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Surgical Options For Prostate Cancer

What Are The Side Effects

Prostate Cancer Surgical Treatment – Mayo Clinic

The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .

Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.

Questions To Ask Your Doctor Or Nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What type of surgery do you recommend for me and why?
  • What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
  • How many of these operations have you done and how many do you do each year?
  • Can I see the results of radical prostatectomies youve carried out?
  • What pain relief will I get after the operation?
  • How and when will we know whether the operation has removed all of the cancer?
  • How often will my PSA level be checked?
  • What is the chance of needing further treatment after surgery?
  • What is the risk of having urinary problems or erection problems and what support can you offer me?

How Is Prostate Cancer Treated

Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are

  • Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
  • Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
  • Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
  • Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
  • Radiation therapy. Using high-energy rays to kill the cancer. There are two types of radiation therapy
  • External radiation therapy. A machine outside the body directs radiation at the cancer cells.
  • Internal radiation therapy . Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.
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    Signs Of Prostate Cancer Include A Weak Flow Of Urine Or Frequent Urination

    These and other signs and symptoms may be caused by prostate cancer or by other conditions. Check with your doctor if you have any of the following:

    • Weak or interrupted flow of urine.
    • Sudden urge to urinate.
    • Frequent urination .
    • Trouble starting the flow of urine.
    • Trouble emptying the bladder completely.
    • Pain or burning while urinating.
    • Blood in the urine or semen.
    • A pain in the back, hips, orpelvis that doesn’t go away.
    • Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia.

    Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called benign prostatic hyperplasia , and although it is not cancer, surgery may be needed. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer.

    Chemotherapy For Prostate Cancer

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    https://www.youtube.com/embed/O24t-bbE1k4 The decision on when to start chemotherapy is difficult and highly individualized based on several factors: What other treatment options or clinical trials are available. How well chemotherapy is likely to be tolerated. What prior therapies you have received. If radiation is needed prior to…

    Get the Free Prostate Cancer Patient Guide here

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    Side Effects Of Prostate Surgery

    The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

    Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

    • Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
    • Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
    • Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
    • Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

    After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

    There are several options for treating erectile dysfunction:

    Active Surveillance And Watchful Waiting

    If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

    Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

    ASCO encourages the following testing schedule for active surveillance:

    • A PSA test every 3 to 6 months

    • A DRE at least once every year

    • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

    Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

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    Staging Of Prostate Cancer

    Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .

    The stage of the cancer will determine which types of treatments will be necessary.

    If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

    Laparoscopic Approach To Radical Prostatectomy

    Prostate cancer treatment options

    Beginning in 1999, surgeons in the U.S. began performing radical prostatectomies from a laparoscopic approach. This involves making several small incisions in the lower abdomen and using special surgical instruments including a laparoscope, a long thin instrument with a camera and light on the tip. Smaller incisions and less manipulation of nearby tissue result in a generally easier recovery than in an open approach, although their cancer cure rates are essentially identical.

    There are two types of laparoscopic radical prostatectomies :

    • Traditional Laparoscopic Radical Prostatectomy: Traditional LRP involves the surgeon directly manipulating the laparoscope and other surgical instruments to remove the prostate and lymph nodes. The nerve-sparing technique can be performed in LRP.
    • Robotic-Assisted Laparoscopic Radical Prostatectomy: This procedure is a recent development in radical prostatectomy surgery. Using a robotic interface, the surgeon controls robotic arms that perform the surgery through the small incisions instead of the surgeon directly maneuvering the surgical tools.

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    What Is The Outlook For Men Who Have Benign Prostatic Hyperplasia Surgery

    Benign prostatic hyperplasia surgery has a very high success rate. However, for the best results from treatment, you should seek medical help at the earliest signs of a problem. Also, talk with a doctor if you are experiencing symptoms of BPH after surgery.

    There is no evidence that BPH increases the risk of developing prostate cancer. However, the symptoms of BPH and prostate cancer are similar. The American Urological Association and the American Cancer Society recommend annual prostate screenings for men ages 55 to 69. Men at high risk such as African-American men and men with a family history of prostate cancer should begin screening at age 40.

    Urinary Problems After Surgery

    Leaking urine

    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.

    Difficulty urinating

    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

    Erection problems

    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.

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    Prostate Cancer Surgery Candidates

    Prostate cancer patients whose cancer is prostate-confined could be candidates for prostate cancer surgery. Surgery could also be a viable option for patients with locally advanced prostate cancer, which has barely breached the prostate this will be dictated by the spread rate of the patients prostate cancer. Recurrent prostate cancer can usually also be treated.

    Whichever surgical course of treatment is undertaken to treat prostate cancer, the individual skill and experience of the surgeon is key. Many patients will gauge a surgeons success rates based on previous results, ahead of the actual proven benefits of the technologies and treatments. Patient suitability can also be affected by conditions such as heart disease.

    Considering Complementary And Alternative Methods

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    You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

    Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.

    Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.

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    Certain Factors Affect Prognosis And Treatment Options

    The prognosis and treatment options depend on the following:

    • The stage of the cancer .
    • The patients age.
    • Whether the cancer has just been diagnosed or has recurred .

    Treatment options also may depend on the following:

    • Whether the patient has other health problems.
    • The expected side effects of treatment.
    • Past treatment for prostate cancer.
    • The wishes of the patient.

    Most men diagnosed with prostate cancer do not die of it.

    Thinking About Taking Part In A Clinical Trial

    Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.

    If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

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    Getting Help With Treatment Decisions

    Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.

    Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.

    You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.

    A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer

    Surgical Options for Prostate Cancer Patients

    A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.

    Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.

    If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.

    To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.

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    Radical Prostatectomy For Localized Prostate Cancer

    For patients with localized PCa, RP is a surgical treatment performed with curative intent, and has been demonstrated in a number of trials to provide a survival benefit. Conversely, alternative treatment options for localized PCa have not been studied in a controlled fashion. For patients with organ-confined disease who wish to preserve erectile function, a nerve-sparing retropubic approach to RP is the standard of care. With technologic advances, the traditional open retropubic RP has been mostly replaced by laparoscopic and robot-assisted laparoscopic approaches. Importantly, numerous studies have demonstrated that laparoscopic and robotic RP have similar functional and oncologic outcomes when compared to traditional open RP, while also decreasing perioperative morbidity.68 Due to patient demand and perceived technical advantages, the robotic RP has become the standard surgical approach to RP in the United States, despite higher per case costs when compared to laparoscopic RP.9 Regardless of the surgical approach , the anatomic principles of the retropubic RP remain the same, and thus the results of the following studies can be applied to all techniques.

    How Do You Perform Prostate Cancer Surgery

    There are three ways your doctor may perform prostate surgery:

    • Standard, open surgeries involve large incisions in the belly to give your surgeon access to the area.
    • Minimally invasive surgery, by contrast, only involves a few small cuts in the stomach. Your surgeon then inserts tiny instruments and a camera through the keyhole-sized cuts.
    • Robot-assisted prostate surgery gives your surgeon greater precision and control. They use a robotic arm to hold and move the instruments during surgery.

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