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.
What To Do If My Symptoms Are Not Improved After The Greenlight Pvp Laser Of Prostate
While the urine stream is the first symptom to improve after the Greenlight laser of the prostate, other symptoms may take a few months to improve. In particular, urinary urgency, burning with urination, and frequent urination can take a few months to improve.
Usually, symptoms improve slowly over time. If the symptoms are severe, medical treatment with medications for overactive bladder such as Vesicare, Myrbetriq, oxybutynin, and Detrol is sometimes necessary.
If symptoms do not improve sufficiently as expected within the first 3 months after surgery, cystoscopy, uroflow and bladder ultrasound, as well as urodynamic testing, may be necessary to determine the cause of lack of improvement.
Infrequently, patients may develop urethral stricture or bladder neck contracture. In these situations, the urine stream may become worse a few weeks to a few months after the procedure. If this occurs, re-evaluation is necessary.
Did you know?Dr. Shteynshlyuger has performed over 1,000 surgeries and procedures for enlarged prostate, including Rezum, Urolift, prostate enucleation, laser ablation of the prostate, and TURP. He performs over 100 prostate procedures a year.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
What To Ask When Your Psa Is Rising After Initial Treatment
For the majority of men, prostate cancer is treatable and curable and does not come back after initial treatment. However, about 25%33% of men with prostate cancer will experience a recurrence of their cancer after surgery or radiation. Some of these men can still be cured with additional treatment, but some men develop a form of prostate cancer that, while not curable, remains TREATABLE for a very long time.
Below is a list of questions to ask when your PSA is rising after initial treatment.
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What Can Be Done
If your prostate cancer has recurred, your healthcare provider will likely order some imaging tests to better determine where in your body the cancer has returned. Bone scans, CT scans, and MRIs are the most common tests ordered to find where in the body prostate cancer has recurred.
Many treatment options are available for prostate cancer that has returned. The one that you and your healthcare provider choose depends on individual factors such as what treatment you have already received, where in the body your prostate cancer has returned, how your cancer has spread, your general health, and your age.
If your prostate cancer is thought to have recurred in only a small area and has not spread to other areas of the body, then radiation therapy to that area may be an option.
If your prostate cancer has most likely spread to multiple areas of the body, then hormonal therapy would likely be an option. Chemotherapy can also be used when the cancer has spread to multiple sites.
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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Why Is Radical Prostatectomy Done
Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.
For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:
Differences Among Risk Groups
Men with PCa have been classified into low-, intermediate- and high-risk Groups for tumor recurrence and disease specific mortality, based on PSA level, clinical or pathological staging and GS. High-risk patients have PSA level 20ng/mL or GS 8 or clinical/pathological stage T2c . Lymph-node positive and PSM have also been reported as poor prognosis factors.
Risk Group classification predicts biochemical and clinical progression as well as PCa specific mortality and overall survival. The risk of disease progression in these groups has been validated for patients submited to RP in many studies. In patients from Mayo Clinic, BCR rates were 2.3 and 3.3-fold greater in high and intermediate-risk in comparison with low-risk patients, respectively. In those patients, mortality rates in high and intermediate-risk patients were greater than 11 and 6-fold over low-risk men .
Therefore, it is crutial to understand the role of each clinical and pathologic feature in PCa BCR and disease progression.
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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 youve 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.
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When Is Radiation Therapy Used
There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:
- As the first treatment of cancer, which is still confined to the prostate gland.
- It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
- After the reoccurrence of cancer in the area, it was before surgery.
- To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.
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Psa After Prostatectomy How Important Is It
The PSA after prostatectomy is very important. A major milestone in prostate cancer treatment is obtaining your PSA level close to zero after surgery. The expected result after prostatectomy is an undetectable PSA or 0 PSA level. The surgery itself is a cornerstone of a mans life, but the tests that follow, especially the PSA test, can be very dreaded.
