Thursday, May 19, 2022

Can You Still Have Prostate Cancer After A Prostatectomy

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What Changes Can You Expect

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  • Ejaculation will cease:Without a prostate gland or seminal vesicles, you will no longer experience ejaculation. Even though your orgasm may feel different, it will still be pleasurable.
  • Leaking urine during sex:This is possible but does not happen to all men. Its harmless and temporary.
  • Performance anxiety:Dont underestimate the emotional roller coaster of prostate cancer surgery and recovery. Its normal to worry about sex after prostate cancer. Being open and honest with your partner will help.

Keep in mind that your overall health, age, and present ED status are all factors in your recovery to sex after prostate surgery.

Less commonly, the prostate cancer tumor may bulge to one or both sides of the prostate gland, making nerve-sparing surgery extremely difficult or impossible.

Dr. Samadi will help you understand your exact prostate cancer status and the position and size of your tumor. In some cases, a nerve graft can be performed to regenerate the penile nerves for sex after prostate surgery.

  • Changes in mood and libido:The psychological impact of surgery can be significant; this will leave you tired and irritable, not in the mood for sex so you will need to move towards intimacy slowly and your desire will return back to normal.

Other Medications And Devices

Although medications like sildenafil and tadalafil are effective for many men with post-surgery erectile dysfunction, they arent the best choice for everyone.

If your prostatectomy causes damage to the nerves near your penis, or if you take medication for hypertension, angina or other health conditions, using an oral ED medication may not be a suitable option for you.;

In this case, your healthcare provider may recommend a different type of medication or a device to help you achieve an erection. Your options may include:

  • Penile injection therapy. This involves using injectable medications to stimulate blood flow and improve your erections. These medications are typically administered using a very small needle to minimize discomfort.Although this treatment method may sound unpleasant, its relatively simple to use and has a success rate of 70 percent to 80 percent.

  • Vacuum constriction devices . Also known as a penis pump, a VCD works by creating a vacuum around your penis. This draws blood into your penis and allows it to become erect.

What Determines Erection Recovery After Surgery

The most obvious determinant of postoperative erectile dysfunction is preoperative potency status. Some men may experience a decline in erectile function over time, as an age-dependent process. Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include older age, comorbid disease states , lifestyle factors , and the use of medications such as antihypertensive agents that have antierectile effects.

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Your Emotions And Sex

Your prostate cancer and its treatment wonât just affect your body. Theyâll also have a serious impact on your emotions. Stress and anxiety can trigger your body to make adrenaline, which gets in the way of having sex. The more you worry, the worse the struggle. If youâre in a relationship, your partner will be going through many of the same feelings.

One of the most important things you can do is to talk to your partner. Have an honest conversation about your fears and expectations when it comes to sex. Don’t assume they know how you feel. Being open with each other will help you both feel supported and help you work together to make any adjustments that you may need to stay intimate.

Talking with a mental health professional — either one-on-one or with your partner — can be a powerful way to help manage your emotions. A therapist can also prescribe medications that may ease stress and anxiety. A professional sex therapist can help you and your partner find ways to improve your sex life. It may also be helpful to join a support group where you can talk with others who share your experience.

Prostate Cancer Foundation: “Erectile Dysfunction.”

UCLA Urology: “Prostate Cancer: Dealing with Erectile Dysfunction.”

Albaugh, J. Reclaiming Sex & Intimacy After Prostate Cancer: A Guide for Men and Their Partners. Anthony J. Jannetti, Inc., 2012.

Harvard Prostate Knowledge: “Achieving orgasm after radical prostatectomy.”

What Is Hormone Therapy For Prostate Cancer

modern surgery: Surgery 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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Table : Predictors Of Biochemical Recurrence At Time Of Diagnosis

Although a number of clinical factors contribute to your risk of relapse after treatment, the parameters below provide a simpler assessment of your chances of biochemical recurrence, based on your clinical profile at the time of diagnosis. For more sophisticated estimates, based on specific risk factors, see Figures 1 through 3.

Low risk Gleason score less than or equal to 6and Cancer stage T2c or more

How Is Prostate Cancer Staged

Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.

