How To Heal From Hitting The Sciatic Nerve
What should you do if you have hit the sciatic nerve? If you accidentally inject yourself with a needle into your buttocks, you should seek immediate medical attention. If you have any sensory or motor abnormalities, you should seek medical attention as well. If you have paralysis or causalgia, you will need to see a doctor to determine the extent of the damage and if surgery is required. Although most sciatica patients recover completely in six weeks, about half of them require surgery. To completely heal the nerve, the process can take up to six months.
Dr Thompsons Perspective On Testosterone Replacement
What concerns do you have about prescribing testosterone to men who have been successfully treated for prostate cancer?
Obviously, testosterone supplementation has salutary effects for someone who is hypogonadal and suffering from osteoporosis, muscle loss, erectile dysfunction, and other problems. Unquestionably, otherwise healthy men given the choice of being on testosterone or being off testosterone would rather be on it. So, why not prescribe testosterone supplements to men who are hypogonadal and have been treated for prostate cancer?
Well, imagine two men with prostate cancer. The first man had a 12-core biopsy that showed cancer in just a small percentage of one core, cancer that was graded a Gleason 3 + 3. Hes had several prior biopsies, all of which have been negative, and his PSA is 2.5 ng/ml, which is within the normal range. The second mans biopsy shows cancer in every core on the right side of his prostate, graded a Gleason 5 + 4. The cancer can be felt during a digital rectal exam but is confined to the prostate capsule. Both men have undergone treatment.
How does that happen? Testosterone could reactivate existing disease. Or, if the patient had external beam radiation, not all of the tissue becomes fibrotic. Some normal epithelium, the cell layer that lines the prostate, will persist, and that normal epithelium is at risk of becoming cancerous.
Do you have patients who are on testosterone therapy?
So whats your biggest concern?
About the Author
Psa And Total Testosterone Levels In Men With Prostate Cancer
Prostate-specific antigen is a protein produced by the prostate. Because PSA levels are often elevated in men with prostate cancer, health care providers use PSA blood measurements to screen for and monitor prostate cancer. For example, if a man is found to have high levels of PSA in his blood, a prostate biopsy may be recommended to determine if prostate cancer is present.
Additionally, there is a higher incidence of prostate cancer among men with low testosterone. Since low testosterone and prostate cancer may occur at the time same time, medical professionals might choose to measure prostate cancer patients serum total testosterone levels, even though medical guidelines currently do not include serum testosterone testing as a necessary/required part of prostate cancer assessment.
Given the independent associations of PSA and testosterone levels with prostate cancer, a team of researchers sought to better understand the potential relationship between these two measures in prostate cancer patients. To do so, they collected and analyzed the PSA and serum total testosterone levels of 646 prostate cancer patients in a retrospective study. The mean age of the men included in the study was 61 years.
Regarding PSA levels, the patients were divided into three groups: < 2 ng/mL, 24 ng/mL, > 4 ng/mL. Of the 646 participants, 8% had PSA levels of < 2 ng/mL, 17% had between 24 ng/mL, and 76% had > 4 ng/mL.
Resources:
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How Will I Know If My Treatment Is Working
You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen blood tests to measure the amount of PSA in your blood.
PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.
How your treatment is monitored will depend on whether youre having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.
You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that youd like to talk about.
What Are The Advantages And Disadvantages Of Hormone Therapy
What may be important to one person might be less important to someone else. So speak to your doctor or nurse about your own situation.
- Its an effective way to control prostate cancer, even if it has spread to other parts of your body.
- It can be used alongside other treatments to make them more effective.
- It can help to reduce some of the symptoms of advanced prostate cancer, such as urinary symptoms and bone pain.
- It can cause side effects that might have a big impact on your daily life.
- It cant cure your cancer when its used by itself, but it can help to keep the cancer under control, sometimes for many years.
