How Will Treatment Affect My Libido
Prostate cancer may dampen your sex drive. Knowing that you have cancer and going through treatment can both cause you to feel too anxious to have sex.
Hormone therapy used to treat prostate cancer can also affect your libido. This treatment slows prostate cancer growth by lowering testosterone levels in your body. You need testosterone to have a healthy sex drive. Hormone therapy can also affect your self-esteem and sex drive by making you gain weight or causing your breast tissue to enlarge. If your hormone levels are low, your doctor may be able to prescribe testosterone replacement therapy to bring them back up to normal. This depends on your overall cancer treatment plan.
2013 study , about 3 percent of participants reported that they had a reduced penis size after radical prostatectomy or radiation plus hormone therapy. The men said their smaller penis affected their relationships and their satisfaction with life.
For men who do experience this, the change in size is generally half an inch or less. This decrease in size may be due to tissues shrinking in the penis. These tissues may shrink because of nerve and blood vessel damage.
If youre concerned about this side effect, ask your doctor about taking a drug for an erectile dysfunction , such as Cialis or Viagra. The increased blood flow from these drugs may help prevent your penis from getting smaller. Theyll also help with acquiring and maintaining an erection.
Certain Factors Affect Prognosis And Treatment Options
The and treatment options depend on the following:
- The of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
How Will Treatment Affect My Ability To Orgasm Or My Fertility
Surgery for prostate cancer can affect both your orgasms and your ability to have children. The prostate gland normally adds a fluid called semen to sperm to nourish and protect it. Youll no longer make semen after surgery, which means your orgasms will be dry. Radiation therapy can also reduce the amount of fluid you ejaculate. Without semen, you wont be able to father children. If youre concerned about fertility, you can bank your sperm before your surgery.
After surgery, orgasms will also feel different. You wont have that normal buildup of sensation before you have an orgasm. Youll still be able to feel pleasure, though.
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What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
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Urinary And Bladder Changes
Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:
- Burning or pain when you begin to urinate or after you urinate
- Trouble starting to urinate
- Bladder spasms, which are like painful muscle cramps
Ways to manage include:
- Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
- Avoid coffee, black tea, alcohol, spices and all tobacco products.
- Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
- Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
- Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.
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When To Start Androgen Deprivation Therapy
Experts disagree about the best time to start ADT. Many doctors recommend starting it when metastatic prostate cancer is first diagnosed the hope is that treatment will slow the growth of the cancer, and possibly prolong survival. Others believe that early ADT is not curative and can cause bothersome side effects. Doctors in this group recommend delaying the start of treatment until symptoms of cancer develop. Discuss the benefits and risks of each approach with your doctor.
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Treating Locally Advanced Prostate Cancer
You may need a combination of treatments.
Radiotherapy is often the main treatment. You may have internal radiotherapy as well. You usually have hormonal therapy with radiotherapy.
- Hormonal therapy
Hormonal therapy with radiotherapy helps to make treatment more effective. You may have hormone therapy before, during and for up to 3 years after radiotherapy. It reduces the risk of the cancer coming back.
- Watchful waiting
Instead of having treatment straight away your doctors monitor the cancer with watchful waiting. You do not have regular tests or scans. You will not start treatment unless the cancer is changing, or you get symptoms. If this happens your doctor will usually advise you start hormonal therapy on its own to control the cancer.
A prostatectomy is not commonly done to treat locally advanced prostate cancer. Surgery may not be able to remove all the cancer cells that have spread outside the prostate. If you have a prostatectomy you usually have radiotherapy afterwards.Other types of surgery are sometimes done to relieve symptoms.
Chemotherapy uses anti-cancer drugs to destroy cancer cells. It is sometimes used to treat locally advanced prostate cancer that is harder to treat.
Sometimes doctors may advise having hormonal therapy on its own. For example, if you are older, have health problems or do not want other treatments.
What Is Androgen Deprivation Therapy
Male hormones fuel the growth of prostate cancer. Treatments that decrease the body’s levels of androgens, or ADT, decrease the size of prostate cancer. ADT can be done by taking medicines that interfere with androgens, or by having surgery to remove the testicles . In Canada, medical treatment is usually preferred to surgery for advanced disease.
Examples of the medicines used in ADT include:
- GnRH agonists – GnRH agonists are medicines that temporarily “turn off” the testicles’ production of male hormones . This starves the cancer cells, causing the prostate to shrink. GnRH agonists are given as a shot every three to six months and include leuprolide and goserelin .
- Combined androgen blockade – Some doctors recommend a second medicine, called an antiandrogen, in addition to the GnRH agonist. Examples of antiandrogens include flutamide , enzalutamide and bicalutamide .
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What Does External Beam Radiotherapy Involve
You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.
Before your radiotherapy treatment
Radiotherapy planning session
A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.
During your radiotherapy treatment
You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.
If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.
At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.
Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.
Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
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Chemotherapy For Prostate Cancer
The decision on when to start chemotherapy is difficult and highly individualized based on several factors:What other treatment options or clinical trials are available.How well chemotherapy is likely to be tolerated.What prior therapies you have received.If radiation is needed prior to …
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Radiation Therapy: What It Is
This therapy, also known as radiotherapy, is a cancer treatment procedure that uses high doses of radiation to kill cancerous cells and shrink the tumor as well. At low doses, this procedure is used as an x-ray.
This therapy can be internal or external or both form. For external beam, a machine that is outside your body aims at the cancerous cells. For internal therapy, the radiations are placed inside your body inside or near the cancer.
