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.
Who Should Get A Radical Prostatectomy
Men younger than 75 years old with limited prostate cancer and who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.
Before doing a radical prostatectomy, doctors first try to confirm that the prostate cancer has not spread beyond the prostate. They can figure out the statistical risk of spread by looking at tables comparing the results of a biopsy and PSA levels.
Other tests to check for signs of spread, if needed, can include CT scans, bone scans, MRI scans, ultrasound, PET scans, and bone scans.
If it appears that the prostate cancer hasnât spread, your surgeon may first offer you other options besides surgery. These can include radiation therapy, hormone therapy, or simply watching the prostate cancer over time, since many prostate cancers grow slowly.
Depending on how high your risk of the cancer spreading is, your surgeon may also consider doing an operation called pelvic lymph node dissection.
What Happens After Urethral Sling Surgery
Patients usually recover from this surgery quickly. Its best to limit demanding activities for approximately six weeks after surgery to avoid having the sling loosen before healing is complete.
After surgery, there may be swelling that makes it difficult to urinate. Youll have a catheter coming out of the urethra for two to three days. After this, the catheter is removed and just about everyone is able to void on their own. In rare cases, the catheter may have to be reinserted for a few days or up to a week if you cannot urinate.
After the swelling goes down, youll gradually be able to urinate on your own and empty your bladder. However, your normal urination pattern may not return for a few weeks.
The majority of men whove had this procedure have been cured of their urinary incontinence and no longer use pads. The others usually improve to the point where they dont use as many pads as they were before.
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How Prostate Cancer Spreads
- The cells escape into the bloodstream, initially by invading small blood vessels around the tumor, then traveling to larger blood vessels that enable the cells to circulate around the body .
- The cells are filtered through the bodys lymph system although some are captured in lymph nodes, others may travel elsewhere in the body.
- The cells migrate along the length of a nerve, escaping from the prostate into adjacent soft tissue .
What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery
I would rather have surgery.
I would rather have radiation.
I am more concerned about the risks of radiation than I am about risks from surgery.
I am more concerned about the risks of surgery than I am about the risks from radiation.
I’m not worried about the higher risks of erection problems in the first few years after surgery.
I don’t want to risk having erection problems in the first few years after surgery.
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What Is The Prostate Gland
The prostate gland is about the size of a walnut and surrounds the neck ofa man’s bladder and urethrathe tube that carries urine from the bladder.It’s partly muscular and partly glandular, with ducts opening into theprostatic portion of the urethra. It’s made up of three lobes, a centerlobe with one lobe on each side.
Researchers don’t know all the functions of the prostate gland. However,the prostate gland plays an important role in both sexual and urinaryfunction. It’s common for the prostate gland to become enlarged as a manages, and it’s also likely for a man to encounter some type of prostateproblem in his lifetime.
Many common problems that don’t require a radical prostatectomy areassociated with the prostate gland. These problems may occur in men of allages and include:
Cancer of the prostate is a common and serious health concern. According tothe American Cancer Society, prostate cancer is the most common form ofcancer in men older than age 50, and the third leading cause of death fromcancer.
There are different ways to achieve the goal of removing the prostate glandwhen there’s cancer. Methods of performing prostatectomy include:
When To Get Tested
You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.
Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.
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Prostate Removal May Be Option For Older Men
Prostatectomy to Treat Prostate Cancer May Be Safe in Men up to Age 79
Oct. 18, 2005 — Aggressive treatment of prostate cancer with removal of the entire prostate gland, known as a radical prostatectomy, may be a safe option for otherwise healthy men up to age 79, according to a new study.
Radical prostatectomy is the preferred treatment for men with prostate cancer that has not spread to other organs, but many doctors do not recommend the procedure for men over age 70 due to a perceived higher potential risk for complications.
Compared with more conservative treatments, like radiation and chemotherapy, previous studies have shown that treating men with localized prostate cancer with radical prostatectomy is associated with a lower risk of the tumor spreading to other organs or causing death.
Despite these advantages, researchers say recent surveys show more than half of American and Canadian urologists believe age 70 should be the upper limit for the invasive surgical procedure.
What Are The Side Effects Of Prostate Cancer Surgery
People often ask what happens if the prostate is removed? What to expect after prostate surgery? And can you have your prostate removed at all? The answer is yes it is possible to have the prostate removed.
Life without a prostate can be close to normal for some, though not free from the after effects of prostate removal.
There are few prostate surgery complications. Some are acute, and others chronic. Among acute side effects could be a reaction to anesthesia, bleeding issues, blood clots in legs, damage to nearby organs, and infection at the surgery site.
However, in most cases, people are interested in life after prostate removal, the pain after prostate surgery, and the long-term after effects of a prostatectomy.
There are two main side effects of prostate surgery. These are urinary incontinence and erectile dysfunction.
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Diet Fluids And Bowel Movements
Constipation is a common side effect of pain medications and surgery. You should have received prescriptions for an oral stool softener and a laxative.
