Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues;with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life.;Intimacy;is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life,;making healthy choices and feeling as good as you can.
Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- having blood in your urine or semen
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
- stomach pain
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Prostate Cancer Lives As It Is Born: Slow
- By Daniel Pendick, Former Executive Editor, Harvard Men’s Health Watch
This year, more than 238,000 American men will be diagnosed with prostate cancer. In most cases, the cancer consists of small knots of abnormal cells growing slowly in the walnut-sized prostate gland. In many men, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity.
Evidence is growing that early treatment with surgery or radiation prevents relatively few men from ultimately dying from prostate cancer, while leaving many with urinary or erectile problems and other side effects. As a result, more men may be willing to consider a strategy called active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading.
This week, a study by Harvard researchers found that the aggressiveness of prostate cancer at diagnosis appears to remain stable over time for most men. If thats true, then prompt treatment can be reserved for the cancers most likely to pose a threat, whereas men can reasonably choose to watch and wait in other cases.
If you have chosen active surveillance, then this could possibly make you feel more confident in your decision, says Kathryn L. Penney, Sc.D., instructor in medicine at Harvard Medical School and the lead author of a report published today in the journal Cancer Research.
Receiving Treatment For Prostate Cancer That Has Spread
At Moffitt Cancer Center, the experts within our Urologic Oncology Program treat patients with all stages of prostate cancer, including advanced-stage cancers that have metastasized to other areas of the body. Our multispecialty team collaborates as a tumor board, ensuring each patient receives a treatment plan tailored to his unique needs. For individuals with metastatic prostate cancer, treatment plans aim to alleviate symptoms, slow the rate of cancer growth and shrink tumors to help improve quality of life.
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Transitional Cell Prostate Cancer
This is also known as urothelial carcinoma. This cancer starts in the cells that line the urethra . Transitional cell cancer can start in the bladder and spread to the prostate or, more rarely, it can start in the prostate itself.
Studies of men with transitional cell prostate cancer show that;PSA levels;can be low or high. More research is needed before we can know whether PSA tests can help to diagnose transitional cell prostate cancer.
Men with this cancer often have difficulty urinating and find blood in their urine. This is because the cancer grows around the urethra, causing it to narrow. This means transitional cell carcinoma is often diagnosed when men have surgery called;transurethral resection of the prostate ;to treat their urinary problems, as the tissue removed during surgery is looked at under the microscope.
If the cancer started in the prostate and has not spread outside the prostate, then you may be offered;surgery;and;radiotherapy. If the cancer has spread to areas just outside the prostate or to more distant areas of the body such as the bones then chemotherapy and/or radiotherapy may be an option.
Your doctor or nurse will tell you what treatment options are available to you. Read more about how these cancers are treated;below.
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If Prostate Cancer Spreads
Cancer cells can spread from the prostate to other parts of the body. This spread is called metastasis.
Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If prostate cancer spreads, it can spread to the:
- bladder
- urethra
- ejaculatory ducts
- seminal vesicles
- rectum
- lymph nodes in the pelvis
- lymph nodes outside the pelvis
- American Joint Committee on Cancer. AJCC Cancer Staging Handbook. 7th ed. Chicago: Springer; 2010.
- Brierley JD, Gospodarowicz MK, Wittekind C . TNM Classification of Malignant Tumours. 8th ed. Wiley Blackwell; 2017.
- Hermanns T, Kuk C, Zlotta AR. Clinical presentation, diagnosis and staging. Nargund VH, Raghavan D, Sandler HM . Urological Oncology. Springer; 2015: 40: 697-718.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . .
- Scher HI, Scardino PT, Zelefsky. Cancer of the prostate. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 68:932-980.
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How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular;PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
What Types Of Testing Should I Expect For Monitoring My Condition
Since metastatic prostate cancer isnt curable, your doctor will most likely set up regular visits to check the cancers location, and to manage any long-term side effects from the cancer or any medication youre taking.
And since treatments for advanced prostate cancer are changing so fast and need to be given in a certain sequence to be the most effective, youll probably have not only a prostate cancer doctor but other specialists taking care of you. Your care team should coordinate closely, say the authors of a major study of such teams published in August 2015 in the journal Annals of Oncology.
Along with regularly testing your prostate-specific antigen levels, your care team may request blood tests that measure such prostate cancer indicators as alkaline phosphatase and lactate dehydrogenase. Magnetic resonance imaging or PET scans of the spine or other bones can also help identify how your cancer responds to treatment.
