What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
What Happens If My Psa Rises After Surgery
If your PSA starts to rise after youve undergone prostatectomy, salvage radiation therapy might be a good option to explore, and has been shown to improve outcomes over time. With this approach, external beam radiation is delivered to the area immediately surrounding where the prostate was , in the hopes of eradicating any remaining prostate cells that have been left behind. Depending on your PSA level, the addition of hormone therapy can improve outcomes with salvage radiation for details, please see Local Treatments for Recurrent Prostate Cancer in our most recent patient guide. Other trials are looking at more aggressive experimental systemic therapies for these patients.
Second Cancers After Colorectal Cancer
Colorectal cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. Cancer that comes back after treatment is called a recurrence. But some cancer survivors develop a new, unrelated cancer later. This is called a second cancer.
Unfortunately, being treated for colorectal cancer doesnt mean you cant get another cancer. People who have had colorectal cancer can still get the same types of cancers that other people get. In fact, they might be at higher risk for certain types of cancer.
People who have had colon cancer can get any type of second cancer, but they have an increased risk of:
- A second colon cancer
- Rectal cancer
- Kidney cancer
- Cancer of the ureter
People who have had rectal cancer can get any type of second cancer, but they are at increased risk of:
- Colon cancer
- Vaginal cancer
- Kidney cancer
The increased risk with some of these cancers may be due to shared risk factors, such as diet, obesity, and physical activity. Genetics may also be a factor. For example, people with Lynch syndrome have an increased risk of many of these cancers.
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Physical Therapy Helps Patients Manage Life After Prostate Cancer
Its a diagnosis that no one wants to hear.
Richard Johannesen, then 71, had been experiencing symptoms for years elevated prostate-specific antigen levels, frequent urination and softer erections but his doctors chalked it up to an enlarged prostate, especially after two biopsies came back negative for cancer.
For years, these symptoms were managed with two medications: one that controlled his bladder spasms and another that shrunk his prostate. That is, until 2015.
After seeing a new urologist at the USC Verdugo Hills Hospital and having a third biopsy, Johannesen received life-changing news: He had prostate cancer.
You cant help but get a little depressed, said Johannesen, a retired automobile engineer who is now 75. One of the ways I got through it was to get on my computer at home and research all I could.
Physical therapy can improve pelvic health after prostate removal
Of the treatment options available to Johannesen radical prostatectomy, radiation therapy or hormone therapy he chose a prostatectomy, the complete surgical removal of his cancerous prostate.
The prostate is a walnut-shaped gland situated between the bladder and the penis. The urethra runs right through the prostates center, carrying urine out of the body. The gland also secretes fluid that nourishes and protects sperm during ejaculation.
Due to the loss of the bladder neck sphincter, they can also encounter urinary incontinence.
After surgery, a setback
Prostate Cancer Is Common But Treatable
Recently, there has been a movement within the urological community to not treat prostate cancer. Some cases of prostate cancer may never spread to other parts of the body, so treatment may be unnecessary. The benefits of radical surgery or radiation may not be worth the consequences if the cancer is not developing or moving.
The challenge is in knowing which cancers will not spread. No urologist knows when a prostate cancer should be treated. There is no definite signal that tells us that a prostate cancer has already spread. While PSA monitoring, repeated biopsies and MRI studies are of some benefit, the reality is that many patients, while be being watched can have their cancers spread so that a cure is no longer possible.
Another problem with observation or surveillance is that more than 1/3 of prostate cancers have more aggressive cell types or are more extensive than what is found from a biopsy. Not treating these larger or faster growing cancers increases the risk of cancer spread outside the prostate. This is called metastatic cancer and it is not curable.
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Reasons To Have Prostate Surgery
One of the most common reasons for having prostate surgery, or a prostatectomy, is to treat prostate cancer.
