What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenbergs Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
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When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety
Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.
The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.
For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.
You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.
What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages.
- Stages I & II: The tumor has not spread beyond the prostate. This is often called early stage or localized prostate cancer.
- Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called locally advanced prostate cancer.
- Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called advanced prostate cancer.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . If prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer. Stage IV prostate cancer is not curable, but there are many ways to control it. Treatment can stop advanced prostate cancer from growing and causing symptoms.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
If your Prostate Specific Antigen level has risen after the first treatment but you have no other signs of cancer, you have biochemical recurrence.
Castration-Resistant Prostate Cancer
- Lymph nodes outside the pelvis
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Radical Prostatectomy Survival Rates
Men who undergo radical prostatectomy have a high survival rate and low rates of cancer recurrence, cancer spread and death, according to a study of 10,332 men who had surgery between 1987 and 2004. The research showed that between 5 and 20 years after having the surgery, only 3% of the patients died of prostate cancer, 5% saw their cancer spread to other organs, and 6% had a localised recurrence.
Another large Scandinavian study compared men who chose active surveillance with those treated by radical prostatectomy. The results suggest that in the long term, younger men with higher-risk tumours who have a radical prostatectomy, have a definite survival advantage.
Results from another study at Johns Hopkins Hospital in Baltimore confirmed that 82% of men undergoing radical prostatectomy were free of recurrence at 15 years. The data from the research also indicated that in those men whose PSA level starts to rise again after surgery, the recurrent prostate cancer spreads in only around one-third of the men. In addition, unless a man had an aggressive grade of prostate cancer, the spreading of the disease would not become life-threatening for several years and would be amenable to treatment.
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Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when it’s half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
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
- 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.
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Prostate Cancer Survival Rates: What They Mean
As cancer diagnoses go, prostate cancer is often a less serious one. Prostate cancer is frequently slow-growing and slow to spread. For many men, prostate cancer is less serious than their other medical conditions.
For these reasons, and possibly because of earlier detection of low-grade prostate cancers, prostate cancer has one of the highest survival rates of any type of cancer. WebMD takes a look at prostate cancer survival rates and what they mean to you.
Survival Of Prostate Cancer
Survival depends on many factors. No one can tell you exactly how long you will live.
Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.
Survival for prostate cancer is generally good, particularly if you are diagnosed early.
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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.
Results Of Oncological Treatment
Figure 1 shows the KaplanMeier curves for carcinoma-specific survival in patients with tumor stage pT3a, pT3b, pT4, pN1 and/or preoperative PSA > 20 ng/mL and/or prostatectomy Gleason score 8.
Prostate carcinoma-specific survival after radical prostatectomy for patients with confirmed locally advanced tumors and/or confirmed lymph-node metastases and/or preoperative PSA > 20 ng/mL and or Gleason score 8 in the prostatectomy specimen. The dotted lines show the 95% confidence interval. a) Prostate carcinoma-specific survival, stratified according to pT stage. b) Prostate carcinoma-specific survival in patients with lymph-node metastases. c) Prostate carcinoma-specific survival in patients with preoperative PSA > 20 ng/mL. d) Prostate carcinoma-specific survival in patients with prostatectomy Gleason score 8.
The 10-year carcinoma-specific survival rates were:
- 98% for patients with stage pT3a
- 87% for patients with stage pT3b
- 77% for patients with stage pT4
- 81% for patients with confirmed lymph-node metastases
Among patients with a high-risk tumor constellation, the 10-year carcinoma-specific and 10-year overall survival rates were 93% and 85% respectively for those with a preoperative PSA level > 20 ng/mL and 70% and 58% for those with a prostatectomy Gleason score 8 . The corresponding 10-year biochemically recurrence-free survival rates were 32% and 25%.
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Difficulty Getting An Erection
Impotence is more likely to happen if you are older. Nerve sparing surgery and robotic surgery may reduce the risk for some men. Speak to your doctor before you have surgery to get an idea of your risk of problems afterwards.
Differences Among Risk Groups
Men with PCa have been classified into low-, intermediate- and high-risk Groups for tumor recurrence and disease specific mortality, based on PSA level, clinical or pathological staging and GS. High-risk patients have PSA level 20ng/mL or GS 8 or clinical/pathological stage T2c . Lymph-node positive and PSM have also been reported as poor prognosis factors.
Risk Group classification predicts biochemical and clinical progression as well as PCa specific mortality and overall survival. The risk of disease progression in these groups has been validated for patients submited to RP in many studies. In patients from Mayo Clinic, BCR rates were 2.3 and 3.3-fold greater in high and intermediate-risk in comparison with low-risk patients, respectively. In those patients, mortality rates in high and intermediate-risk patients were greater than 11 and 6-fold over low-risk men .
Therefore, it is crutial to understand the role of each clinical and pathologic feature in PCa BCR and disease progression.