For radiotherapy for prostate cancer, high-energy rays are used to kill the cancer cells. This treatment procedure does not cause pain. However, it may result in various side effects that might cause pain and make you feel uncomfortable. The good thing is that there are numerous ways to manage radiotherapy side effects with the help of your radiation oncologist.
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Cyberknife For Prostate Cancer
With CyberKnife because of its precision, there is less risk of burning the rectum or testicles during treatment. There is also a reduced risk of impotence and urinary incontinence. Sexual function remains the same for most patients after treatment. There are also minimal side effects, which may include tiredness, and urinary and rectal irritation. Over-the-counter medications minimizes these, and they usually dissipate in a few days or weeks.
Here are some other benefits:
- CyberKnife has a 98% cure rate for prostate cancer.
- There is less toxicity than with traditional radiation.
- Its quicker and has a high safety record.
- CyberKnife causes less disruption to patients lives.
- Its noninvasive. So, theres no anesthesia or cutting.
- It doesnt come with the risks of surgery like infection and long periods of downtime.
- CyberKnife treatments can be done infive radiation therapy sessions over 10 days. Thats compared to 42 over three months with other types of radiation treatments.
- The CyberKnife radiation beams, which target the prostate, are extremely precise. That means there is less risk of side effects including impotence and incontinence.
Eight Types Of Standard Treatment Are Used:
Watchful waitingor active surveillance
and are treatments used for older men who do not have or or have other medical and for men whose prostate cancer is found during a test.
Watchful waiting is closely a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve .
Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including , , , and transrectal , to check if the cancer is growing. When the cancer begins to grow, treatment is given to the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after are observation, watch and wait, and expectant management.
Patients in good health whose is in the only may be treated with to remove the tumor. The following types of surgery are used:
In some cases, the nerves that control penile erection can be saved with nerve-sparing surgery. However, this may not be possible in men withlarge tumors or tumors that are very close to the nerves.
Possible problems after prostate cancer surgery include the following:
Radiation therapy and radiopharmaceutical therapy
Men treated with radiation therapy for prostate cancer have an increased risk of having and/or cancer.
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Common Treatments For Advanced Prostate Cancer
Doctors can treat, but not cure, advanced prostate cancer. The goal is to slow down the cancer’s spread and help you feel better. Most men with it have a high quality of life for many years.
There are different kinds of treatments, including hormone therapy, immunotherapy, radiation, and chemotherapy. Ask your doctor about the risks, benefits, and side effects of each one, and what’s best for you.
What You Can Do Now
Sexual side effects from prostate cancer treatment are often temporary, especially if your doctor used nerve-sparing surgery. While your body recovers, you can try a few things to maintain your sex life:
- Let your doctor know about any sexual problems youre having right away. Although it can be hard to talk about sex, being open and honest will help you get the treatment you need.
- See a therapist. Couples therapy can help you and your partner understand and deal with sexual issues.
- Take care of yourself by exercising, eating a well-balanced diet, reducing stress, and getting enough sleep. Looking and feeling your best will give your self-esteem and mood a boost.
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Treating Early Prostate Cancer
In early prostate cancer, doctors offer treatments based on the risk group of the cancer.
- Low-risk prostate cancer
This type of prostate cancer is very slow-growing. Sometimes it never causes problems. Surgery or radiotherapy are the main treatments used to cure it. To begin with, you and your doctor may talk about whether you need immediate treatment. This depends on the risk of the cancer progressing and how you feel about the benefits and disadvantages of treatment.
Not having treatment may involve a certain amount of risk. To manage this your doctor may advise monitoring the cancer with active surveillance. Your
doctor assesses the risk of the cancer progressing using your biopsy, PSA test and scan results.
- If you are older, a decision to avoid treatment may be easier to make. You may feel low-risk prostate cancer is unlikely to cause you a problem within your lifetime.
- If you are younger and preserving your erectile function is a priority, avoiding treatment may be important for your quality of life.
You may find the online decision aid called Predict helpful. If you do choose active surveillance you can decide to have treatment at any time if you change your mind.
What Else Should You Consider
Remember, you have options, and itâs important to choose the one that works best for you. When choosing a treatment, think about:
- The risks. Talk to your doctor about the pros and cons of each type of therapy.
- The side effects. Consider whether or not youâre willing to deal with how the treatment might make you feel.
- Whether or not you need it. Not all men with prostate cancer need to be treated right away.
- Your age and overall health. For older men or those with other serious health conditions, treatment may be less appealing than watchful waiting.
American Cancer Society: âCan Prostate Cancer be Found Early?â âConsidering Prostate Cancer Treatment Options,â âHormone Therapy for Prostate Cancer,â âHow is Prostate Cancer Treated,â âProstate Cancer,â âWhat is Prostate Cancer?â âCryotherapy for Prostate Cancer,â âRadiation Therapy for Prostate Cancer,â âSurgery for Prostate Cancer,â âVaccine Treatment for Prostate Cancer.â
National Cancer Institute: âProstate Cancer Treatment.â
Prostate Cancer Foundation: âOther Treatment Options,â âProstatectomy ,â âRadiation Therapy,â âSide Effects,â âTreatment Options.â
UpToDate: âBone metastases in advanced prostate cancer: Management.â
Cancer.Net: âProstate Cancer: Types of Treatment.â
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Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
Expert Review And References
- American Cancer Society. Treating Prostate Cancer. 2019: .
- American Society of Clinical Oncology. Prostate Cancer. 2020: .
- Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
- Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
- Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .
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