According to the American Cancer Society, prostate cancer is the second most common form of cancer in American men, right behind skin cancer. Nearly 174,000 new cases are reported in the United States every year. If the cancer has not yet spread outside of the prostate gland, then surgery will be a great treatment option. Another reason to have prostate surgery is to treat an enlarged prostate.
As the prostate grows, it may block the flow of urine which can create bladder, urinary tract, and kidney related problems. Removing a part of the prostate can help to solve or prevent these issues.
Where Can I Learn More
To learn more about cryotherapy, to view a video of doctors, patients and their spouses. The video is provided by Healthtronics and is not affiliated with ZERO The End of Prostate Cancer. This video is provided as an educational resource not an endorsement of treatment.
To learn more about localized disease, go to our Localized Cancer section.
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How To Handle A Relapse After Treatment For Prostate Cancer
Am I going to die? This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen level has risen after he has already undergone treatment for prostate cancer . The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.
Thats usually of small comfort to the patient whose PSA has risen. Its emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, its as if theyre dealing with another diagnosis of cancer, except this time its much worse because there is less likelihood of getting cured. A mans confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.
Cancer Treatments And Erectile Dysfunction
Following surgery, many men experience erectile dysfunction , but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. Another factor is the surgeons skill level for performing the nerve-sparing technique, which if done correctly, may improve patients likelihood of retaining erectile function, says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapybrachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
When you compare surgery with radiation, both may affect erections, says Dr. Shelfo. Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over timemonths or, sometimes, yearssexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.
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Interpreting The Data On Prostate Cancer Recurrence
Depending on these factors, secondary treatment can be individualized to best manage the case at hand. Using the PSA in this way can be crucial in mapping out a predicted course of the disease and helping patients manage their disease as best as possible. Some factor combinations could predict a localized, slow-moving cancer best treated and cured with radiation therapy by targeting the remaining prostate cells. For example, if the Gleason score is less than 7, the PSA level started to rise more than 2 years after surgery and the PSA Doubling Time is almost a year, the chances to be cancer-free for a longer period of time are higher. .
Other factor combinations could predict aggressive, metastatic disease, in which case hormonal treatment may be the best treatment. For example, if the Gleason Score is greater than 8, the PSA level started to rise less than 2 years after surgery and the PSA Doubling Time is less than 10 months, there are greater chances to develop metastatic cancer. .
Still in other cases, when evaluating all the aspects of the PSA and the patient, no treatment may be the best treatment, says Dr. Samadi, Director of Mens Health at St.Francis Hospital.
Im Worried About All The Side Effects From Prostate Cancer Medications What Can I Do
Carefully review the side effect profile of the different hormone therapy regimens, and discuss with your health care team potential ways to minimize the effects. In the end, its important that you not only understand the value of the therapy in the management of your prostate cancer, but also that you learn how to live your life as best as possible while fighting the disease.
When To Call Your Doctor Or Nurse
Its important to tell your doctor or nurse if:
- your bladder feels full or your catheter isnt draining urine
- your catheter leaks or falls out
- your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
- your wound area or the tip of your penis becomes red, swollen or painful
- you have a fever
- you feel sick or vomit
- you get cramps in your stomach area that will not go away
- you get pain or swelling in the muscles in your lower legs.
Your doctor or nurse will let you know if you should go to the hospital.
What Happens If Prostate Cancer Comes Back
The prostate is a small gland about the size of a walnut that helps make seminal fluid. Its intertwined with your urinary tract system, resting below your bladder and surrounding the urethra. As you age, this gland continues to grow, sometimes resulting in benign prostatic hyperplasia. While this growth is normal, cancerous growth is not. Cancer occurs when the cells in your prostate gland begin to grow out of control.
While prostate cancer is common, especially among older men, its got a fairly positive outcome. When caught early and treated, most men survive and continue on with remission after five years. Unfortunately, for a small percentage of men, the cancer returns. To give you some clarity on this situation, heres what happens if prostate cancer comes back.
