What Is This Post All About
This is a hard decisionsurgery or radiation?
Now remember, what I am going to talk about here is for prostate cancer that hasnt spreadLOCALIZED prostate cancer.
From a 30,000-foot view, surgery and radiation or both EXCELLENT treatment choices for prostate cancer. In general, you can pick and choose certain studies to support one treatment over the other but by and large they are both EQUAL in terms of cancer control.
Now remember, I am a urologist. I try my hardest to provide as unbiased as an opinion as I can but its impossible to remove the fact that I am urologist when providing this information. This is why I will always have my patients meet with a Radiation Oncologist as well as me to hear from them about what radiation is all about as I talk to them about what surgery is all about.
What Is Hormone Therapy For Prostate Cancer
Androgen deprivation therapy is a key treatment strategy for prostate cancer that has recurred following local treatment. The goal of all hormone therapies is to stop the production and/or interfere with the effects of testosterone, which fuels the growth of prostate cancer cells. However, because not all prostate cancer cells are sensitive to increases or decreases in testosterone levels, hormone therapy is a treatment for prostate cancer but does not cure the disease. The decision on starting testosterone lowering or blocking therapies is individualized, based on your PSA, the PSA doubling time, whether the cancer has spread visibly or caused symptoms, and the potential risks involved with this type of therapy.
What Do The Test Results Mean
PSA tests can be difficult to interpret. Tests can also vary from laboratory to laboratory. To ensure accurate comparison, its important to use the same lab each time youre tested.
If your PSA level is low and not rising after repeated tests, its probably not a cancer recurrence. Thats because other cells in your body can produce small amounts of PSA.
Ideally, your post-prostatectomy PSA will be undetectable, or less than 0.05 or 0.1 nanograms of PSA per milliliter of blood . If thats the case, your doctor may call it a remission.
If the result is greater than or equal to 0.2 ng/mL and its risen on two separate tests taken at least two weeks apart, its called a biochemical relapse. You still have PSA in your bloodstream. Theres a chance that cancer has recurred.
A PSA level higher than that may indicate a locally advanced tumor.
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What Factors Increase The Chance Of Cancer Recurrence
The likelihood of metastasis occurring increases with higher grade and stage of the cancer as the more aggressive and developed the cancer is, the higher the chance of it breaking out of the prostate. More specifically:
- High Gleason grades
- High clinical stages
- Positive surgical margins .
However, most prostate cancers are cured with surgery. As an example, using my results from operations performed on over 2,300 men with a variety of stages and grades, 96.3% of operations resulted in full cancer cure. Some combinations of minor prostate cancer had a 100% cancer cure rate, but the higher you go, the lower the full cancer cure rate.
The commonest sites of recurrence of prostate cancer following surgery are:
- the prostate bed 80% of recurrence cases
- lymph nodes 15% of cases
- bones 5% of cases.
Radical Prostatectomy Perineal Approach
You’ll be placed in a supine position in which the hips and knees will be fully bent with the legs spread apart and elevated with the feet resting on straps. Stirrups will be placed under your legs for support.
An upside-down, U-shaped incision will be made in the perineal area .
The doctor will try to minimize any trauma to the nerve bundles in the prostate area.
The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.
The seminal vesicles may be removed if there’s concern about abnormal tissue in the vesicles.
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Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
What Is A Normal Psa Reading Post Prostatectomy
A few months after a prostatectomy, the PSA level should be undetectable or very low, explains the American Cancer Society. The first PSA test should be taken no earlier than six to eight weeks after surgery because the protein takes time to clear out of the blood.
The presence of any PSA after surgery is often a cause of concern for patients because rising PSA levels can mean prostate cancer recurrence, according to the American Cancer Society. Cancer is not always the cause, however, and PSA levels that are very low, steady and not rising can be produced by normal, leftover prostate tissue, says the Prostate Cancer Foundation.
When the protein is detectable after surgery, doctors frequently measure PSA levels a few times to determine if they are increasing, according to the Prostate Cancer Foundation. Cancer recurrence is considered to be indicated by a PSA level that is greater than 0.2 nanogram per milliliter that has risen at least twice in an interval of two or more weeks. When this occurs, doctors often proceed to salvage radiation therapy. This procedure is frequently performed with external beam radiation and aims to destroy the remaining prostate cancer cells.
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When To Get Tested
You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.
Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.
S Used In Best Practice Statement Development
The AUA convened a multidisciplinary panel for the purpose of developing a resource about PSA testing for urologists and primary care physicians. Panel membership included six urologists, one radiation oncologist, two medical oncologists, one internist and one epidemiologist. Funding in support of panel activities was provided by the AUA. Panel members received no remuneration for their efforts, and each member provided conflict of interest disclosure.
The Panel formulated its policy statements and recommendations by consensus, based on a review of the literature and the Panel members’ own expert opinions. The current policy was based on a reassessment of the previous policy published in 2000. After Panel members agreed on the general areas to be covered, each member took on the task of conceptualizing and writing and/or revising a section of the document in an area where he/she had specific expertise. Every part of the document was thoroughly critiqued by Panel members, both in written comments and in verbal discussions in a series of conference calls. Over the course of successive manuscript revisions, the Panel scrutinized and modified the conceptual framework, reworked the wording of key statements, and reexamined supporting evidence reported in the literature until Panel members reached consensus.