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Strengths And Limitations Of The Study
This study had two major strengths it is a population wide study evaluating 15 year quality of life outcomes in men with localised prostate cancer across a range of different common treatments and includes a population based control group of men without prostate cancer for comparison. A major advantage of using a population based control group is that it allows men to quantify their expected decline in quality of life resulting from the combination of their cancer and its treatment choice, while also allowing them to indirectly compare quality of life difference between treatments . A few limitations need to be considered, however, when interpreting our results.
Firstly, we considered it important to use men without prostate cancer as controls in order to provide the most meaningful comparator for patients with prostate cancer and clinicians, and therefore we were unable to adjust for disease severity in the multivariate analysis . Nevertheless, we believe that this choice of reference group had little association with our findings as a sensitivity analysis indicated that clinical stage, Gleason score, and prostate-specific antigen level at baseline did not appreciably confound the association with treatments .
Fourthly, although we adjusted for a wide range of potential confounders to account for differences in patient characteristics between groups, as with all non-randomized studies, the possibility of residual confounding cannot be ruled out.
The Main Advantage Of Prostatectomy
This is a very important comment I am gonna make right now. If your cancer ever comes back after surgery, the idea of having a plan B of having low-dose radiation after surgery is feasible. If you start with radiation and cancer comes back, surgery would be very difficult and challenging. So, I want you to know this because not too many people are aware of this.
Again, one more time. If you start with surgery, you still have the radiation as an option. If you start with radiation, surgery would be very difficult because the tissue becomes like a cement attached to the rectum and the surrounding tissues and it would be very difficult to do that operation.
As you get older, because we have removed the prostate with the surgery, you do not have to worry about the old-man disease, an enlarged prostate. With radiation may be some consequences with bleeding from the rectum or bleeding from the bladder. Certainly, in the hands of an experienced radiation oncologist, the results are better. We have superb doctors at St. Francis Hospital. One of my colleagues, Dr. Jay Bosworth, whom I am looking forward to interviewing him at this program, is a fine radiation oncologist and you will have what to learn from him. So, the risks of side-effects in the hands of an experienced radiation oncologist would be less. But there is a small chance of having secondary cancers such as rectal cancer or bladder cancer at some point down the road after radiation.
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Early Mortality Of Prostatectomy Vs Radiotherapy As A Primary Treatment For Prostate Cancer: A Population
- Department of Radiation Oncology, University Hospital Halle , Halle , Germany
Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population.
Methods: Data from the Surveillance, Epidemiology, and End Results database and East German epidemiologic cancer registries were used for the years 20052013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age , risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models.
Results: In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy approaching the null effect value not before 24-months after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population comparing surgery and radiotherapy. The same was true in the German cohort . Considering low-risk cases, the adverse surgery effect appeared stronger.
There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months.
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Most Prostate Surgeries Are Now Done Robotically
In the U.S., about 95% of prostate surgeries are performed robotically, with the surgeon sitting apart from the patient at a control console, watching progress on a high-definition monitor while controlling the robot remotely. The robot translates the surgeons hand movements into precise micro-movements, making it easy for them to manipulate a tiny camera and surgical instruments with greater range of motion than they could with their hands.
Robotic procedures are done with the patient under general anesthesia and take two hours or more to complete. The possibility of side effects is a concern with any type of prostatectomyeven with the aid of a robotthe main ones being an inability to control urine after surgery, and difficulty having or maintaining an erection. There are several different types of robotic surgeries, and each one comes with its own set of benefits.
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Further Treatment After Radical Prostatectomy
Two other therapies are occasionally recommended after surgery, based on the pathology report after the surgery as well as the subsequent PSA response.
Radiation therapy may be offered to some men with high-risk prostate cancer who have cancer that has penetrated through the prostate capsule or have positive margins after surgery. Studies have shown that recurrence rates drop by approximately 50% in these men if they receive radiotherapy after surgery. However, some of these men may not develop recurrent tumours even without further treatment and may also suffer the additional side-effects of the radiotherapy. The most standard strategy, therefore, is to use radiation therapy only if PSA levels rise above 0.2 ng/mL.
Hormone therapy may be recommended for men who have cancer found in their lymph nodes at the time of surgery. Studies have shown that for some of these men, hormone therapy helps patients live longer.
Ultimate Outcomes Are Similar Regardless Of The Surgical Approach
In general, while each approach has its advantages, all have been shown to have similar outcomes, adds Dr. Sprenkle. There are no significant differences in outcomes for patients between the open surgery and robotic ones. There is less blood loss on average with robotic surgery, and in the hands of a good surgeon, continence and sexual preservation is the same, he says, adding that while it varies from patient to patient, average recovery time is six weeks. And cancer control is the same. Put another way: Its better to focus on finding the right surgeon rather than the approach or type of surgery.
As far as what that means for patients deciding on which surgery they should get, Dr. Sprenkle says that its important to take time to think about all of your options.
And ask a lot of questions, he says.
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