What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
What Happens On Treatment Days
External radiation therapy requires regular sessions during a period of about five to eight weeks. For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure you are positioned well, they will leave the room and start the radiation treatment.
You will be under constant observation during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Be sure to remain still and relaxed during treatment. Let the therapist know if you have any problems or discomfort.
The therapist will be in and out of the room to reposition the machine and change your position. The treatment machine will not touch you, and you will feel nothing during the treatment. Once the treatment is complete, the therapist will help you off the treatment table.
The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that you are being positioned accurately during your treatments.
Port films do not provide diagnostic information, so radiation therapists cannot learn about your progress from these films. However, port films are important to help the therapists make sure the radiation is delivered to the precise area that needs treatment.
What Is Prostate Removal
A prostatectomy is a surgical procedure for the partial or complete removal of the prostate, which is a small gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum in men. The prostate supplies part of the seminal fluid , which mixes with sperm from the testes. Sperm needs this fluid to travel and survive for reproduction.
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Help To Continue The Work
The Prostate Cancer Free Foundation, reviews the results of hundreds of thousands of men treated for prostate cancer. Tracking them for years. This information is available to you, and others like you, to help find the best prostate cancer treatment. This work takes time, effort, resources all of it done by volunteers. Please help us continue. Please Donate!
What Is A Prostatectomy
A common surgical approach to prostatectomy includes making a surgicalincision and removing the prostate gland . This may beaccomplished with either of two methods, the retropubic or suprapubicincision , or a perineum incision .
Prior to having a prostatectomy, it’s often necessary to have aprostate biopsy. Please see this procedure for additional information.
Prostate Cancer: Treatment Advances You Should Know About
Prostate cancer treatment has entered the robotics age. Using advancedrobotic technology, Johns Hopkins surgeons can see the prostate in 3-D,magnifying everything 10 times. Johns Hopkins urologist Mohamad Allaf, M.D., explains what this means for patients, including fewer side effects.
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Benefits Of Prostate Artery Embolization
The benefits of the PAE procedure include:
- It is a non-invasive, outpatient procedure
- Patients can expect to see results within a few days
- Recovery time is significantly lower
- Less risk of urinary incontinence
- Less risk of sexual side effects
- No retrograde ejaculation
- Less pain/discomfort during and after the procedure
Patients who have BPH typically suffer from the following symptoms:
- Difficulty starting the urination process
- Frequent and urgent need to urinate
- Weak stream of urine or a stream of urine that stops and starts
- Increased nocturnal urination
- Blood in the urine
Once a man undergoes this procedure, it typically takes a couple of weeks to get relief and feel like his body is functioning like it did when he was younger.
Does Incontinence Happen If I Treat Prostate Cancer With Radiation
Some men need radiation therapy after prostate removal. During radiation therapy, some of the normal tissues around the urinary sphincter, urethra and bladder may be exposed, causing irritation to occur post therapy, leading to incontinence. This typically subsides within a few months after radiation therapy, however if it persists, additional treatments described below may be helpful.
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Prostate Biopsy Side Effects Are Common
Complications from prostate biopsies are common but usually not severe, a study in Urology reveals. Participants in the study had biopsies to look for cancer after an abnormal rectal exam or prostate-specific antigen blood test. In a biopsy, a fine needle punches quickly through the rectal wall to remove a tiny sample of prostate tissue for examination under a microscope. Doctors took 12, 18, or 24 samples per participant. Typical problems from biopsy include pain, soreness, and infections. A more serious complication, which may lead to hospital admission, is acute urinary retention, in which a man is temporarily unable to drain his bladder.
Here is what the study found:
40% of the men experienced a complication.
The complication rate was as high as 57% in men with 24-sample biopsies.
Only 1.2% of the men required hospital admission.
9.1% ended up visiting an emergency room.
6.7% developed acute urinary retention.
Prostate needle biopsy is the only way to diagnose prostate cancer, regardless of PSA test results. The complication rate would vary with the general health of the men involved.
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- Research health conditions
- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
Open Rp Versus Robotic
The ability to perform robotic-assisted laparoscopic RP was first described in 2000. Over the past decade, RALRP has gained widespread acceptance and now is the dominant approach to RP in the United States. Many attribute the adoption of the RALRP to marketing as opposed to any objective outcomes data showing superiority over the open approach.
All of the intermediate- and long-term HRQOL outcomes reported in the literature are limited to open RP. The question is, are these findings relevant to RALRP?
Unfortunately, there are no randomized studies comparing HRQOL outcomes following open versus robotic RP. The majority of studies comparing HRQOL outcomes between the two techniques are flawed in design. First, the level of experience of surgeons performing the two techniques and their patient volume are often not comparable. In addition, validated instruments for capturing outcomes are usually not employed. Surgeons are sometimes involved in the data acquisition, entry, and interpretation, which can introduce bias. There are several studies that have examined large administrative databases, which often mitigate bias, but the quality of outcome measures is subject to criticism. A few studies stand out as objective and worthy of comment.
Barocas and colleagues compared men undergoing open and RALRP and failed to show any advantages of either approach for preventing biochemical recurrence.
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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
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Incontinence After Prostate Surgery Forums
Going through prostate cancer and having your prostate removed can be a physically and emotionally trying time in life. Many men are unprepared for the extent to which they may experience bladder leaks after prostate removal and it can be disheartening to have undergone surgery only to experience a loss of bladder control for a period afterward.
Fortunately, this is usually resolved within a year. During that time though, you may find that you need someone to talk to about your experience. Finding a forum or message board filled with people who can relate can help ease some of the tensions that you may be going through.
The NAFC message boards are a great way to connect with others who may also be experiencing incontinence, due to prostate surgery or other conditions. Theyre free to join and the forum is anonymous so you can speak freely without the worry of feeling embarrassed or ashamed. NAFC is proud of this amazing group of individuals who visit the forums and courageously share their stories, offer support, and provide inspiration to each other. We encourage you to check it out!
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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.
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Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
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Will Radiation Therapy Make Me Tired
Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.
If your doctor thinks you should limit your activity, they will discuss it with you.
To minimize fatigue while you are receiving radiation treatment:
- Be sure to get enough rest.
- Eat well-balanced, nutritious meals.
- Pace your activities and plan frequent rest periods.
Tips For Talking With Your Partner
Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:
- Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
- Listen to your partners concerns, too. Remember that this issue affects both of you.
- See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
- If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.
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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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Why Does It Take So Long To Recover Erections After The Very Best Surgery
A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma.
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How Will Sex After Prostate Cancer Be Different
One of the treatments of prostate cancer is to remove a portion of the prostate or the totality of the gland before cancer spreads beyond it You may have heard that the tumor is inside the capsule, but moving fast.
The procedure is known as radical prostatectomy and involves incisions, either above the perineum or on the lower abdomen.
Newer surgeries are sometimes robot-assisted, and we also have laparoscopic prostatectomies that do not require a large incision.
The end result is the removal of a portion or the totality of the prostate, and certain surgical approaches may be associated with a lower risk of nerve damage than others. Youll see this referred to as nerve-sparing prostatectomies throughout this guide.
As soon as a man is informed that he will need to go through a Radical Prostatectomy, the likelihood is that one of the very first questions will be about the effect that it will have on their sex life. In a lot of mens minds, the surgery is thought of like its castration.
However, now that there are multiple types of nerve-sparing prostate surgery, many men have found they can maintain sexual activity after surgery.
Likewise, there are plenty of sexual activities open to those who do find they still have the desire, even with some physical changes. We want to help you understand the changes that men can experience after prostate surgery, whether that is physical or mental.
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 Paulâs story for one manâs 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.