Sunday, February 5, 2023

Surgery After Radiation For Prostate Cancer

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What Symptoms Should I Look Out For

PSA Relapse after Surgery or Radiation | Prostate Cancer Staging Guide

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 â rel=ânofollowâ> 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.

Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Side Effects Of Surgery For Prostate Cancer

The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.

According to the patient-reported outcomes from men who participated in the ProtecT trial, men who underwent a radical prostatectomy experienced more sexual dysfunction and urinary problems than those treated with radiation therapy.

While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.

Although men treated with radiation reported experiencing bowel function problems after treatment, the study participants who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.

Also Check: What Is A High Psa Level For Prostate Cancer

Surgically Removing The Prostate Gland

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, such as urinary incontinence and erectile dysfunction.

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

It’s 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.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .

What If My Psa Rises While Im On Hormone Therapy

Postoperative Radiation for Prostate Cancer

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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Life After Treatment: Alan Weiners Story

When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.

The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.

Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.

I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.

Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.

Management Of Bowel Dysfunction

Short of treating individual symptoms as needed, there are few, if any, treatment options for bowel dysfunction following radiation therapy. Laser therapy can stop rectal bleeding caused by radiation. Anti-diarrheal agents can help with loose bowel movements. Increasing fiber intake through whole grains, fruits and vegetables, or fiber supplements can also help.Avoiding foods that might irritate the gastrointestinal tract is important, but complete elimination of fibrous, bulky foods can lead to constipation and straining, which in turn can exacerbate rectal bleeding.

Read Also: What Is The Function Of Male Prostate Gland

Vitamins And Dietary Supplements

Its OK to take a multivitamin during your radiation therapy. Do not take more than the recommended daily allowance of any vitamin or mineral.

Dont take any other dietary supplements without talking with a member of your care team. Vitamins, minerals, and herbal or botanical supplements are examples of dietary supplements.

Possible Side Effects Of Ebrt

Surgery after Radiation Therapy for Prostate Cancer?

Some of the side effects from EBRT are the same as those from surgery, while others are different.

Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

Recommended Reading: Institute For Prostate Cancer Research

Urinary And Bowel Changes

Radiation therapy can cause permanent urinary and bowel changes. Many people dont notice any changes or have any symptoms. However, some people have late side effects.

Late side effects may be similar to the ones you had during treatment. Theres a very small chance you may develop other side effects. For example:

  • The opening of your bladder may become narrower.
  • You may lose your ability to control your bladder.
  • You may have blood in your urine.
  • You may have bleeding from your rectum.
  • Your rectum may be injured.

These side effects are rare. They may come and go over time or be persistent and chronic. Your healthcare team will help you manage them.

Even if you dont develop any late side effects, remember that the tissues in your bladder and rectum were affected by your radiation therapy. Call your radiation oncologist if you:

  • Have any new urinary, bladder, or bowel symptoms.
  • Need to have a colonoscopy. Avoid having a colonoscopy for the first year after radiation therapy.
  • Need any type of urological or rectal procedure.

Are Surgery And Radiation Therapy Ever Used Together

In some cases, your care team may use both surgery and radiation therapy as part of your prostate cancer treatment plan. Typically, radiation therapy is delivered after surgery to target remaining cancer cells or that came back. However, in some situations, doctors may recommend radiation therapy first to kill cancer cells in tissues near the prostate gland before performing the prostatectomy.

Also Check: Is Stage 3 Prostate Cancer Serious

Focal Ablative Salvage Therapy

More recently, there is a growing body of research on focal salvage therapy to target just the identified tumor. This approach is called Focal Ablative Salvage Therapy, or FAST. Thanks to mpMRI and MRI targeted biopsy, the tumors location, extent, aggressiveness and genomics can be identified. Ablating just the tumor offers the dual advantage of cancer control plus low side effect risks. As with whole-gland primary treatment, the same three ablation methods can be used.

As of this writing, the most recent data was presented at the 2022 annual meeting of the American Urological Association by Dr. Deepika Reddy . The statistics were drawn from 288 consecutive cases of radiation recurrence that were treated with either focal HIFU or focal cryo . According to Dr. Reddys presentation, 265 patients had pertinent follow-up records for analysis. Patients had either stage T2 or T3 disease, and Grade Group 2, 3 or > 3.

Treatment was deemed successful based on failure-free survival and retreatment-free survival . The numbers are very encouraging, with 77% success rates for both FFS and RFS at 6 years post-FAST. About 7% of patients had adverse events following ablation, most of which were urinary infections. These patients avoided the surgical trauma of salvage prostatectomy, the increased cancer risk of salvage radiation, and the likely side effects of both.

Side Effects From Hormone Therapy

Complications of Prostate Cancer Treatment: Spectrum of Imaging ...

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.

Read Also: Is Prostate Cancer More Common Than Breast Cancer

Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

  • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
  • As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
  • If the cancer is not removed completely or comes back in the area of the prostate after surgery.
  • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

What Are The Current Expectations With Regard To Outcomes After Radical Prostatectomy

Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes. Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 inhibitors within 2 years.

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Frequent Urination Burning With Urination And Difficulty Urinating

These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.

Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment

Local Relapse after Surgery or Radiation for Prostate Cancer | Prostate Cancer Staging Guide

If your prostate-specific antigen blood level or another test shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment you’ve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.

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Why Does It Take So Long To Recover Erections After The Very Best Surgery

A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma.

Sexual And Reproductive Health

You can be sexually active during your radiation therapy, unless your radiation oncologist gives you other instructions. You wont be radioactive or pass radiation to anyone else.

If youre sexually active with someone whos able to get pregnant, its important to use birth control during and for 1 year after your radiation therapy. During your radiation therapy, your sperm may be damaged by the radiation. If you conceive a baby with this sperm, the baby might have birth defects. Using birth control helps prevent this.

For more information about your sexual health during cancer treatment, read Sex and Your Cancer Treatment. The American Cancer Society also has resources about sexual health issues during cancer treatment. The one for men is called Sex and the Adult Male with Cancer. You can search for it at www.cancer.org or call for a copy.

Male Sexual and Reproductive Medicine Program

MSKs Male Sexual and Reproductive Medicine Program helps people address the impact of their disease and treatment on sexual health. You can meet with a specialist before, during, or after your treatment. We can give you a referral, or you can call for an appointment.

Read Also: What To Expect After Prostate Cancer Surgery

Can Surgery And Radiation Be Used Together

If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.

This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.

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