The PSA test is a blood analysis that checks for the level of the prostate-specific antigen in the blood cells. The PSA is an enzyme secreted only by the prostate cells. When the post-prostatectomy PSA level is zero or close to zero after radical prostatectomy, the patient is reassured that he is cancer-free and can regain peace of mind. In the majority of cases, this is the scenario. There are also rare cases when the follow-up tests reveal rising PSA after prostatectomy. What to do if this is your case?
The Initial Causes How Often Will Prostate Cancer Return After Robotic Surgery
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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How Is A Recurrence Detected
After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.
When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.
Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.
Im Worried About All The Side Effects From Prostate Cancer Medications What Can I Do
Carefully review the side effect profile of the different hormone therapy regimens, and discuss with your health care team potential ways to minimize the effects. In the end, its important that you not only understand the value of the therapy in the management of your prostate cancer, but also that you learn how to live your life as best as possible while fighting the disease.
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Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
Are Other Tests Needed
A doctor will not generally recommend further treatment after a single PSA test result. They will typically monitor a persons PSA levels over time to see whether they are rising.
PSA testing is only one way to check a persons health after having a prostatectomy. A doctor may use an imaging test to look for a tumor or a growing number of cancer cells.
They are also likely to ask the individual about any possible symptoms that could suggest that prostate cancer has returned.
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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 the prostate-specific antigen level starts to rise quickly after initial treatment but there are no other signs of cancer. This is called a biochemical recurrence or PSA failure.
The following are treatment options for recurrent prostate cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment 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 health and whether you have other illnesses
- your age and life expectancy
- your personal preferences
What Is Intermittent Hormone Therapy
With intermittent hormone therapy, the LHRH agonist is used for 612 months, during which time a low PSA level is maintained. The drug is stopped until the PSA rises to a predetermined level, at which point the drug is restarted. During the drug holidays in between cycles, sexual function and other important quality of life measures might return. However, this approach is not right for all patients, and a patient-by-patient approach should be used based on response to and tolerability of hormone therapy.
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Psa Recurrence After Prostatectomy
Unlike PSA persistence, PSA recurrence is characterized by a PSA of 0 postoperative and a rising in the blood test after an unspecified period of time. Traditionally, the value of 0.2 PSA after prostatectomy has been used as the benchmark to indicate PSA recurrence.
This indicates that a level of PSA lower than 0.2 should not be considered worrisome. Instead, it should be monitored frequently.
What If My Psa Rises While Im On Hormone Therapy
When the PSA is rising or cancer is 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 may progress and become more aggressive and resistant, and you should be prepared to discuss additional 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 medical, systemic treatments for prostate cancer, which is useful at this time given that your disease is typically metastatic, 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 where you are having symptoms, such as problems with urination.
Fortunately, more and more treatments for metastatic castration-resistant prostate cancer have become available in recent years, including certain newer androgen directed therapies, taxane chemotherapy, immunotherapy, PARP inhibitors, and, in 2022, lutetium-PSMA radionuclide therapy. Additional tests are required for some of these treatments to see if your particular type of prostate cancer is likely to respond. See Chapter 5 in PCFs Prostate Cancer Patient Guide for more details.
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Helping People Imagine Their Future
The hardest thing we can do as physicians is help patients envision their future selves, Dr. Buyyounouski said. So patient-reported outcomes are very helpful, because you can tell patients exactly what side effects people had, and the frequency and bother of those side effects at points in time.
For many, he added, the trade-off in more side effects right after treatment will be worth it for a shorter treatment duration.
Unless youve been a patient, its hard for folks to imagine all the things that need to happen for somebody to go and get treatment every for weeks, Dr. Buyyounouski said.
Theres transportation costs, gas, parking, co-pays. And there are costs associated with the things youre not doing, like time away from work or responsibilities at home. Its more than just the medical bills.
I think people are itching to shorten the treatment because there are a lot of patients for whom its a barrier to getting treatment. And radiation therapy is a potentially curative treatment, added Dr. Citrin. So, making it easier for patients without increasing the long-term side effects is a huge win.
However, a less-intensive standard course of radiation will still likely appeal to some people, she added, especially if they are experiencing ongoing side effects from surgery.