Treatments May Have Side Effects
The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.
Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.
If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.
Advantages And Disadvantages Of Surgery
What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.
- If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
- The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
- Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
- If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
- Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.
Diagnostic Tests Are Limited
We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.
As PSA screening has grown more widespread, we are finding more tumors that otherwise would have escaped detection. Yet current diagnostic technology does not always enable urologists to determine which tumors will lie dormant and which will become active, spreading elsewhere in the body.
Studies estimate that anywhere from 16%56% of men diagnosed with prostate cancer, generally because of an abnormal PSA test, have tumors that might never have caused problems had they not been found. And the landmark Prostate Cancer Prevention Trial unexpectedly yielded data that early-stage prostate tumors are incredibly common, even at PSA levels considered normal.
The PCPT was a randomized controlled study the type considered to be the gold standard in research . The study, which involved almost 19,000 healthy men, was designed to evaluate whether the drug finasteride could prevent prostate cancer from developing. Finasteride is a hormonal medication originally approved to treat benign prostatic hyperplasia , but which has also been investigated as a potential treatment for prostate cancer.
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Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
What Happens During Turp
TURP requires a hospital stay. Procedures may vary depending on yourcondition and your healthcare providers practices.
Generally, a TURP follows this process:
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Caring For Your Incision
The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.
Table 2 What Guides Treatment Recommendations
Both of the situations below involve men diagnosed with a tumor that is small in size , yet who may require quite different treatments, based on their PSA level and Gleason score. Of course, many men have clinical profiles that vary from these two extremes.
Clinical profile Low PSA
Low Gleason score
80% of men with this profile probably have locally confined disease.
It is likely that fewer than 3% will have evidence of cancer in lymph nodes.
Surgery, radiation, or active surveillance . High PSA
High Gleason score
5% of men with this profile probably have locally confined disease.
More than 20% probably have evidence of cancer in the lymph nodes.
Systemic therapy rather than surgery .
Radical prostatectomy . The surgeon removes the prostate and seminal vesicles . In some cases, pelvic lymph nodes are also sampled. This is most often performed through an abdominal incision abdominal surgery may also be done with a laparoscope. A third option is the perineal technique, involving an incision in the area between the scrotum and the anus . The most common side effects are
- mild to severe incontinence .
External beam radiation therapy. After a CT scan constructs a three-dimensional picture of the prostate and seminal vesicles, the radiation oncologist directs rays of high-energy radiation at the prostate tumor and sometimes at nearby lymph nodes. The most common side effects are
- mild to severe incontinence .
- mild to severe incontinence .
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What Symptoms Should I Look Out For
If your cancer does come back, the first sign is likely to be a rise in your PSA level, rather than any symptoms. And problems will often be side effects of treatment rather than a sign that your cancer has come back.
However, its important to let your doctor or nurse know if you do get any new symptoms or side effects, or are worried that your cancer might have come back. If your cancer has come back and has spread from the prostate to other parts of the body, it can cause symptoms, such as extreme tiredness ” rel=”nofollow”> fatigue), bone pain and problems urinating.
Your doctor or nurse can help find out what might be causing your symptoms and help you manage any side effects. They can also look at your PSA level and do other tests to see whether or not your cancer might have come back.
What other tests might I have?
If your doctor or nurse is concerned about your PSA level or if you have new symptoms that suggest your cancer might have come back, they may recommend that you have some other tests, such as a prostate biopsy, MRI scan, CT scan, bone scan or PET scan.
Your doctor or nurse will explain these tests to you if you need them, or you can get in touch with our Specialist Nurses for more information.
Days Before Your Surgery
Follow your healthcare providers instructions for taking aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare providers instructions. Dont stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.
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Reasons For The Procedure
The goal of radical prostatectomy is to remove all prostate cancer. RP isused when the cancer is believed to be confined to the prostate gland.During the procedure, the prostate gland and some tissue around the gland,including the seminal vesicles, are removed. The seminal vesicles are thetwo sacs that connect to the vas deferens , and secrete semen.Other less common reasons for radical prostatectomy include:
Inability to completely empty the bladder
Recurrent bleeding from the prostate
Bladder stones with prostate enlargement
Very slow urination
Increased pressure on the ureters and kidneys from urinary retention
There may be other reasons for your doctor to recommend a prostatectomy.
