If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Laser Surgery For An Enlarged Prostate Is No More Effective Than Standard Surgery
This is a plain English summary of an original research article
Two procedures to treat men with enlarged prostates are both effective, new research has shown.
A benign enlarged prostate is not cancer and is not usually a serious threat to health. But it is common in men over 50 and some need surgery to treat troublesome urinary symptoms caused by the growing prostate. The most common procedure is transurethral resection of the prostate which is usually successful but can lead to complications such as bleeding in some men.
The UNBLOCS trial compared the effectiveness of TURP to a new laser procedure which might reduce a patients hospital stay and cause fewer side effects. The thulium laser, ThuVARP, vaporises excess prostate. Men who needed a prostate operation were asked to consent to either procedure without knowing which one they would receive.
One year later, men in both groups were satisfied with their surgery. They reported similar improvements in their urinary symptoms and quality of life. There was no difference between the two procedures in terms of hospital stay or complications. However, men in the TURP group achieved a faster urinary flow rate . TURP was also slightly more cost-effective and faster to perform than the laser procedure.
Prostate Cancer Risk Groups
Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .
Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.
The risk group of the cancer will help determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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What Are The Side Effects
The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .
Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.
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 Pauls story for one mans experience of managing urinary problems after surgery below.
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So Why Would You Go See The Doctor
An important clinical goal for you and your doctor should be to detect risk for prostate cancer long before it can cause symptoms.
Thus, any initial detection of signs that you may have prostate cancer is now most commonly the result of a regular check-up carried out by your primary care physician, which may include a digital rectal examination or a prostate specific antigen test.
The most common symptom which may make a man go to either his primary care physician or a urologist, and which might subsequently lead to a diagnosis of prostate cancer, is some form of problem with normal urination.
Since all the symptoms listed above may be caused by prostate cancer and/or by a number of other disorders , it would be wise to talk to your family doctor if you or someone else in your family is having one or more of these problems on a regular basis.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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How To Choose Between Different Types Of Prostate Cancer Surgery
I frequently see patients who have been diagnosed with prostate cancer, have decided on surgery, but are struggling with the choice of different types of surgery. Increasingly, there can be a choice, especially if patients seek opinions from two or three different urologists . A common scenario might be: the patient sees a doctor who argues robotic prostate cancer surgery is superior to other approaches. He might see another specialist who argues that a laparoscopic prostatectomy remains the gold standard the best minimally invasive approach. A third consultant might advise him that his best chance of maintaining his usual erections would be open surgery. Who to believe?
The only way to understand this variety of approaches and the marketing behind them is to look at how they each developed. In the UK, up until 2000, the only prostatectomy on offer was via open surgery. Thereafter, a small number of surgeons, myself included, started to carry out prostatectomies using a laparoscopic approach. The number of surgeons was relatively small because this is a technically difficult operation to perform. Compared with, for example, removing a gall bladder, reaching and safely removing a prostate laparoscopically is very challenging. However, I felt there were clear benefits of keyhole surgery for patients in terms of post-operative recovery and performed many hundreds of laparoscopic operations.
Types Of Prostate Cancer
The type of prostate cancer tells you which type of cell the cancer started in. There are different types of prostate cancer. The most common type is adenocarcinoma of the prostate.
Doctors use the information about your prostate cancer type along with:
- how abnormal the cancer cells look under the microscope. This is the grade of the cancer
- the size of the cancer and whether it has spread. This is the stage
This helps your doctor decide which treatment you need. Another way doctors may describe your cancer is as localised, locally advanced or advanced.
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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:
What Is The Prognosis Of Prostate Cancer Has Spread To The Bones
More than 60% of men with advanced prostate cancer will develop bone metastases in the future. The most common types of bone damage are those on the spine, hips, and ribs.
In the United States, the second most common cancer is prostate cancer. It is the earliest stage of prostate cancer, and it is the most common type of cancer. When the cancer has spread to other parts of the body, it is referred to as advanced. It is found in the bones of more than 90% of men with advanced prostate cancer. A cancer can spread from one part of the body to another, but the spine is the most commonly affected. Aside from a weak urine flow, frequent urination, and constipation, you may also experience urinary incontinence. Hypercalcemia is a condition that can affect men who have bone metastases.
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Transurethral Resection Of The Prostate
A transurethral resection of the prostate abbreviated as TURP is another operation to treat BPH symptoms by removing blockages to urine flow.