If youve had radiation, youre at an increased risk for bladder and colorectal cancer and should get screened regularly for these as well.
The tests youll have and how often youll need them should be customized to you. Your care team will consider your overall health, medications that are safe for you to take, other health conditions you might have, and what stage your cancer was when you were diagnosed.
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How Is Prostate Cancer Staged
With these tests, a stage is assigned to help decide the treatment plan. The stage of cancer, or extent of disease, is based on information gathered through the various tests as the diagnosis and work-up of the cancer is being performed.;
Prostate cancer is most commonly staged using the TNM system;plus the Gleason score. The TNM system is used to describe many types of cancers. In prostate cancer it has four components:;
- T- Describes the extent of the “primary” tumor .
- N- Describes if there is cancer in the lymph nodes.;
- M- Describes if there is spread to other organs .
- G- Describes the Gleason score and takes into account the PSA and the histologic grade of the tumor.
The staging system is very complex. The entire staging system is outlined at the end of this article.;Though complicated, the staging system helps healthcare providers determine the extent of the cancer, and in turn, make treatment decisions for a patient’s cancer.;;
How Quickly Does Prostate Cancer Spread
Prostate cancer is a cancer that develops in the prostate gland in men and it is one of the most common types of cancer. It is usually seen in men over the age of 50. The prostate is a small walnut-shaped gland in men, which produces seminal fluid required to nourish and transport the sperm. Prostate cancer is a slow-growing cancer and, more often, it is confined to the prostate gland, requiring minimal or no treatment.;
In some cases, it can take up to eight years to spread from the prostate to other parts of the body , typically the bones. In many cases, prostate cancer does not affect the mans natural life span.;
However, certain types of prostate cancer can be aggressive and spread quickly to other parts of the body. If prostate cancer is detected early and is confined to the prostate gland, the prognosis is excellent.;
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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.
How Is Prostate Cancer Diagnosed
If you have symptoms of prostate cancer, your provider will perform a digital rectal exam and a PSA blood test. If either of those two tests are abnormal, then most likely your provider will recommend that you have a prostate biopsy. A biopsy is the only way to know for sure if you have cancer, as it allows your providers to get cells that can be examined under a microscope.;
The most common way that a biopsy is done is with a trans-rectal ultrasound . A trans-rectal ultrasound is a thin cylinder that puts out sound waves and monitors them when they bounce off of tissue. It is inserted into your rectum, and allows the provider performing the biopsy to view your prostate and choose where to remove the tissue for further evaluation. Any suspicious areas are biopsied. In addition, some tissue will be removed from all of the different parts of the prostate . The procedure is done while you are awake, with the help of some numbing medicine. Unfortunately, a trans-rectal ultrasound isn’t a perfect tool. Even though many samples are taken, it can occasionally miss the area of the cancer. If this happens, and your PSA remains elevated, you may need to have the procedure repeated.
Your provider may order other tests including a;bone scan, CT scan or MRI to see if the cancer has spread to the bones, lymph nodes or other organs.;
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How Doctors Find Metastatic Prostate Cancer
When you are diagnosed with prostate cancer, your doctor will order tests such as:
- X-rays
- MRI scans
- PET scans
These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.
If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spread in your bones.
Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.
PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate a prostate infection, trauma to the perineum, or sexual activity can also cause PSA level to be high.
If you’ve been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait seve,ral weeks after surgery before checking PSA levels. A rise in PSA after treatment may suggest the possibility cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.
Though very rare, it’s possible to have metastatic prostate cancer without a higher-than-normal PSA level.
What Is Metastatic Cancer
In metastasis, cancer cells break away from where they first formed , travel through the blood or lymph system, and form new tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a;microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as;stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called;cancer of unknown primary;origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
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Urinary Problems After Surgery
Leaking urine
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are;things that can help;and;ways you can manage it.
Difficulty urinating
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch;Paulâs story for one manâs experience of managing urinary problems after surgery below.
Sexual problems after surgery
Change in penis size and shape
Changes to orgasm
The seminal vesicles, which make some of the fluid in semen, are removed during surgery. This means you wont ejaculate any more. You may have a dry orgasm instead where you feel the sensation of orgasm but dont ejaculate. This may feel different to the orgasms youre used to.