What Is Prostate Cancer
The prostate is a walnut-shaped gland that lies below the bladder and in front of the rectum. In men, the size of the prostate increases with increasing age. Its primary function is to make fluid to nourish and lubricate the semen.
Growth in the prostate can be of two types:
- Benign growths: These are noncancerous growths and are rarely a threat to life .
- Malignant growths: These are cancerous growths that are potentially life-threatening.
How Long Does Urinary Incontinence After Prostate Surgery Last
Its impossible to say exactly how long it lasts. The chances of you having urinary problems may be influenced by your age, weight and the physical characteristics of your urethra .
However, a majority of men are eventually continent after a radical prostatectomy. In many cases, men are able to go safely without any kind of incontinence product after about three months. This is especially true of men who are healthy overall and fall into the age range of 40 to 60 years. If you are having persistent problems, its important to know that there are ways to treat urinary incontinence after prostate surgery.
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Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides what’s called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, we’re not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 96%
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The Risk Of Your Cancer Coming Back
For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.
One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.
Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.
When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.
When Prostate Cancer Spreads Where It Goes Matters A Lot
And if the cancer progresses or spreads beyond his prostate? We can treat it then, Callaghan said.
The study shows that you have no business treating low-grade prostate cancer in someone with a life expectancy of less than 15 years because the side effects outweigh any benefits, said urological surgeon Dr. Peter Albertsen of the University of Connecticut Health. The Oxford scientists reported that 46 percent of men who had their prostate removed were using adult diapers six months later . Similarly, only 12 percent of men who got surgery and 22 percent who had radiation could sustain an erection, compared to 52 percent of the monitoring group.
An estimated 180,890 men in the US will be diagnosed with prostate cancer this year, according to the American Cancer Society. Some 26,120 will die of it in 2016, almost always because it has spread to a vital organ.
In an editorial accompanying the study, radiation oncologist Dr. Anthony DAmico of Brigham and Womens Hospital focused on the finding that men who opted for monitoring were more than twice as likely to develop metastatic prostate cancer. That is, malignant cells reached the bones, lung, liver, or brain.
Garnick agreed: The intermediate-risk men we would never assign to active monitoring. If the increased metastases came from these patients, it would explain those differences and even more strongly encourage the role of active management in truly low-risk prostate cancer.
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What Happens To Cancer Patients Who Choose Not To Receive Chemotherapy
Every cancer situation is different. Some cancers are more associated with pain than others. Pancreatic cancer can be particularly bad when it grows into nerves near the back of the pancreas. But Ive had many patients with pancreatic cancer where pain wasnt a problem.
Instead, like many other patients with advanced cancers, they became weaker and more frail as their cancer worsened, then became wheelchair and then bed bound.
Cancers metastatic to bone are often painful but in some cases the discomfort is mild or more severe pain can be relieved with radiation therapy.
There are specialists who assist in managing cancer symptoms.
The most frequent outcome when cancer patients die is that whatever pain they have is controlled with narcotics and or sedatives.
There often comes a point in poorly treatable cancer situations that the treatment is as bad or worse than the disease. Everyone should understand the goals of chemotherapy as well as potential side effects and common complications.
Almost everyone is willing to try chemotherapy if there is a meaningful chance for cure. Many patients decline chemotherapy for low odds of benefit especially if they have gotten very weak or have other symptoms that make their quality of life very poor.
After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
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Questions To Think About Before Having A Psa Test
To help you make your decision, you could think about the following questions:
- What would you do if your PSA level is high?
- What would you do if further tests find that you have an early prostate cancer?
- What difference will it make for you to know about an early prostate cancer?
Before you decide whether to have the PSA test, you may want to talk to your GP about it. You can also call our cancer support specialists on 0808 808 00 00. They can discuss the options with you and send you more information.
What Happens If You Are Diagnosed With Prostate Cancer
A diagnosis with prostate cancer does not mean that a persons life has come to a full stop. Many people with prostate cancer, if diagnosed early, go on to live for many years. If the disease is diagnosed in very early stages, the doctor may only keep the patient under surveillance and treat as required. However, the patient must make some changes in their life during and after the treatment.
Some of the adjustments include
Changes in sex life: If a patient had surgery to remove their prostate gland, they may have erectile dysfunction. This may be a symptom of cancer and a result of the treatment. Some of the risks after an operation or a radiation therapy are
- Trouble getting erections
Some of the alternative options to bladder removal surgery include
- Nerve-sparing surgery
- More precise radiation therapy where a radioactive seed is placed inside the prostate
Most problems may go away on their own once the body heals completely. Some of the methods to improve sex life post-surgery include
- Penile implants
- Couple counseling
Bladder control: Most men with prostate cancer may have trouble with their bladders. Some of the side effects include
- Feel the urge to use the bathroom all the time
- Unable to pass urine at will
- Leak in between trips to the toilet
- Having a weak stream of urine
They can work on all these issues by talking to a professional, people close to them or other survivors.