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Restoring Sexual Function After Prostate Surgery
Prostate cancer affects nearly 1 in 7 men. Fortunately, its a very treatable condition, especially when its caught early. One of the most common treatments for prostate cancer or having an enlarged prostate is to undergo prostate surgery, also known as a prostatectomy. This surgery comes with a very high success rate, boasting a 10 year survival of nearly 90%, but just like any other surgery it will come with potential risks and side effects.
According to the Prostate Cancer Foundation, one of the most common side effects of a prostatectomy is erectile dysfunction. Luckily, there are plenty of ways to fight back against erectile dysfunction and restore sexual function while recovering from prostate surgery.
How Are Hormone Therapies For Prostate Cancer Administered
LHRH agonists, the most commonly used drug class for hormone therapy, are given in the form of regular shots: once a month, once every three months, once every four or six months, or once per year. These long-acting drugs are injected under the skin and release the drug slowly over time. There are newer agents called LHRH antagonists that also lower testosterone and may be used.
Are Other Tests Needed
A doctor will not generally recommend further treatment after a single PSA test result. They will typically monitor a persons PSA levels over time to see whether they are rising.
PSA testing is only one way to check a persons health after having a prostatectomy. A doctor may use an imaging test to look for a tumor or a growing number of cancer cells.
They are also likely to ask the individual about any possible symptoms that could suggest that prostate cancer has returned.
Going Home With A Catheter
You will be discharged from the hospital with a catheter in place to drain urine from your bladder into a bag. The doctor will remove this in the office in five to 14 days. Be sure to clean the catheter where it exits your penis twice a day with soap and water and to empty the bag frequently. The bag should always be positioned lower than your bladder.
On occasion, the catheter may irritate the bladder, causing bladder spasms that can be quite uncomfortable. If these occur, your doctor can prescribe medication that can help. Leakage of urine around where the catheter exits the penis also may occur and can be managed by wearing incontinence pads as described in the next section.
It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This also is common. If you see large clots â more than an inch in length â or if the catheter becomes plugged, contact your doctor. No anesthesia is required for catheter removal, and most patients experience only a little discomfort.
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Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment
If your prostate-specific antigen blood level 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.
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 Can Be Done
If your prostate cancer has recurred, your healthcare provider will likely order some imaging tests to better determine where in your body the cancer has returned. Bone scans, CT scans, and MRIs are the most common tests ordered to find where in the body prostate cancer has recurred.
Many treatment options are available for prostate cancer that has returned. The one that you and your healthcare provider choose depends on individual factors such as what treatment you have already received, where in the body your prostate cancer has returned, how your cancer has spread, your general health, and your age.
If your prostate cancer is thought to have recurred in only a small area and has not spread to other areas of the body, then radiation therapy to that area may be an option.
If your prostate cancer has most likely spread to multiple areas of the body, then hormonal therapy would likely be an option. Chemotherapy can also be used when the cancer has spread to multiple sites.
Factors That Increase Risk Of Recurrence
There are many different factors that can help you determine what your risk of recurrence is. Your doctor will go over these during the initial course of treatment, therefore stressing the importance of follow up appointments.
One factor is the involvement of your lymph nodes. If your cancer has metastasized to your lymph nodes, recurrence is more likely. Similarly, the larger the tumor, the more likely that you are to experience complications and rates of recurrence. If the tumor is intertwined or growing into other areas of your body, this also increases risk. The Gleason score is a system of grading your prostate cancer based on severity and localization. The higher the grade, the more likely youll experience recurrence. Finally, the stage of prostate cancer affects recurrence rates. When caught early, recurrence is not as likely as cancers that are in stage three or four.
Cancer can be extremely aggressive and will change your life forever. Make sure that youre doing everything you can to avoid potential problems. Eat well, exercise regularly, and get enough sleep. Strengthening your immune system is a great way to reduce your risk of recurrence.
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