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How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented byCT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
Challenging Beliefs Of Testosterone Therapy And Prostate Cancer
volume 16, pages 699701
The relationship between testosterone therapy and prostate cancer continues to challenge historic and current beliefs. A new cohort analysis revealed a ~33% reduction in prostate cancer incidence in men with increased testosterone use. The mechanisms underlying this protective effect are unclear, but these findings challenge current paradigms and warrant further investigation.
Refers to Lopez, D. S. et al. Association of the extent of therapy with prostate cancer in those receiving testosterone therapy in a US commercial insurance claims database. Clin. Endocrinol. .
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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 Rosenberg’s 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.
Changes In Serum Psa Levels
Testosterone treatment was associated with a small but substantially greater increase in serum PSA levels over one year than placebo treatment . At baseline PSA values were 1.1 ± 0.9 ng/mL in the testosterone group and 1.3 ± 0.9 ng/mL in the placebo group . PSA levels increased on average by 0.3 ± 0.5 ng/mL at 3 months and by 0.5 ± 1.1 ng/mL at 12 months in the testosterone group . Five percent of men treated with testosterone had an increase 1.7 ng/mL and 2.5% of men had an increase of 3.4 ng/mL at month 12 . The median increment in PSA values in the testosterone group at both 3 and 12 months was 0.2 ng/mL .
In the testosterone group, six men had confirmed increases of adjusted PSA levels > 1.0 ng/mL at 3 months and 13 at 12 months . Two of the men in the testosterone group at 3 months are included in the 13 men at 12 months. Approximately 50% of the observed increases in adjusted PSA > 1.0 ng/mL were confirmed by the second test 27% of men with an observed increase of > 1.0 ng/mL had no retest.
PSA Changes, Prostate Nodules, Prostate Biopsies, and Prostate Cancers Diagnosed During and 6 Mo After Stopping Testosterone Treatment
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An absolute PSA value > 4.0 ng/mL was observed in 2.2% and 4.4% of men in the testosterone group at 3 and 12 months, respectively, and in 1.6% and 1.7% men in the placebo group .
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Benefits Of Testosterone Replacement
Hypogonadism is a major cause of secondary osteoporosis in men. Up to 20% of men with symptomatic, pathologic vertebral fractures and 50% of men with hip fractures are found to be hypogonadal. In a study of 72 hypogonadal men, testosterone replacement was associated with an average 39% increase in bone density in the first year. Bone density eventually increased into the normal range and was maintained there throughout the study.
Previous guidelines have suggested there is too little evidence in the literature regarding the safety of TRT in the setting of prostatic diseases including prostate cancer to make a definitive recommendation. The 2008 European Association of Urology guidelines indicate that testosterone replacement can be used in men with symptomatic hypogonadism after successful treatment of prostate cancer provided that a prudent interval has passed with no evidence of recurrent disease. The duration of a prudent interval is not specifically defined in the guidelines. Additionally, the guideline advises that a high risk of developing prostate cancer should be considered a contraindication for TRT. High risk for developing prostate cancer is not defined. As more information regarding the effects of TRT on the prostate and prostate cancer becomes available the risks and benefits of TRT can be more accurately assessed.
An Excerpt From Testosterone For Life
The oldest and most strongly held prohibition against testosterone therapy is its use in men previously diagnosed with prostate cancer. The fear has been that even in men who have been successfully treated for prostate cancer, raising testosterone levels will potentially make dormant, or sleeping, cancer cells wake up and start growing at a rapid rate. Thus, the FDA requires all testosterone products to include the warning that T therapy is contraindicated in men with a prior history of prostate cancer.
However, attitudes about this are changing and changing rapidly over just the last few years. The reasons for this are several, including the ongoing re-evaluation of the old belief that raising the concentration of testosterone is to prostate cancer like pouring gasoline on a fire or feeding a hungry tumor. In addition, there is growing recognition that T therapy can provide important benefits to a mans quality of life, so the delicate medical balancing act between potential risk and possible benefit is shifting.
