an erection.
How Will Treatment Affect My Ability To Orgasm Or My Fertility
Surgery for prostate cancer can affect both your orgasms and your ability to have children. The prostate gland normally adds a fluid called semen to sperm to nourish and protect it. Youll no longer make semen after surgery, which means your orgasms will be dry. Radiation therapy can also reduce the amount of fluid you ejaculate. Without semen, you wont be able to father children. If youre concerned about fertility, you can bank your sperm before your surgery.
After surgery, orgasms will also feel different. You wont have that normal buildup of sensation before you have an orgasm. Youll still be able to feel pleasure, though.
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Getting Treatment And Support
Speak to your GP or doctor or nurse at the hospital.
Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether its for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit.
Talking about sex
It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. It can also help you feel more positive and more in control.
You can ask about sexual problems at any stage before, during or after your prostate cancer treatment. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they dont then you may need to bring it up yourself.
Not everyone is used to talking about sex. You might need to bring it up more than once, or with a different person in your team. You can also ask to be referred to an expert in sexual problems or an ED clinic they will be used to talking about sexual problems.
Our sexual support service
Prostate Cancer Urine Test
This test detects the gene PCA3 in your urine and can also help your doctorbetter assess your prostate cancer risk.
PCA3 is a prostate-specific noncoding RNA. Its a gene thats only in yourprostate. If the gene is overexpressed , then theres a greater chance you have prostate cancer.
Like PSA and PHI tests, this isnt definitive, either. But data suggestthat when cancer is present, the PCA3 will be positive 80 percent of thetime. This test can also help your doctor determine whether a biopsy isnecessary.
Both of these new tests are more accurate than the PSA test. Your doctormay recommend one or more than one, based on the specifics of your case.
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What Is The Prostate
The prostate is a small gland in the pelvis, found only in men.
About the size of a satsuma, it’s located between the penis and the bladder, and surrounds the urethra.
The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.
How May Erectile Dysfunction Affect My Sex Life
Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.
If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a problem shared is a problem halved. Not everyone wants a sexual relationship. Dont try to guess or assume what your partner wants. Have an open and honest discussion with your partner.
This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.
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Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
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If Youre The Receiving Partner
Youll want to be as relaxed and aroused as possible, because itll make the experience easier and more enjoyable.
The whole poop-comes-out-of-the-butt thing gives some people a case of the heebie-jeebies even when its their own butt.
Remedy this by taking a shower and paying a little extra attention back there to get it squeaky clean. Some people like to use an enema before engaging in butt play, but it isnt necessary.
Use the bathroom before getting started. Prostate stimulation can make you feel like you need to pee, and anal penetration can cause the sensation of needing to poop.
Even though you wont actually do either, worrying that you might can interfere with your ability to let go and enjoy yourself. Knowing your bladder and bowels are empty can help.
Getting used to the sensation of having your prostate touched can help, too. Practice with an anal sex toy, like a butt plug, or your fingers.
Be sure to set the mood so that youre turned on and primed for action. Light candles, watch porn, or engage in some good old-fashioned masturbation or foreplay to get there.
Finally, be sure to lube up real good. Applying a water-based lubricant will allow for easier penetration and make for some easy gliding if stimulating your prostate externally.
Other Conditions That Can Cause Urinary Symptoms
- Benign prostatic hyperplasia BPH is when the prostate gland grows larger. BPH is common in middle-aged and elderly men because the prostate gland often gets bigger as you get older. BPH is not cancerous but it may cause prostate urinary symptoms.
- ProstatitisProstatitis means that the prostate gland has become inflamed. It can be caused by an infection in the prostate gland. It is not a form of prostate cancer. Symptoms can include pain in your testicles, pain when passing urine or an uncomfortable feeling when sitting down.
What Tests Do I Need After A Biopsy
If you have a biopsy that shows that you have cancer cells in your prostate, then you’ll have more tests to work out where and how big the cancer is .
The tests you might have include a CT scan and a bone scan.
The National Institute for Health and Care Excellence , 2019
The use of PI-RADSvs2 in pre-biopsy multi-parametric MRIThe Royal College of Radiologists, 2018
PI-RADS Prostate Imaging Reporting and Data System version 2American College of Radiology, 2015
The 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma – Definition of Grading Patterns and Proposal for a New Grading SystemJ Epstein and others American Journal of Surgical Pathology, 2016. Vol 40, Issue 2, Pages 244-252
National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection recommendations from a UK consensus meetingM Appayya and others
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Does Prostate Cancer Have Any Symptoms
Most men with early prostate cancer dont have any signs or symptoms.
One reason for this is the way the cancer grows. Youll usually only get early symptoms if the cancer grows near the tube you urinate through and presses against it, changing the way you urinate . But because prostate cancer usually starts to grow in a different part of the prostate, early prostate cancer doesnt often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem. But its still a good idea to get it checked out. Possible changes include:
- difficulty starting to urinate or emptying your bladder
- a weak flow when you urinate
- a feeling that your bladder hasnt emptied properly
- dribbling urine after you finish urinating
- needing to urinate more often than usual, especially at night
- a sudden need to urinate you may sometimes leak urine before you get to the toilet.
If prostate cancer breaks out of the prostate or spreads to other parts of the body , it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- blood in the urine or semen
- unexplained weight loss.
These symptoms can all be caused by other health problems. But its still a good idea to tell your GP about any symptoms so they can find out whats causing them and make sure you get the right treatment, if you need it.
Can I Look For Signs Of Prostate Cancer
Often there are very few signs of prostate cancer, and they can be confused with symptoms of other prostate problems. Some men may experience difficulty passing urine , such as slow starting, a weak flow, a sudden urge to wee and getting up more frequently in the night. But especially in older men, these can often be due to enlarged prostate symptoms where the prostate presses against the bladder and the urethra and affects the flow of urine.
Prostate cancer is slightly different. Usually it grows around the outside of the prostate and doesnt really make the prostate gland bigger in the early stage so doesnt press on the bladder or urethra. However, you can have both BPH and prostate cancer at once so your doctor will want to check it out to be sure.
The prostate is a small gland and its role in life is to secrete fluids into semen to keep sperm in tip top condition. It is tucked between the bladder and the rectum and gradually gets larger as you age.
Pain and difficulty passing urine can frequently be caused by prostatitis, a bacterial infection causing swelling and pain. A urine infection can also often be a cause of troublesome symptoms, particularly in older men. A GP will usually check for an infection early on, but may suggest a prostate cancer check at the same time, usually just to rule it out.
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