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When To Get Tested
Youll 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 youll 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 youll need a test.
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The Criteria For Active Surveillance
My own cancer met the three Cancer Care Ontario criteria for active surveillance:
- It is not detectable by a digital exam .
- My PSA score is under 10 and steady.
- My Gleason score is under seven.
For me, active surveillance is by no means an easy decision. I feel fear every time I await the results of my PSA test. I know there is a significant chance that the next one will require life-changing action, and that this delay incurs a risk that the cancer has spread without my team of doctors knowing it. I have a small child, and the thought plagues me that for his sake I should take less risks. But life itself is risk. I will live with risk and an active sex life for now. I will be a guinea pig for this experimental science.
The chances are that something else will kill me anyway. Why does that make me happy now?
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Multidisciplinary Nature Of Treatment In Todays Advanced Prostate Cancer Care Paradigm
As the therapeutic landscape evolves to include increasingly complex combinations of systemic therapies with or without local therapies, advances in imaging, and germline and somatic genetic testing, treating men with advanced prostate cancer is increasingly one that must embrace multidisciplinary management approaches. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum when supporting treatment decisions for advanced disease. Additional specialists may also include genitourinary pathology, genetic counseling, palliative care, and holistic specialists, as appropriate, in addition to primary care. Best practices must also include clinicians comfortable describing the use of germline and somatic genetic testing, and when advanced imaging techniques could be optimally used or avoided. Radiologists and nuclear medicine specialists are valuable in helping to accurately interpret scans. Palliative care team members may also play a key role when treating men with symptomatic metastatic disease. Palliative care itself is an interdisciplinary, holistic approach to managing an advanced disease such as prostate cancer with a guarded prognosis. It can include controlling symptoms that are physical, psychological, spiritual, and social. The goal of palliation is to prevent and relieve suffering and to support the best possible QOL for the patient and family.
Choosing A Prostate Cancer Surgeon
When you are choosing a surgeon to treat your prostate cancer, it is important to select someone you trust and have confidence in. He or she should have enough experience to not only perform the operation you need but also to make an informed clinical judgment and change course, if necessary.
The prostate cancer experts at Seattle Cancer Care Alliance recommend choosing a surgeon who has done at least 250 prostatectomies total and who does at least 40 a year.
As you consider your options, you might want to ask your surgeon these questions.
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My Decision To Do Nothing About Prostate Cancer
What are the early signs of prostate cancer? Absolutely none, as it turns out. By the time this common, slow-growing scourge is giving you trouble, its probably far advanced. It may already be threatening your life.
Prostate cancer is an odd one. If its caught early, your chances of survival are very high but so are your chances of having your prostate removed, a solution as crude as it is effective.
A guy with no prostate has no prostate cancer , but he may not have a lot of sex either. He may also have urinary incontinence.
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
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What Kind Of Treatment Will I Need
There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.
The treatment thats best for you will depend on:
- Your age
- Any other health problems you might have
- The stage and grade of the cancer
- Your feelings about the need to treat the cancer
- The chance that treatment will cure the cancer or help in some way
- Your feelings about the side effects that might come with treatment
Surgery For Prostate Cancer
There are many types of surgery for prostate cancer. Some are done to try to cure the cancer others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.
Side effects of surgery
Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know so they can help you.
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How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again
This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.
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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.
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Prostate Cancer Patients Underestimate Life Expectancy Without Treatment
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Recent findings published in the Annals of Family Medicine showed that most patients with prostate cancer underestimated their life expectancy without treatment and overestimated their life expectancy with treatment.
We found that all men, regardless of age, race, education, and comorbidity, held unrealistic survival expectations of active treatment,Jinping Xu, MD, MS, in the department of family medicine and public health sciencesat Wayne State University, and colleagues wrote. This unrealistic expectation appears to be driven by perceived severity of their cancer after adjustment for patient age and general health.
Fear of cancer progression is commonly cited as the reason for choosing surgery or radiation over surveillance in the management of prostate cancer, the researchers wrote. However, a recent study showed that surgery did not reduce all-cause or prostate cancerspecific mortality when compared with surveillance. Overall, studies have yet to show that surgery and radiation are better options than surveillance.
Disclosure: The researchers report no relevant financial disclosures.