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How Long Will I Have To Take Hormone Therapy
With intermittent hormone therapy, the LHRH agonist is used for 612 months, during which time a low PSA level is maintained. The drug is stopped until the PSA rises to a predetermined level, at which point the drug is restarted. During the drug holidays in between cycles, sexual function and other important quality of life measures might return. However, the clinical benefits of this approach remain unclear, and large clinical trials are currently underway to evaluate its use in this setting.
Standard Care Post Treatment
After radiation treatment, doctors typically measure the PSA level every three months in a patient for the first year, and every six months thereafter. During the first year or two, patients normally experience a decline in their PSA blood test score. If the PSA level steadily decreases and stays relatively level after reaching its low point, then the treatment is considered a success.
However, if the PSA reaches a low point and then begins to steadily rise, the patient may be having a reoccurrence of the cancer, which could require additional treatments such as a hormonal blockade.
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The Purpose Of Prostate Surgery
Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.
It has been performed for many years and was regarded as the gold standard of prostate cancer treatment. However, few studies compare its efficacy to other techniques.
Most men diagnosed with prostate cancer today are typically diagnosed with Gleason 6 cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:
Misuse of the term cancer has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.
The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they dont really have.
Aggressive treatment, usually a complete surgical removal of the prostate , is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.
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What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
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If Your Prostate Cancer Has Spread
If cancer has spread to other parts of your body it cant be cured. This is advanced prostate cancer. Treatment can help to control the cancer and your symptoms. This might be:
- hormone treatment to lower your testosterone levels
- bisphosphonates to help with bone pain
- radiotherapy to particular parts of the skeleton
- radioactive liquid treatment radiotherapy , such as radium-223
If hormone therapy is no longer working for you, you might have:
What Other Tests Do I Need
After prostatectomy, youll probably have a PSA test in about six weeks or so. Your doctor will recommend a follow-up schedule, usually every three months for two years. Depending on the results, you may need to test once or twice a year thereafter. Testing may be more frequent if it appears to be rising.
If your PSA levels are high and you have symptoms such as bone pain, imaging tests can be used to determine if cancer has spread. These may include bone scans and CT scans. If a mass is found, a biopsy can determine if its cancerous.
You might not need treatment right away. If youve had multiple PSA tests and it appears that your PSA level is rising, a number of other factors determine the next steps. These factors include:
- age and life expectancy
- if cancer has spread and where
- previous treatments
Radiation therapy after prostatectomy, also known as salvage radiotherapy, can be quite effective after a prostatectomy. External beam radiation can be delivered directly to the area around where the prostate was. The goal is to destroy prostate cells that may have been left behind after surgery. This lowers the risk of recurrence and metastasis, or of the cancer spreading.
Metastatic prostate cancer may not be curable, but there are treatments to slow progression and manage symptoms. Treatments may include:
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How Is Psa Testing Used For Pretreatment Staging Of Prostate Cancer
Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy and assigned a cancer grade , PSA is used in combination with the grade of the prostate cancer to determine further medical studies needed for cancer staging. Staging determines if the cancer is localized or metastatic . Staging therefore drives the best management and appropriate treatment for the cancer. As mentioned earlier, serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion as well as metastasis to the pelvic lymph nodes.
How Important Is The Psa Test After Prostatectomy
The answer is: very . A major milestone in prostate cancer treatment is obtaining your PSA level close to zero after surgery. The expected result after prostatectomy is an undetectable PSA or level of 0. The surgery itself is a cornerstone of a mans life, but the tests that follow, especially the PSA test, can be very dreaded.
The PSA test is a blood analysis that checks for the level of the prostate-specific antigen in the blood cells. The PSA is an enzyme secreted only by the prostate cells. When the PSA level is zero or close to zero after radical prostatectomy, the patient is reassured that he is cancer-free and can regain peace of mind. In the majority of cases, this is the scenario. There are also rare cases when the follow-up tests reveal an elevated PSA after prostatectomy. What to do if this is your case?
Sex After Surgery To The Prostate Gland
When your prostate gland is removed, you will still make sperm, but it wonât come out through your penis. It will be absorbed back into the body. You may also have problems with erections or lose interest in sex after prostate surgery. Although you may feel embarrassed, doctors who deal with prostate cancer are very used to talking about these issues and will be able to give you advice. There are treatments that can help with this.
Immediate Radiation When Psa Levels Spike After Prostate Cancer Surgery Helps Reduce Risk Of Recurrence
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Following surgery to remove a cancerous prostate gland, some men experience a biochemical recurrence, meaning that prostate-specific antigen has become detectable in their blood. Since only the prostate releases PSA, removing the gland should drop this protein to undetectable levels in the body. Detecting PSA could signify that prostate cancer cells are lingering, and forming new tumors before they can be seen with modern imaging technology. PSA isnt always reliable for cancer screening, but it is a very sensitive marker of new cancer growth after initial treatment.
Doctors usually treat biochemical recurrence by irradiating the prostate bed, or the area where the gland used to be. Studies have shown that this treatment, which is called salvage radiation, helps to minimize the risk that prostate cancer will return and spread, or metastasize. But when to initiate salvage radiation has been open question, since PSA will also rise if small amounts of benign prostate tissue have been left behind after surgery. Many times, doctors dont know if biochemical recurrence is really cancer, so they wait to see if the PSA levels will rise any further.
In this newer era of ultra-sensitive PSA testing we didnt know if giving salvage radiation at lower levels would make a difference or not, Tendulkar said. Now we know that it does.
What Happens At A Follow
Discussion with your doctor or nurse
At each appointment, your doctor or nurse will ask how youve been since your last appointment.
Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.
Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.
You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.
You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.