Rather than using a laser, the procedure employs a resectoscope into the urethra to get a visual of the prostate tissue and the lining of the bladder. Using the resectoscope, the urologist can trim away enlarged lobes of the prostate. The capsule of the prostate is left intact. This uses electricity as an energy source rather than laser energy.
Everything You Need To Know About Prostate Cancer
Of the many health issues that men face throughout their lives, prostate cancer ranks as one of the most prevalent. In fact, among males, prostate cancer is the most common type of cancer aside from skin cancer. Despite its frequent occurrence, the disease is often overlooked and misunderstood.
1 in 8 men will get prostate cancer, says Craig Rogers, M.D., a urologist with Henry Ford Health. More than 175,000 men are diagnosed with prostate cancer each year and there are more than 30,000 deaths from it each year. Of these deaths, many are diagnosed in an advanced, untreatable stage.
If its caught in time, however, prostate cancer is very treatable. Here, Dr. Rogers answers all of the questions men should know about prostate cancer.
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Types Of Prostate Surgery
There are several different approaches to prostate cancer surgery and they can be performed in a variety of ways. The type and extent of your surgery will depend on how aggressive your cancer is and whether it has spread beyond your prostate.
Radical prostatectomy is when your surgeon removes the whole prostate gland. If cancer has spread, your surgery may extend beyond your prostate and include the surrounding lymph nodes.
There are several types of surgery available when you need to have your prostate gland cut, partially removed or removed, each with its own benefits.
Open retropubic surgery
Your surgeon makes a 10cm incision in your abdomen, then removes the entire gland. If you have very aggressive prostate cancer, some of the surrounding lymph nodes may also be removed for testing. Your surgeon may not continue the surgery if they discover that your cancer has already spread.
Keyhole surgery
Your surgeon accesses your prostate gland by inserting instruments through several small incisions in your abdomen. Keyhole prostate surgery is usually done robotically: miniature robotic arms, controlled by your surgeon, are inserted through the incisions. It has similar benefits to traditional non-robotic surgery, but the procedure tends to cost more because of substantial out-of-pocket costs from your surgeon.
Nerve-sparing surgery
Other surgeries for prostate cancer
Open perineal surgery
Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
-
Reactions to medications, such as anesthesia
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Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
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Side Effects Of Targeted Therapy
Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:
Liver blood tests may also be abnormal.
One of the targeted therapies for prostate cancer, Lynparza® , may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.
Fast Facts On Bph Surgery:
- Surgery is rarely the first line of treatment for BPH.
- A doctor who specializes in the urinary tract does most TURP surgeries.
- TURP is considered a fairly safe, effective procedure for treating BPH.
According to the American Urological Association, transurethral resection of the prostate or TURP is the most common type of surgery used to treat BPH. Every year, doctors perform it on around 150,000 American men.
Surgeons perform most TURP procedures when the patient is under general anesthesia and unconscious or asleep.
Alternatively, they use spinal anesthesia, where a needle is placed in the spine to stop any sensation below the waist.
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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.
The Different Types Of Prostate Surgery
Prostatectomy
The term prostatectomy is used to describe a number of different surgical procedures to remove either part or all of the prostate gland. This may be required to treat prostate cancer or BPH.
When only a part of the prostate is removed, this is called a simple prostatectomy. This process involves enucleating it from its capsule to trim away excess tissue, but where the sphincter muscle and nerves remain intact. It is usually used to treat BPH, which is a benign condition, meaning there is no risk of malignant cells having moved on to surrounding tissue.
When the entire prostate gland, capsule , the surrounding lymph nodes and neighbouring tissue is removed, this is known as a radical prostatectomy. This is usually a treatment for men with localised prostate cancer and there a number of techniques used:
Open Surgery This is where the prostate is removed via a large single incision in the lower abdomen, or the perineum .
Laparoscopic Radical Prostatectomy This is where the prostate is removed via several small incisions in the lower abdomen using small surgical instruments. This process is much less invasive than open surgery.
Robotic-assisted radical prostatectomy Much like laparoscopic radical prostatectomy, the prostate is removed via small incisions in the lower abdomen. Robotic-assisted instruments are inserted through the incisions and controlled by a surgeon.
Holmium Laser Enucleation of the Prostate
Transurethral Resection of the Prostate
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