Long Term Urinary Symptoms
Flomax can be taken long-term if needed. If the long-term symptoms are very troubling, then sometimes a TURP is performed. The urologist places an instrument up the penis and widens the urine passage as it passes through the prostate. It is important that as little tissue be removed as possible, as doing a TURP after radiation therapy can increase the chance of urine leakage. Other options are to try to stretch the urethra with a procedure called dilatation. Self catheterization, I.e learning to insert a catheter through the penis and up to the bladder, is also an option for the most severe cases.
Getting Chemotherapy Through An Iv
If you are getting chemotherapy medicines that are given through an I.V. , you will go to a clinic on the day you are scheduled to have your chemotherapy. If your blood test shows that you can get your chemotherapy, a chemotherapy nurse will start you on an I.V. A thin needle is carefully placed into one of the veins in your arm or in the back of your hand. The needle will be taken out of your arm when your chemotherapy treatment is finished. This needle will be connected to two bags of liquid by a small tube. One bag contains your chemotherapy medicine. The second bag contains a fluid that will be used: 1) to wash all the chemotherapy medicine out of the tubing and into your body and 2) to make sure that you have fluid going into your vein until the nurse removes the needle. This extra fluid will help you feel better during your treatment. The chemotherapy nurse will give the medicine to you slowly through the I.V. Everything will probably go well during your treatment. If you have a problem during your treatment, there will be a nurse nearby who will check on you while you get your chemotherapy. Do not be afraid to tell the nurse if you do not feel good or if your arm starts to hurt at the place where the needle goes into your vein.
Cytotoxics And Targeted Therapies
Targeted therapies are a relatively new class of cancer drugs that can overcome many of the issues seen with the use of cytotoxics. They are divided into two groups: small molecule and antibodies. The massive toxicity seen with the use of cytotoxics is due to the lack of cell specificity of the drugs. They will kill any rapidly dividing cell, tumor or normal. Targeted therapies are designed to affect cellular proteins or processes that are utilised by the cancer cells. This allows a high dose to cancer tissues with a relatively low dose to other tissues. Although the side effects are often less severe than that seen of cytotoxic chemotherapeutics, life-threatening effects can occur. Initially, the targeted therapeutics were supposed to be solely selective for one protein. Now it is clear that there is often a range of protein targets that the drug can bind. An example target for targeted therapy is the BCR-ABL1 protein produced from the Philadelphia chromosome, a genetic lesion found commonly in chronic myelogenous leukemia and in some patients with acute lymphoblastic leukemia. This fusion protein has enzyme activity that can be inhibited by imatinib, a small molecule drug.
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Provenge For Advanced Prostate Cancer
Provenge isn’t your everyday vaccine. It’s an immune therapy created by harvesting immune cells from a patient, genetically engineering them to fight prostate cancer, and then infusing them back into the patient.
It’s approved only for treatment of patients with few or no prostate cancer symptoms whose cancer has spread outside the prostate gland and is no longer responding to hormone therapy.
Once a cancer grows beyond a certain point, the immune system has a hard time fighting it. One reason is that cancer cells look a lot to the immune system like normal cells. Another reason is that tumors may give off signals that manipulate the immune system into leaving them alone.
Provenge bypasses these problems. The treatment first removes a quantity of dendritic cells from a patient’s blood. Dendritic cells show pieces of tumor to immune cells, priming them to attack cells that carry those pieces.
The patient’s doctor ships the cells to Provenge’s manufacturer, Dendreon, which then exposes them to Provenge. Provenge is a molecule made inside genetically engineered insect cells.
Once these cells have been exposed to Provenge, they’re shipped back to the doctor who infuses them back into the patient. This is done three times in one month. The first infusion primes the immune system. The second and third doses spur an anticancer immune response.
What Chemotherapy Drugs Are Used To Treat Prostate Cancer
The chemotherapy drugs used for prostate cancer are typically used one at a time. These drugs include:
In most cases, the first chemotherapy drug given to patients with metastatic prostate cancer is Taxotere.
If Taxotere doesnt work or stops working, the next chemotherapy drug doctors typically try is Jevtana, although doctors may try other drugs or treatment options.
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Combination Radiation And Endocrine Therapy
Sometimes, patients receive hormone therapy in combination with external beam radiation therapy for the treatment of prostate cancer. This treatment uses a high-energy X-ray machine to direct radiation to the prostate tumor. For patients with intermediate or high risk prostate cancer, studies show this combination is more effective at slowing the disease than endocrine therapy or radiation therapy alone.
Radiation can also come in the form of a monthly intravenous drug called Xofigo. Xofigo is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received therapy designed to lower testosterone. The drug works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.
Two other similar drugs are strontium-89 and samarium-153 .
What Have I Learned By Reading This
You learned about:
- Ways to get chemotherapy, and
- What to expect when you have chemotherapy.
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 chemotherapy treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment.
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Antiandrogens For Prostate Cancer
These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.
Available antiandrogens include abiraterone acetate , apalutamide ,Ã biclutamide , darolutamide ,Ã enzalutamide , flutamide , and nilutamide . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.
How Is Chemotherapy Given
Chemo drugs for prostate cancer are typically given into a vein , either as an infusion over a certain period of time. This can be done in a doctors office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
Many different kinds of CVCs are available. The most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have.
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Standards Of Care In Hormone Therapy
Most doctors agree that hormone therapy is the most effective treatment available for patients with advanced prostate cancer. However, there is disagreement on exactly how and when hormone therapy should be used. Here are a few issues regarding standards of care:
Timing of Cancer Treatment
The disagreement is due to conflicting beliefs. One is that hormone therapy should begin only after symptoms from the metastases, like bone pain, occur. The counter belief is that hormone therapy should start before symptoms occur. Earlier treatment of prostate cancer is associated with a lower incidence of spinal cord compression, obstructive urinary problems, and skeletal fractures. However, survival is not different whether treatment is started early, or deferred.
