How Soon Can We Detect This
One of the main advantages of surgery over radiotherapy for prostate cancer is that following prostate removal, the PSA should be very low , which we can of course detect with blood tests. If metastasis occurs, because the metastatic cells originated in the prostate and therefore make PSA, the PSA level in the blood starts to rise. Once it has reached a given threshold additional or salvage treatment will be discussed.
A PSA level of more than 0.2 ng/ml defines biochemical recurrence. At this stage the cancer is still much too small to be seen on scanning. If it can be seen on a scan it is termed clinical recurrence, which generally does not occur until the PSA level is more than 0.5 ng/ml. Symptoms, such as bone pain, dont usually occur until the PSA is more than 20 ng/ml.
Dry Orgasm And Infertility
Both the prostate and the glands responsible for semen production are removed during surgery, which is a common prostate cancer treatment. If you received this treatment, youd still be able to have an orgasm but youd no longer ejaculate.
This means that youll no longer be fertile. If you plan to have children in the future, you may consider banking your sperm before your surgery.
Surgery For Prostate Cancer
There are many types of surgery for prostate cancer. Some are done to try to cure the cancer others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.
Side effects of surgery
Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know so they can help you.
Also Check: Prostate Cancer Recovery Time After Surgery
Types Of Radical Prostatectomy
There are three main types of radical prostatectomy:
- Retropubic. In this procedure, the surgeon uses an incision in the lower abdomen to remove the prostate and the lymph nodes for examination. This procedure allows for a nerve-sparing approach, which can lower but not totally eliminate the risk of impotence following surgery. In the nerve-sparing approach, the surgeon tries to preserve one or both of the small nerve bundles needed for unassisted erections. However, if the cancer has spread to the nerves, this approach may not be advised.
- Laparoscopic. In this recently developed procedure, the prostate is removed in a fashion similar to a retropubic prostatectomy, but the procedure is performed through five very small incisions using lighted, magnified scopes and cameras. The prostate specimen is then removed in a small bag through one of the incisions, which is expanded to 2 to 3 cm to allow specimen removal.Potential benefits of this procedure are less pain and earlier return to full activities. Nerve-sparing methods and lymph node dissections can be performed with this technique as well.
- Perineal. In this procedure, the prostate is removed through an incision in the skin between the scrotum and anus. The lymph nodes can’t be removed through this incision. If the lymph nodes need to be examined, removal can be done through a small abdominal incision or by a laparoscopic procedure. A nerve-sparing approach can be performed perineally.
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.
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Can Prostate Cancer Be Prevented
There are no clear prevention strategies for prostate cancer. There is some conflicting evidence that a healthy diet composed of low fat, high vegetables and fruits may help reduce your risk of prostate cancer. Routine screening, with PSA blood test and physical exam, is important to detect prostate cancer at an early stage. A healthy diet and regular exercise are also critical in maintaining good health and preventing disease in general.
Questions To Ask Your Doctor Or Nurse
- How could my prostate cancer treatment affect my sex life?
- How soon after treatment can I masturbate or have sex?
- Which treatments for erection problems would be best for me? Can I get them on the NHS?
- Is there anything I can do to prepare myself before I start my prostate cancer treatment?
- What happens if the treatment doesn’t work? Are there others I could try?
- What other support is available to me?
- Can my partner also get support?
Recommended Reading: What Is The Psa Test For Prostate
Resources For More Information
Prostate Cancer Foundation
Leading philanthropic organization funding and accelerating prostate cancer research globally. Also provides information about prostate cancer, treatment and resources to help patients and families.
Offers peer-to-peer support and educational materials to help men and their families/caregivers make informed decisions about prostate cancer detection, treatment options and related side effects.
Provides cancer support for men with anal, prostate and breast cancer, with emphasis on African-American and gay males. Provides multiple language support.
What Causes Prostate Cancer
Researchers do not know exactly what causes prostate cancer. But they have found some risk factors and are trying to learn just how these factors might cause prostate cells to become cancer cells.
On a basic level, prostate cancer is caused by changes in the DNA of a normal prostate cell. DNA is the chemical in our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.
Some genes control when our cells grow, divide into new cells, and die:
- Certain genes that help cells grow, divide, and stay alive are called oncogenes.