Why Might I Need Turp
TURP is most often done to relieve symptoms caused by an enlarged prostate.This is often due to benign prostate hyperplasia . BPH is not cancer.It is a common part of aging. When the prostate gland is enlarged, it canpress against the urethra and interfere with or block the passage of urineout of the body.
Sometimes a TURP is done to treat symptoms only, not to cure the disease.For example, if youre unable to urinate because of prostate cancer, butsurgery to remove the prostate isnt an option for you, you may need aTURP.
There may be other reasons for your healthcare provider to recommend aTURP.
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Going Home With A Catheter
You will be discharged from the hospital with a catheter in place to drain urine from your bladder into a bag. The doctor will remove this in the office in five to 14 days. Be sure to clean the catheter where it exits your penis twice a day with soap and water and to empty the bag frequently. The bag should always be positioned lower than your bladder.
On occasion, the catheter may irritate the bladder, causing bladder spasms that can be quite uncomfortable. If these occur, your doctor can prescribe medication that can help. Leakage of urine around where the catheter exits the penis also may occur and can be managed by wearing incontinence pads as described in the next section.
It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This also is common. If you see large clots â more than an inch in length â or if the catheter becomes plugged, contact your doctor. No anesthesia is required for catheter removal, and most patients experience only a little discomfort.
How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasn’t spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
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What Is A Prostatectomy
A common surgical approach to prostatectomy includes making a surgicalincision and removing the prostate gland . This may beaccomplished with either of two methods, the retropubic or suprapubicincision , or a perineum incision .
Prior to having a prostatectomy, it’s often necessary to have aprostate biopsy. Please see this procedure for additional information.
Prostate Cancer: Treatment Advances You Should Know About
Prostate cancer treatment has entered the robotics age. Using advancedrobotic technology, Johns Hopkins surgeons can see the prostate in 3-D,magnifying everything 10 times. Johns Hopkins urologist Mohamad Allaf, M.D., explains what this means for patients, including fewer side effects.
How Long Will My Follow
You will have follow-up appointments for some time after your treatment. Exactly how long will depend on your cancer, any side effects of treatment and the services in your area. You will usually have appointments for several years.
After your follow-up appointments finish, you may continue to have PSA tests. Speak to your GP if you have any problems or concerns they can refer you back to the hospital. Make sure you remind them about your prostate cancer, especially if its been a while since you had treatment or a PSA test.
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Q: Am I Guaranteed To Have Gleason Score 4+3 If That Is What My Results Showed
A: No and there are two reasons. First, when a 12-needle biopsy is performed, only a tiny amount of prostate tissue is removed. Thus, a needle could hit a large area of tumor and show that you have a Gleason score of 4+3. However, it is possible that you could have a small area of Gleason 4+4=8 or more that was missed. We learned this from comparing biopsy Gleason scores to men who later had a Radical Prostatectomy in which the entire prostate is studied. Fortunately, this is uncommon with the 12-needle biopsy. As for the second reason, the Gleason score determination is made by the pathologist who looked at your biopsy material. The accuracy depends on his skill and experience. Thus, pathologists can sometimes make a mistake in the Gleason score. Because of this, we always have a mans biopsy material double checked by expert pathologists before we treat someone.
Adverse Reactions To The Anesthesia
If a person has a history of swelling of the face or generalized itching, it is important to inform the anesthetist before the procedure because, although allergic reactions to anesthesia can be mild, involving only wheezing or some skin irritation, it is also possible to experience an anaphylactic response which can be life-threatening.
Somebody suffering from an allergic reaction to an anesthetic may display signs like breathing difficulties, low blood pressure, rashes, hives and swollen skin around the eyes or mouth and throat. It is possible to perform tests prior to the surgery to identify which chemicals trigger an allergic reaction and if necessary an appropriate alternative anesthetic solution can then be chosen.
Other adverse reactions, such a muscle soreness, a sore throat from the breathing tube or nausea and vomiting after the surgery are a lot more common than allergic reactions. Around 10 percent of people will experience some kind of adverse reaction to anesthetic drugs, and anesthetists are trained to recognise and treat reactions as and when they occur during or after surgery.