The only exception to the above, is in lymph node-positive, post-prostatectomy patients, given androgen deprivation as an adjuvant immediately after surgery. In this situation, immediate therapy resulted in a significant improvement in progression free survival, prostate cancer specific survival, and overall survival.
Length of Cancer Treatment
The disagreement in this situation is between continuous androgen deprivation and intermittent androgen deprivation.
Combination vs. Single-Drug Therapy
How Vitamins Affect Chemotherapy Drugs
Many people want to take an active role in improving their overall health. They want to help their bodys natural defenses fight the cancer and speed up their recovery from chemo. Most people think of vitamins as a safe way to improve health, so its not surprising that many people with cancer take high doses of one or more vitamins. But some vitamins might make chemo less effective.
More research is needed, but until more is known about the effects of vitamins on chemo, keep these points in mind:
- If your doctor has not told you to take vitamins, its best not to take any.
- Always check with your doctor first before starting to take a vitamin of any kind, even a simple multivitamin.
- Ask your doctors if and when it might be OK to start taking vitamins after treatment.
- If youre concerned about nutrition, you can usually get plenty of vitamins by eating a well-balanced diet. See Nutrition for People With Cancer to learn more about nutrition during and after cancer treatment.
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Overview Of Side Effects
Alas, every treatment for prostate cancer involves a risk of side effects, both short term and long term. There is no magic bullet that produces zero side effects, and you should not trust any treatment which claims to have zero risk of side effects.
CyberKnife does tend to have mild side effects. Many men I see in follow-up at 3 12 months report that it is as if they never had the treatment, they are not aware of any residual side effect. Everyone is different however, and there is a wide range of what they experience. Side effects from radiation can be subdivided into short term and long term.
Short-time side effects typically occur from 1 week to 2 months following CyberKnife, and are due to inflammation caused by the radiation. Long-term side effects typically start 6 months or later after the radiation, and are due to scarring and fibrosis.
The most common situation we see is this: During the treatment sessions there are no side effects. A week or two after radiation, the urination becomes a little more frequent with mild burning and more frequent urination. This lasts a month or so. By the 3 month mark the patient has recovered pretty much fully, and reports no remaining side effects. In the years that follow, the erections may be weaker and the patient may request a Viagra or Cialis prescription. The occasional patient reports more severe side effects during and after the CyberKnife treatment, such as more severe slowing of the urine stream, or greater discomfort.
Understand Your Treatment And Its Possible Side Effects
“It’s critical to have that discussion with your doctor. Ask questions like, ‘Is the location of my tumor likely to impair my urinary control or sexual function,'” says Dr. Tollefson.
Cancer type, location and tumor size will determine your course of treatment, but your provider won’t be able to address your questions and concerns about that treatment, unless you share them.”The effects that we’re dealing with, like erectile dysfunction and urinary control, are very personal,” says Dr. Tollefson. “Having a good connection with your physician and making sure that they understand is critical because the concerns are so intimate that it can be difficult to share.”
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Side Effects Of Chemotherapy
All chemotherapy drugs work in slightly different ways, making it challenging to predict side effects for individual patients. Dosages, drug combinations and drug responses will vary from patient to patient.
The American Cancer Society lists the following as the most common side effects of chemotherapy:
Increased risk of infections
Easy bruising or bleeding
What Are The Prostate Cancer Treatment Side Effects Of A Prostatectomy
The primary prostate cancer treatment side effects after a radical prostatectomy are incontinence and erectile dysfunction. These side effects are a product of the location of the prostate and the type of surgery performed. The prostate gland lies deep within the pelvis behind the pubic bone and in front of the rectum. The urinary bladder lies just above the prostate, the urinary sphincter control muscle is located just below it, and the erectile nerves lie just outside the prostate on either side. A patients age and overall health also influence the potential risks of radical prostatectomy just as it does with any major operation. Such risks include cardiac or pulmonary events, infections, blood clots, or injuries to structures around the prostate.
Following surgery, all men will have some urinary leakage. A good amount of bladder control is often regained within 12 weeks and continues to improve over 12 months. Multiple studies have shown that there is often a several month interval before a patient recovers normal erections, even with bilateral nerve-sparing surgery. Advantages to the Robot Assisted Laparoscopic Prostatectomy technique are a reduced risk of intra-operative bleeding and a shortened hospital stay.
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Androgen Receptor And Biosynthesis Inhibitors
The following treatments are newer treatment options that often work when doesnt work for you:
However, there are no studies available yet directly comparing these drugs, and its not clear which is most effective.
Enzalutamide and apalutamide are in a class of drugs called androgen receptor inhibitors. They block male sex hormones from binding to receptors on your prostate.
Abiraterone is in a class of drugs called androgen biosynthesis inhibitors. They work by blocking the production of testosterone.
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 someone’s 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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Managing The Side Effects Short Term Urinary Symptoms
We usually routinely prescribe tamsulosin for about three months, starting when you start your CyberKnife treatments. This medication helps relax the bladder and urine passage, and generally makes the urine flow easier, and reduces the number of times you get out of bed at night to use the bathroom. It can also reduce the burning a little. The usual dose is one tablet daily, but it can be increased to two tablets daily. If the urine burning is annoying, we prescribe pyridium an over the counter pill that you take by mouth, and the body excretes it in the urine and it numbs the urine tract a little. Over the counter anti-inflammatories such as naproxen are also helpful in reducing some of the irritation.