The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.

The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.

  • Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
  • The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
  • Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.

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Do I Need Additional Treatment After Prostate Surgery

After surgery, one of the most important questions to ask is whether you may benefit from additional therapy like adjuvant radiation. The decision to use radiation to lower your risk of recurrence and dying from prostate cancer after surgery is based on whether the cancer has spread to your seminal vesicles, whether there were positive margins, and whether the cancer spread beyond the prostate capsule. In addition, it is important to allow time to recover your urinary function before considering radiation therapy after surgery, as radiation to this region increases the risk of urinary strictures, leakage, and high urination frequency.Many, but not all men, often can safely avoid adjuvant radiation therapy, and closely monitor their PSA to determine if they will need early salvage radiation therapy.

What Does Psa Velocity Mean

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PSA velocity or PSA doubling time, both of which measure the rate at which your PSA rises, can be a very significant factor in determining is the aggressiveness of your cancer. Men with a shorter PSA doubling time or a more rapid PSA velocity after initial therapy tend to have more aggressive disease, and are therefore more likely to need more aggressive therapies. Likewise, men who have recurrence soon after surgery have a higher risk of aggressive disease.

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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:

How Your Doctor Monitors You After Treatment

After treatment you have follow up appointments, which usually include regular blood tests to check the levels of a protein called prostate specific antigen . They check to see if your PSA level rises. And they also look at how quickly it rises.

An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in or around the prostate. Or they might have spread to other parts of your body. You might need treatment if it rises.

Prostate cancer that comes back after treatment is called recurrent prostate cancer.;

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Side Effects From Hormone Therapy

Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.

The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.

Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.

Surgically Removing The Prostate Gland

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A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks.

A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.

Before having any treatment, 67% of men said they could get erections firm enough for intercourse.

When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.

When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.

In extremely rare cases, problems arising after surgery can be fatal.

Its possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

After a radical prostatectomy, youll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

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What Are The Side Effects Of Hormone Therapy For Prostate Cancer

Testosterone is the primary male hormone and plays an important role in establishing and maintaining the male sex characteristics, such as body hair, muscle mass, sexual desire, and erectile function. Most men who are on hormone therapy experience at least some effects related to the loss of testosterone, but the degree to which you will be affected by any one drug regimen is impossible to predict. Side effects from testosterone-lowering therapies include hot flashes, breast enlargement or tenderness, loss of bone mineral density and fractures, increased weight gain , higher cholesterol, a higher risk of diabetes, and a slightly higher risk of heart problems like heart attacks and chest pains. Some men complain of mood problems and depression during this time as well. Dont be afraid to discuss these issues with your doctors. For all of these reasons, maintaining a healthy overall lifestyle is vital to doing well with hormonal therapies over time.

Treatments For Recurrent Prostate Cancer

    Recurrent prostate cancer is cancer that comes back after it has been treated. Recurrent prostate cancer is also diagnosed when theprostate-specific antigen level starts to rise quickly after initialtreatment but there are no other signs of cancer. This is called a biochemicalrecurrence or PSA failure.

    The following aretreatment options for recurrent prostatecancer. Your healthcare teamwill suggest treatments based on your needs and work with you to develop atreatment plan. The type of treatment that you receive will depend on:

    • the treatments you’ve already had
    • where the cancer comes back
    • whether the cancer has spread
    • your overall healthand whether you have other illnesses
    • your age and life expectancy
    • your personal preferences

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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

    Remission And The Chance Of Recurrence

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    A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

    A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

    In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

    When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.

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    How A Radical Prostatectomy Is Performed

    In cases of cancer, radical prostatectomy is the removal of the prostate along with the nearby seminal vesicles, vas deferens and lymph nodes if they are cancerous as well. This is a surgery of last resort when other treatments will not achieve success. It is considered radical because it involves the removal of entire components of the reproductive and lymphatic systems. After the prostate has been extracted in a radical prostatectomy, the surgeon then reattaches the urethra to the bladder to allow urination.

    The following methods may be used to perform a radical prostatectomy.

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