Final Thoughts: Preventive Maintenance Is Always A Good Idea
Prostate cancer is never an easy diagnosis to receive, and if youve already endured the physical and mental toll of a prostatectomy surgery, you certainly would like to hope it has been effective in its removal of the diseased tissue. However, approximately one-twentieth of men who undergo this procedure may not be completely free of the cancer.
If you or a loved one has reason to believe that prostate cancer recurrence is at play, or an increased risk of onset is likely, please contact HIFU Prostate Services today to discuss your options for noninvasive treatment. For more patient guides, healthcare resources, and medical news updates, please feel free to explore all of our articles on the official HIFU blog.
What Does Rising Psa Mean
When the PSA is rising or cancer spreading despite a low level of testosterone, prostate cancer is called castration-resistant, or hormone-refractory. Despite this name, some hormonal therapies may still work. But prostate cancer in this setting will inevitably progress and become more aggressive and resistant, and you should be prepared to discuss more aggressive treatment strategies with your doctor. This is the time when a medical oncologist, if not already involved in your care, gets involved. These doctors specialize in systemic treatments for prostate cancer, which is useful at this time given that your disease is typically systemic, meaning that it is not confined to only one location. Cancer cells in this situation have typically spread through the blood stream or lymphatics to other places in the body, and localized treatments are rarely helpful except in circumstances where urination becomes difficult. You should talk to your doctor about these systemic therapies, when to start chemotherapy, and clinical trials that may be available.
How Is A Recurrence Detected
After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.
When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.
Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.
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What Do We Know About Potency After A Robitic Prostatectomy
The return of potency is dependent on several factors:
- Previous sexual function before surgery. Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery. It will not improve upon what you already had before surgery.
- Age. Theyounger you are, the better your chances. Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
- How many nerves are spared. As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections. However,even men with no nerve sparing can regain erectile function.
Ejaculation will no longer occur in any patient. This is because the seminal vesicles and the vas deferens , are removed and cut during the surgery. This means that you will no longer be able to father children
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .
The stage of the cancer will 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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After Surgery To Remove The Prostate
Following a prostatectomy, the course of treatment generally follows a similar path for all patients, with variations and adjustments made as needed based on test results, physical response, and overall progression of recovery, from both a provider and patient perspective. Almost universally among post-operative men who have had a cancerous prostate removed, levels of PSA are expected to drop, and this decrease is seen in a measurable way that follows suit.
However, prostate cancer is not limited to the borders of the gland itself, and it is commonly found to metastasize in the tissues directly surrounding the prostate, or in the nearby seminal vesicles . If cancer spreads after a prostatectomy, it is likely going to be found in one or both of these areas. It can also cause the affected individual to exhibit elevated levels of PSA, which, as youll recall, should be steadily dropping or fully depleted after surgery has been completed.
When Is Radiation Therapy Used
There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:
- As the first treatment of cancer, which is still confined to the prostate gland.
- It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
- After the reoccurrence of cancer in the area, it was before surgery.
- To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Testosterone is the primary male hormone and plays an important role in establishing and maintaining the male sex characteristics, such as body hair, muscle mass, sexual desire, and erectile function. Most men who are on hormone therapy experience at least some effects related to the loss of testosterone, but the degree to which you will be affected by any one drug regimen is impossible to predict. Side effects from testosterone-lowering therapies include hot flashes, breast enlargement or tenderness, loss of bone mineral density and fractures, increased weight gain , higher cholesterol, a higher risk of diabetes, and a slightly higher risk of heart problems like heart attacks and chest pains. Some men complain of mood problems and depression during this time as well. Dont be afraid to discuss these issues with your doctors. For all of these reasons, maintaining a healthy overall lifestyle is vital to doing well with hormonal therapies over time.
Table : Predictors Of Biochemical Recurrence At Time Of Diagnosis
Although a number of clinical factors contribute to your risk of relapse after treatment, the parameters below provide a simpler assessment of your chances of biochemical recurrence, based on your clinical profile at the time of diagnosis. For more sophisticated estimates, based on specific risk factors, see Figures 1 through 3.
Low risk Gleason score less than or equal to 6and Cancer stage T2c or more
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Why Is A Simple Prostatectomy Performed
There are varying degrees of prostate enlargement.
If your prostate grows only slightly, many minimally-invasive surgeries can remove part of the gland, such as transurethral resection of the prostate .
However, if your prostate becomes very large , your surgeon will need to perform a simple prostatectomy. This involves removing the inner core of your prostate gland. Most men who undergo this type of surgery are age 60 or older.
Special diets, changes in drinking habits, and medications are often tried before surgery is recommended.
Your doctor may recommend a simple prostatectomy if your prostate is very large and you are suffering from:
- extremely slow urination
What Should My Psa Level Be After Treatment
Following surgery , your PSA number should be undetectable after about a month. That means zero PSA, not 04 ng/dl. However, some men will have a very low non-rising PSA after surgery, which can sometimes be caused by normal prostate tissue left behind. This is uncommon, and referred to as benign regeneration. However, the most widely accepted definition of a cancer recurrence is a PSA > 0.2 ng/mL that has risen on at least two separate occasions, at least two weeks apart, measured by the same lab. If youve had radiation therapy, the most widely accepted definition is a PSA that has risen from nadir in at least three consecutive tests, conducted at least two weeks apart, measured by the same lab. Some doctors believe that failure after radiation is not clear until the PSA has risen 2 points above its lowest value after radiation. Either way, its important to always use the same lab for all of your PSA tests because PSA values can fluctuate somewhat from lab to lab. Defining failure after other forms of therapy like seeds or cryotherapy is more challenging, but similar to that used with external radiation.
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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.
Psa Levels After Treatment
A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.
The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.
Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.
After radiotherapy or brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.
Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.
If your PSA level rises by 2 ng/ml or more above its lowest level, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.
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Following Up After Surgery
Because surgery for benign prostatic hyperplasia leaves behind most of the prostate gland, it is still possible for prostate problemsincluding prostate cancer or benign prostatic hyperplasiato develop or return.
After your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor.
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Higher Dose Radiation Raises Cure Rate
In the 2006 study conducted on nearly 5,000 radiation patients treated in nine academic U.S. radiation oncology departments standard doses for external beam radiation of the prostate were at or below 60 Gy.
Yet since then, radiation doses are often at or well above 70 Gy, due to the high-dose delivery systems in newer 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy , and Imaged Guided Radiation Therapy . Studies have shown that a higher dose of radiation significantly improves chances of the cancer not returning.
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Prostate Cancer Recurrence Isnt Limited To The Prostate
It is important to understand exactly where the recurrent prostate cancer is located in your body so that you and your doctor can choose the most appropriate treatment plan for you.
There are limitations with each of the current imaging tests used to locate recurrent prostate cancer.
While routine imaging tests including bone scans, CT scans, and MRIs can help provide some information about recurrent prostate cancer, these tests have limitations. There are newer advanced imaging tests available today. Talk to your doctor about which imaging tests are right for you.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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What Is Prostate Cancer
Prostate cancer develops in the prostatea small gland that makes seminal fluid. It is the second most common type of cancer in men. Prostate cancer usually grows over time and in the beginning stays within the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
Prostate cancer that is caught early has a better chance of successful treatment.
Prostate Size And Blockage Of The Urethra
If the inner part of the prostate gland obstructs the urethra during urination, this will irritate the bladder and cause urinary symptoms.Urinary symptoms may include:
- frequent urination, particularly at night
- urgency and possible urgency incontinence
- passing drops of urine involuntarily after you think youve finished
- blood in the urine although this can never be assumed to be due to the prostate until other causes have been excluded.
The actual size of the prostate does not appear to determine whether or not there is a blockage. Some men with large prostates never develop obstruction, but some men with small prostates can have severe bladder obstruction, which causes difficulty with urinating.Around one in three Victorian men over the age of 50 years have some urinary symptoms. In most cases, these symptoms are due to a blockage caused by an enlarged prostate, but they may be due to other causes.
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Caring For Your Incision
The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.
Types Of Radical Prostatectomy
There are three main types of radical prostatectomy:
- Retropubic. In this procedure, the surgeon uses an incision in the lower abdomen to remove the prostate and the lymph nodes for examination. This procedure allows for a nerve-sparing approach, which can lower but not totally eliminate the risk of impotence following surgery. In the nerve-sparing approach, the surgeon tries to preserve one or both of the small nerve bundles needed for unassisted erections. However, if the cancer has spread to the nerves, this approach may not be advised.
- Laparoscopic. In this recently developed procedure, the prostate is removed in a fashion similar to a retropubic prostatectomy, but the procedure is performed through five very small incisions using lighted, magnified scopes and cameras. The prostate specimen is then removed in a small bag through one of the incisions, which is expanded to 2 to 3 cm to allow specimen removal.Potential benefits of this procedure are less pain and earlier return to full activities. Nerve-sparing methods and lymph node dissections can be performed with this technique as well.
- Perineal. In this procedure, the prostate is removed through an incision in the skin between the scrotum and anus. The lymph nodes can’t be removed through this incision. If the lymph nodes need to be examined, removal can be done through a small abdominal incision or by a laparoscopic procedure. A nerve-sparing approach can be performed perineally.
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Common Side Effects Of Turp
Common side effects after surgery include:
- bleeding after the operation this usually reduces over time and should stop after four weeks
- retrograde ejaculation most men are able to have erections and orgasms after surgery to treat an enlarged prostate. However, they may not ejaculate because the bladder neck is removed along with prostate tissue. This causes the ejaculate to collect with urine and pass out of the body in the next urination.
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