What Have I Learned By Reading This
You learned about:
- 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
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someones risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.
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Open Prostatectomy For Prostate Cancer
Open prostatectomy is a traditional open surgical procedure, which means the surgeon accesses the prostate gland through a standard surgical incision. For most patients, the incision is 4 to 5 inches long.
In contrast, a robotic prostatectomy performed with laparoscopic instruments requires several smaller incisions.
The open procedures longer incision results in a slightly longer recovery time. While the average recovery time following robotic prostatectomy is 4-1/2 weeks, recovery following open prostatectomy is about 6 weeks.
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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.
The Morning Of Your Surgery
Instructions for drinking before your surgery
You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower with a 4% CHG solution antiseptic skin cleanser
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Dont put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Dont wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Dont put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Leave valuable items at home.
What to bring
Once youre in the hospital
Get dressed for surgery
When its time to change for surgery, youll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
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Urinary Problems After Surgery
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.
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 Paul’s story for one man’s experience of managing urinary problems after surgery below.
Sexual problems after surgery
Change in penis size and shape
Changes to orgasm
The seminal vesicles, which make some of the fluid in semen, are removed during surgery. This means you wont ejaculate any more. You may have a dry orgasm instead where you feel the sensation of orgasm but dont ejaculate. This may feel different to the orgasms youre used to.
Biopsy: Things You Need To Know
The first thing you should know is that theres still plenty of room for confusion after a . The prostate in a young man is about the size of a walnut with age and it can get bigger think of a lime, or a lemon, or even an orange. Now, imagine that you have about 14 tiny needles each needle has a hollow center, and when it is stuck into the prostate, it takes out a very small core of tissue. Theres a lot of potential to miss any cancer that might be hiding in there.
This is why many men end up getting multiple repeat biopsies, says NYU Stacy Loeb, M.D. This means that you might have a that is elevated. Your doctor orders a , and no cancer is found. But the PSA keeps on creeping up, so your doctor recommends another biopsy, and maybe even another. About a third of men in one study got another biopsy within five years of a negative biopsy, says Loeb. If the PSA is elevated, do we do another biopsy, or what do we do? This is where some of the second-line PSA tests, like the Prostate Health Index or 4K Score, can be helpful.
A urine test, called the PCA3 test, may also be helpful. Unlike the PSA test, which is prostate-specific but not cancer-specific , the PCA3 test targets genes produced by prostate cancer cells.
First, it can hurt. To get to the prostate, the doctor goes through your rectum. With needles. To minimize pain, your urologist may use conscious sedation or an anesthetic called a prostatic block .
What About Problems With Potency
Return of normal erectile function depends on a number of physical and psychological factors, including the type of prostatectomy . Function may return from one week to one year after surgery, It typically takes several months. A program of penile rehabilitation, using medications such as Viagra or Muse, is recommended as part of the process to facilitate healing and return of erectile function. Additional factors that can affect erectile function include hypertension, diabetes, obesity, atherosclerosis, smoking and anxiety.
Do Laser Treatments Have Any Advantages Over Turp
As well as the standard approaches such as TURP, there are a number of other surgical techniques. They mainly differ in terms of the instruments and sources of energy used to remove or destroy the prostate tissue. Most of the other techniques are carried out using laser beams. Like in TURP, the instruments are inserted into the urethra and guided to the prostate.
The laser treatments include:
- Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995 332: 75-79.
IQWiG health information is written with the aim of helpingpeople understand the advantages and disadvantages of the main treatment options and healthcare services.
Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.
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Life After Prostate Removal: Postoperative Care And Recovery
The duration of time people stay in hospital after their prostatectomy varies, though it will usually be between two and three days. However, if open surgery is performed this timeframe may rise to seven or more days in hospital, depending on which hospital and country the surgery is performed in.
After this, it will be necessary to spend some recovery time at home while the surgery site heals the length of this may vary depending on the type of operation. It is possible, particularly if the procedure was a laparoscopic prostatectomy, to recover sufficiently to return to work after a period of two to three weeks. Nearly everybody who undergoes a prostatectomy recovers sufficiently to return to work after six weeks.
As soon as the operation is complete, and while the person undergoing the procedure is still in the operating room, a temporary suprapubic catheter will be inserted to assist them in urinating during the immediate recovery process. A suprapubic catheter is a hollow, flexible tube which is inserted into the bladder through an incision in the stomach above the navel . The catheter is left in place for one or two weeks and helps drain the urine from the bladder whilst the area, which has undergone surgery, is healing. In some cases, instead of the suprapubic catheter, a transurethral catheter leading from the exit of the urethra at the tip of the penis to the bladder may be inserted.
What Is Robotic Prostate Surgery
A surgical treatment for prostate cancer, the radical prostatectomy procedure removes the entire prostate gland. Radical prostatectomy can now be done by laparoscopic or robotic techniques.In open prostate surgery, the prostate gland is removed through a larger incision in the lower abdomen. Laparoscopic prostate surgery involves key-hole incisions which used for inserting a lighted viewing instrument into the pelvic region and allows examination and removal of the prostate without a large abdominal incision.
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Erectile Dysfunction Following Radical Prostatectomy
Assuming the management of erectile dysfunction requires expert diagnosis and treatment.
Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.
Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.
Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins noted Sexual Behaviors Consultation Unit.
Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.
Now, newly published results from a phase 3 clinical trial are providing some needed guidance.
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What Medications Cause An Enlarged Prostate
Diuretics, or medications that increase urination, can also worsen symptoms. While they are not medications, alcohol and caffeine can also worsen the symptoms associated with prostate enlargement. Many popular nonprescription cold and allergy medications contain decongestants that can cause the bladder neck to contract.
Treatment For Prostate Cancer: Surgery
The operation to remove the prostate, called a radical prostatectomy, is one of the most difficult surgical procedures there is. There are several reasons for this: One is simply the prostates hard-to-get-to location deep in the pelvis. Two, there are a lot of blood vessels and important nerves around there, particularly the nerve bundles that are responsible for erection, which sit on either side of the prostate. It takes an expert surgeon to know how to navigate this treacherous terrain, which also includes the rectum, bladder, and a muscle called the urinary sphincter, which you use for urinary control.
And three, there is the urethra. The urethra runs down from the bladder all the way through to the tip of the penis its the tube through which you urinate. Strategically placed between the bladder and the penis is the prostate. Basically, the prostate is like a walnut-sized donut, and the urethra is like a straw stuck right in the middle of it. You cant take out the prostate without cutting through the urethra. And you cant leave the urethra cut, because the urine would just spill out of the bladder into your body, so it must be reattached to the bladder. None of this is easy, and all of it needs to be done skillfully.
Were talking about the difficulty here to make a few key points:
If you have a very large prostate, greater than 100 grams, open surgery is most likely better for you, because it gives the surgeon more room to work.
Biopsy And Gleason Score
A pathologist looks for cell abnormalities and grades the tissue sample from 1 to 5. The sum of two Gleason grades is the Gleason score. These scores help determine the chances of the cancer spreading. Gleason grades of 1 and 2 are not usually given in biopsies, so 6 is typically the lowest score for a prostate cancer. Cancer with Gleason scores of 8 to 10 is called high-grade, and can grow and spread more quickly. Gleason scores help guide the type of treatment your doctor will recommend.
Types Of Prostate Surgery
There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.
Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.
The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.
Keyhole surgery .
- Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
- Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.
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