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A number of physicians have told me that they have treated occasional patients with testosterone despite the fact that theyd been treated for prostate cancer in the past. The first people to publish their experience with doing this were Drs. Joel Kaufman and James Graydon, whose article appeared in the Journal of Urology in 2004.
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What Types Of Hormone Therapy Are Used For Prostate Cancer
Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
Prostate Cancer In Men Receiving Exogenous Testosterone
To date no study or review has documented any direct evidence that testosterone therapy increases incident prostate cancer risk. However, it is still difficult to argue that androgen replacement is safe since no long-term studies have been completed in large populations receiving exogenous androgens over many years. The question of whether androgen replacement increases prostate cancer incidence in an aging population has yet to be answered. The Institute of Medicine, recognizing the need for additional clinical trials to clarify the risks and benefits of testosterone replacement therapy , formed a committee to evaluate the present status of TRT in 2003. This was the most recent statement on the issue of TRT from the Institute of Medicine.
Even studies of TRT in men with high risk for incident prostate cancer because of preexisting prostatic intraepithelial neoplasia did not show an increased risk of prostate cancer. There has been one small study examining the risk of TRT in men with high-grade PIN. These men should presumably be at higher risk for prostate cancer development. After a year of TRT, only one patient with previous high-grade PIN had a detected prostate cancer. The study included 70 men overall 20 with high-grade PIN and 50 controls. This study suggests that TRT does not significantly increase the risk of incident cancer even in an already high-risk population.
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Treatment Of Sciatic Nerve Injury From Injection
There is no one definitive answer to this question as the best course of treatment for a sciatic nerve injury from injection will vary depending on the individual case and the severity of the injury. However, some possible treatment options that could be considered include physical therapy, massage, acupuncture, and/or chiropractic care. In some cases, medication may also be prescribed in order to help manage pain and inflammation. Surgery is generally only considered as a last resort option if other forms of treatment are not effective.
Children and the elderly are the most vulnerable to sciatic nerve injuries. If other administration routes are available, the total avoidance of intramuscular injections is recommended. If the injection is required in the gluteal muscle, the ventrogluteal region has a better safety profile. Song S, Muhumuza MF, Penny N, and Sabatini CS were cited. Clinical decision support for the delivery of human rabies immune glubulin is being implemented in the emergency department. Yuan F. Iso T., Rizk E., Saldana RB, Tran AT, Vietnamese NA, Boyareddigari PR, Espino D. Swan. An injection of intra-spine nerve stimulation is linked to neuropathic pain in the sciatic nerve injured through nerve conduction studies.
Testosterone Therapy And Prostate Cancer
Testosterone therapy may increase the risk of prostate cancer recurrence for some people.
Some factors that are particularly associated with a high risk of recurrence:
- Extraprostatic extension
- Positive margins
- Gleason scores of 8 or more on biopsy
- Invasion of the seminal vesicles
There are some situations when testosterone therapy would not be harmful and may be beneficial for people who have had prostate cancer.
- Men who have low-grade or benign tumors
- Men who have completed therapy with surgery or radiation and appear to be cured can use testosterone therapy after an appropriate waiting period between two and five years. The risk of cancer recurrence at this point is generally quite low.
- When a man with known prostate cancer has a low testosterone level and severe physical infirmity or very advanced muscle loss that is associated with notable weakness.
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Testosterone Laboratory Blood Testing
Blood tests are a factor that is used to determine whether testosterone replacement is needed. If you are having your testosterone level checked with a home test or at a laboratory as ordered by your doctor, your results might not be clear-cut.
Issues that affect blood levels of testosterone:
- Testosterone blood levels are higher in the morning and lower in the evening. A test drawn at 4 pm that was low may simply be outside the normal range due to the time of day the blood was taken.
- There are two types of testosterone tests: total testosterone and free testosterone. Most routine tests only measure total testosterone. However, free testosterone is a much more accurate measure of the physiologic activity of testosterone.
Making a decision about your need for testosterone therapy is not based solely on the level of testosterone in your blood. It is equally important to consider your symptoms and whether they are indicative of low testosterone levels.