You should start drinking fluids as soon as you are comfortable after surgery, and you can resume your normal diet the first day after surgery. But while waiting for normal bowel function to return, you should avoid large meals in favor of several small meals a day. To prevent constipation, we recommend drinking at least eight to 10 glasses of fluids each day and eating lots of fruits and vegetables. Avoid carbonated beverages and cruciferous vegetables such as broccoli, cauliflower, brussels sprouts and cabbage for approximately two weeks, as they frequently cause gassy discomfort and distention.
Take your stool softener and laxative as prescribed. Normal trajectory for return of bowel function is one to two days to pass gas, three to five days for the first bowel movement.
If you haven’t had a bowel movement by day three after your surgery, take oral Miralax , an over-the-counter laxative. You can combine Miralax with the prescribed stool softener and laxative. Follow the instructions on the box. Do not use any enemas or take stronger laxatives, such as magnesium citrate. Contact the clinic if you still haven’t had a bowel movement by day five.
Help Managing Cancer Treatment Side Effects
The team at Compass Oncology is experienced in helping patients treat prostate cancer and manage the side effects of treatment. If you live in the Portland-Vancouver area, have more questions about the side effects of prostate cancer treatment, or need help managing your side effects, request an appointment at one of our locations that’s convenient for you. We’re here with you every step of the way.
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Surgery To Remove Your Prostate Gland
You might have surgery to remove your prostate gland if:
- your cancer hasnt spread outside the prostate gland
- you are younger and have a fast growing tumour
- as part of treatment for locally advanced or high risk localised prostate cancer
The aim of a radical prostatectomy operation is to cure prostate cancer. It is major surgery with some possible side effects. If youre an older man with a slow growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer might grow so slowly that youre more likely to die of old age or other causes than from prostate cancer.
Elevated Psa After Prostate Removal What Influences The Predictions
As previously noted, elevated PSA after prostate removal can mean many different things in terms of the status of prostate cancer. These different prognoses are based on several different factors, outlined below:
- Gleason Score of Prostate Cancer: The Gleason score is a measure of how aggressive the cells of prostate cancer are. The higher the score, the more aggressive the cancer is. Men with higher Gleason scores who experience PSA recurrence are at greater risk for metastasis of prostate cancer than those men with lower Gleason scores. Is the Gleason Score 7 or less or is it 8 or higher?
- Time from Surgery: How soon after surgery the PSA reappears is one indicator specialists use to determine the aggressiveness of cancer. Generally, the longer the time between surgery and PSA recurrence, the less likely cancer is aggressive and going to spread. In turn, the better rate of survival will be. Is the time greater or less than 2 years?
- PSA Doubling Time: The term refers to the time it takes for the PSA to double in value. The value measures the rate at which the PSA rises, and can be a very significant indicator of the aggressiveness of cancer. Men with a shorter PSA doubling time postoperatively are more likely to have more aggressive disease. In these cases, a more aggressive secondary treatment plan may be advised. Is the PSA doubling in less or greater than 10 months?
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Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when it’s half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
How Will Prostate Surgery Affect My Sex Life
Experienced robotic surgeons like Dr. David Samadi dont open the endopelvic fascia during surgery, which spares the rick of damage to nerve bundles that control sexual function. The recovery of the function, however, is not immediate and you should not feel discouraged if weeks or even a few months after surgery you experience erectile dysfunction. It is not an indication of long-term damage.
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Rising Psa After Prostatectomy Should You Worry
Dr. David Samadi says that elevated levels of the PSA after prostatectomy are very rare incidents that come up every once in a while.
The main benefit of surgery is that you can remove entire cancer, while the patients know exactly what type of cancer they have and how much cancer, so the PSA after surgery should be undetectable or zero. This is why it is better to choose surgery over radiation.So, first, you need to have the surgery, and only if the PSA levels come back after the prostatectomy, which can happen 5% to 10% of the time, only then radiation should be used as a form of treatment for persistent PSA after prostatectomy. It is very difficult to have surgery after radiation. Prostate surgery outcomes are usually positive in the hands of an experienced surgeon.
Changes In Your Sex Life
Most men experience some decline in erectile function after their prostate is removed, but this can be managed. It can take six months or even up to a year for the affected nerves to recover from surgery. But with proper therapy and treatment, most patients can have good erectile function again, says Dr. Fam.
Treatment options include:
Work with your doctor to find a treatment that is right for you.
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Am I Too Old To Have Prostate Surgery
How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense that is, for the benefits to outweigh the risks you need to be young enough to take advantage of the added survival time that surgery can offer. Thats why I generally dont recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
What Is Localized Prostate Cancer
Prostate cancer is the abnormal growth of cells in the prostate gland. Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn’t cause symptoms.
Most cases of prostate cancer occur after age 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.
African Americans have the highest rates of both prostate cancer and deaths from it.
About 12 out of 100 men in the U.S. will get prostate cancer.footnote 5 But most people who are diagnosed with prostate cancer don’t die from prostate cancer.
Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery.
Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.
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Things You Should Expect After Prostate Surgery
Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.
In the immediate hours after surgery: