Key Points To Remember
- Radiation therapy or surgery may be used to treat your prostate cancer. Both treatments work well. With either treatment, the chance of your cancer spreading is low.
- Both treatments have side effects, such as bladder, bowel, and erection problems. Radiation therapy is more likely to cause bowel problems. Surgery is more likely to cause leaking urine or erection problems.
- If your goal is to treat the cancer by having your prostate removed, then you may want to choose surgery. For some men, the idea of “getting the cancer out” brings a sense of relief. For other men, avoiding radiation may be what is important to them.
- If your goal is to treat the cancer and avoid the risks of major surgery, then you may want to choose radiation therapy. For some men, preserving their sexual function for as long as possible is what they value most. Having radiation rather than surgery may help avoid erection problems.
- One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about your situation.
What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.
Approaches To Radical Prostatectomy Surgeons Can Use Different Approaches And Techniques Toremove The Prostate They Can Make A Large Incision To Reach The Prostate They Can Also Use Laparoscopic Orrobotic Techniques Which Are Done Through Smaller Incisions In The Pelvis Laparoscopicand Robotic Types Of Surgery Are Less Invasive Than An Open Radicalprostatectomy Men Often Have Shorter Recovery Times Less Blood Loss Lesspain And Shorter Hospital Stays With These Procedures Retropubic Radicalprostatectomy Is Done Through An Incision In The Lower Abdomen The Surgeoncan Also Remove Lymph Nodes From The Pelvis Through The Same Incision Incanada A Retropubic Radical Prostatectomy Is The Most Common Approach Toremoving The Prostate To Treat Cancer
Perineal radical prostatectomyis done through an incision in the area between the scrotum and the anus. This surgery usually doesn’t take as long to do as aretropubic radical prostatectomy, but it may lead to more problems with gettingan erection . In addition, surgeons can’t removepelvic lymph nodes through the same incision so they would have to do aseparate procedure through a small cut in the lower abdomen to remove them.
Laparoscopic radical prostatectomyuses a laparoscope and other surgical instruments passed through small cuts. A laparoscopicprostatectomy has some advantages over an open radical prostatectomy, includingless blood loss and pain, shorter hospital stays, faster recovery and less timewith a catheter.
Robotic radicalprostatectomy is a type of robotic surgery. The surgeon sits near theoperating table and uses remote controls to move robotic arms. The robotic armshave tiny video cameras and surgical instruments that remove tissue throughsmall cuts. The robotic arms can bend and turn like a human wrist. A roboticprostatectomy also has advantages over an open radical prostatectomy includingless blood loss and pain, shorter hospital stays, faster recovery and less timewith a catheter.
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Reasons For The Procedure
The goal of radical prostatectomy is to remove all prostate cancer. RP isused when the cancer is believed to be confined to the prostate gland.During the procedure, the prostate gland and some tissue around the gland,including the seminal vesicles, are removed. The seminal vesicles are thetwo sacs that connect to the vas deferens , and secrete semen.Other less common reasons for radical prostatectomy include:
Inability to completely empty the bladder
Recurrent bleeding from the prostate
Bladder stones with prostate enlargement
Very slow urination
Increased pressure on the ureters and kidneys from urinary retention
There may be other reasons for your doctor to recommend a prostatectomy.
What Will I Learn By Reading This
When you have treatment for your prostate cancer, you may have erectile dysfunction also known as impotence. Erectile dysfunction is a very common side effect . Side effects from prostate cancer treatment are different from one man to the next. They may also be different from one treatment to the next. Some men have no erectile dysfunction. The good news is that there are ways to deal with erectile dysfunction. In this booklet you will learn:
- What erectile dysfunction is
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
It is important for you to learn how to deal with erectile dysfunction so that you can continue to have a satisfying intimate relationship.
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Prostate Cancer Pain And Weakening Bones
Prostatecancer most commonly spreads to the bones. This is called bone metastases. This condition can cause pain. It can also weaken bones and make them prone to fractures. So, too, can the endocrine therapy thats often used to slow the spread of prostate cancer. But doctors can offer treatments to relieve bone pain and support weakened bones.
Bisphosphonates to Strengthen Bones
These drugs help reduce or delay problems such as fractures caused by bone metastases in prostate cancer. The drug zoledronateÃ can improve bone density but is not approved to reduce fractures or bone loss in men with prostate cancer on endocrine therapy
A new class of drugs, the rank ligand antagonists, specifically denosumabÃ , has been found to be superior to zoledronate in reducing fractures in castrate independent prostate cancer. It is administered subcutaneously. Denosumab is also used to prevent osteoporosis caused by endocrine therapy for non-metastatic prostate cancer,
The drug toremifeneÃ , a serum estrogen receptor modifier used primarily for metastatic breast cancer, is can also be useful in the treatment of osteoporosis related to prostate cancer.
Both denosumab and zoledronate have the unique side effect of destroying the jaw bone. Therefore, before beginning either therapy dental disease should be addressed.
Radiation Therapy for Bone Pain
Radiation is given to reduce bone pain in advanced prostate cancer.
Surgery to Stabilize Bones
Lifestyle Changes to Maintain Bone Health
How Common Is Depression In Prostatecancer Patients
After removing the prostate, men who get anti-hormonal treatment have 80% bigger odds of suffering from depression compared to those who dont receive any treatment, study shows. Different research also proved similar results.
Scientists evaluated the prevalence of anxiety and depression in 4,494 patients with prostate carcinoma. They studied clinical anxiety and depression as a result of prostate cancer treatment such as surgery. The meta-analysis identified the prevalence rates in post-treatment, on-treatment, and pre-treatment depression.
Based on the results, pre-treatment had a 17.27% prevalence rate, 14.70% on-treatment, and 18.44% post-treatment depression. While for anxiety, the pre-treatment prevalence rate was at 27.04%, 15.09% for on-treatment, and 18.49% post-treatment anxiety.
These findings suggest that depression and anxiety are prevalent problems in every cancer patient-particularly those who undergo a prostatectomy, hormone, and radiation therapy.
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Advantages And Disadvantages Of Surgery
What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.
- If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
- The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
- Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
- If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
- Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.
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What You Need To Know About Prostate Surgery
What is prostate surgery for?
The prostate is a gland located underneath the bladder, in front of the rectum. It plays an important role in the part of the male reproductive system that produces fluids that carry sperm.
Surgery for partial or complete removal of the prostate is called a prostatectomy. The most common causes for prostate surgery are prostate cancer and an enlarged prostate, or benign prostatic hyperplasia .
Pretreatment education is the first step to making a decisions about your treatment. All types of prostate surgery can be done with general anesthesia, which puts you to sleep, or spinal anesthesia, which numbs the lower half of your body.
Your doctor will recommend a type of anesthesia based on your situation.
The goal of your surgery is to:
- cure your condition
- minimize pain before, during, and after surgery
Read on to learn more about the types of surgery, risks, and recovery.
The goal of prostate surgery also depends on your condition. For example, the goal of prostate cancer surgery is to remove cancerous tissue. The goal of BPH surgery is to remove prostate tissue and restore the normal flow of urine.
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Treatment Options For Urinary Incontinence Can Include:
- Pelvic floor physical therapy. These specialized physical therapists are trained to help men strengthen their pelvic floor muscles. These muscles help you control the flow of urine. The exercises are called Kegel exercises just as you might do bicep curls to strengthen your arm muscles Kegel exercises help you learn to tighten and relax the muscles that control your flow.
- Bladder training. The bladder is a muscular organ that can be trained. A pelvic floor physical therapist or your urologist will provide simple behavioral changes to help retrain your bladder.
- Medication. Prescription medicines help the muscles in your bladder and sphincter . These medications work well for men with urge incontinence.
- Surgery. Surgery may be scheduled if you have a blockage. Other surgical procedures include injecting collagen to strengthen the urinary sphincter that controls urine release or implanting an artificial urinary sphincter.
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.
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Penile Rehabilitation After Prostate Removal May Include:
- Prescription medications. Medications, called phosphodiesterase-5 inhibitors, work for many men unless their nerve bundles were damaged or removed. These medications include Viagra and Cialis.
- An injection. Your body makes prostaglandin E1, a substance that helps your body have an erection. A made-made version is now available. Your doctor can teach you to inject this at the base of your penis about 5-to-10 minutes before intercourse. The injection is virtually painless this medication is also available as a suppository placed into the tip of your penis.
- Vacuum devices. These devices draw the air from around your penis. The vacuum created brings blood into your penis, creating an erection.
- Penile implants. A device is surgically implanted into your penis. Penile implants provide a lasting solution for ED, lasting 10 or 15 years. There are risks, but if none of the other penile rehabilitation methods work, many men agree that a penile implant is a cosmetically-acceptable solution for their prostate cancer-related erectile dysfunction.
What Happens Next
You will have regular check-ups after your operation this is called follow-up. Your check-ups will usually start between six and eight weeks after surgery, and they will usually be every three to six months. Over time you may have these less often and two to three years after your treatment you may start seeing your GP instead of your hospital doctor.
You will have a PSA test a week before your check-up, so the results are available at the appointment. The PSA test is a good way of checking if your treatment has worked.Your PSA level should drop so low that its not possible to detect it . A rise in your PSA level can suggest some prostate cancer cells were left behind. If this happens, your doctor will talk to you about further treatment.
Looking at the prostate
Your prostate will be sent to a laboratory to be looked at under a microscope. This can give a clearer idea of how aggressive the cancer might be and whether it has spread.At your first check-up your doctor might talk about positive surgical margin or negative or clear surgical margin.
- Negative or clear surgical margin this means that the tissue the surgeon removed was surrounded by a layer of normal tissue. It suggests all the cancer was removed.
- Positive surgical margin this means there are cancer cells on the edge of the tissue the surgeon removed. It suggests that some cancer cells may have been left behind and you may need further treatment.
Going back to work
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How Does It Work
There are multiple types of surgery that can be used.
Radical prostatectomy : During this procedure, the prostate is removed from the space between the bladder and urethra. An additional lymph node dissection can be done during the procedure if the surgeon feels it is needed for accurate staging .
An open prostatectomy is done through an incision in either the lower abdomen or in the perineum, which is the area between the rectum and the penis. Most laparoscopic removal is now done with robotic assistance.
Cryoablation: This is a surgical procedure done as primary treatment for prostate cancer or when cancer may return after radiation . Needles are placed into the prostate to deliver cold fluid that becomes ice balls, which destroy the tissues they contact.
Focal therapy:This is done with probes that deliver cold or hot energy into areas targeted within the prostate. With focal therapy, only select areas of the prostate are ablated to minimize side effects.
Side effects from prostate surgery can include:
- Urinary incontinence
- Shortening of the penis
- Injury to the rectum and surrounding structures
- Infertility due to the removal of the vas deferens during surgery
Coping With The Side Effects
The side effects of both surgery and radiation can vary from mild to more severe and potentially significantly impact someones life.
The side effects of urinary and bowel problems can be distressing. There are ways to help manage these, such as with pelvic floor exercise, bladder training, and incontinence products. Other coping strategies include:
- Urinating every few hours
- Limiting caffeine intake
- Talking to your healthcare team about any medications or other interventions that may be helpful
Sexual dysfunction related to prostate cancer treatment can also be an unwelcome side effect. Helpful ways to cope with this can include:
- Having open communication with your partner
- Prioritizing activities for the day and taking breaks as needed
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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.
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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