- Genes that normally keep cell growth under control, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.
Cancer can be caused by DNA mutations that keep oncogenes turned on, or that turn off tumor suppressor genes. These types of gene changes can lead to cells growing out of control.
DNA changes can either be inherited from a parent or can be acquired during a persons lifetime.
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Some General Issues In Prostate Cancer
Patient education is of paramount importance in prostate cancer because often screening results in a high likelihood that further testing, treatment and treatment-related decision making would be warranted. Urologists may at times underestimate the psychiatric comorbidity in prostate cancer, and there are many patients that have a few isolated symptoms that have not been diagnosed and hence may not receive treatment. Anxious preoccupations and strained marital relationships with spouses have been reported. Body image, spouse affection, spouse worry, along with cancer distress and cancer acceptance were some other anxiety-related areas causing psychological distress in prostate cancer., , It is essential that urologists receive training in the screening and identification of various psychological problems seen in prostate cancer to enable faster diagnosis and referral to the psychiatry unit for prompt management in such cases.
Individualized Prostate Cancer Screening
Coltman says that men and their doctors can no longer rely on PSA levels alone when deciding whether to have a prostate biopsy.
The situation now is that the individual man with his individual urologist will have to assess what the person feels are his risk factors, he says. In consultation with his doctor, the individual man must come to grips with the question of whether or not a biopsy should be done. It will become a more personalized interaction.
Whos at high risk? Men with the following factors have the highest risk of prostate cancer:
- Age. A mans risk of prostate cancer increases with age.
- Race.African American men have the highest incidence of prostate cancer and the highest death rate from prostate cancer of any men in the world, Coltman says.
- Family history. A mans risk increases if his brother or father has had prostate cancer.
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What Tests Check For Prostate Cancer
Common tests to check for prostate cancer include:
- Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
- PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
- A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.
If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
The Couple’s Life Stage And Experience In Prostate Cancer
For many couples, by the time prostate cancer sets in, children are maturing and leaving home, leading to fewer responsibilities around the house, an increased desire for companionship and possibly new levels of intimacy and sexual desire. Some couples find the increased time together stressful, as they work to renew their relationship. The occurrence of an illness during this 50- to 64-year-old phase may force early retirement and produce feelings of anger and frustration related to being cheated of a full career and a physically and financially healthy retirement. In spite of the fact that some people are retiring earlier than in previous generations, work continues to be a major source of social status, self-esteem and social contacts, as well as a source of financial well-being.
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What Have Researchers Found About How These Treatments Compare With Each Other
Researchers found that for some men:
- The risk of the cancer spreading to other parts of the body is much lower with surgery to remove the prostate gland than with watchful waiting.
- Surgery to remove the prostate gland appears to increase the chance of surviving the cancer more than external-beam radiation therapy.
- A combination of 3D-CRT and hormone therapy appears to increase the chance of surviving the cancer more than 3D-CRT alone.
Research is only one source that helps guide doctors when they treat localized prostate cancer. Doctors also rely on their experience and on guidelines for treatment based on evidence and recommendations by experts.
When thinking about what treatment may be best for you, your doctor will consider several things, including:
- Your age
- Other health problems you may have
- How long you are expected to live
- Your preferences
Your doctor will also discuss possible side effects to help you decide about treatment. Talk with your doctor about your options and the trade-offs between possible benefits and side effects. Usually, you have time to think about your options before making a decision.
The Prostate Gland And Prostate Cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.
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Your Emotions And Sex
Your prostate cancer and its treatment wonât just affect your body. Theyâll also have a serious impact on your emotions. Stress and anxiety can trigger your body to make adrenaline, which gets in the way of having sex. The more you worry, the worse the struggle. If youâre in a relationship, your partner will be going through many of the same feelings.
One of the most important things you can do is to talk to your partner. Have an honest conversation about your fears and expectations when it comes to sex. Don’t assume they know how you feel. Being open with each other will help you both feel supported and help you work together to make any adjustments that you may need to stay intimate.
Talking with a mental health professional — either one-on-one or with your partner — can be a powerful way to help manage your emotions. A therapist can also prescribe medications that may ease stress and anxiety. A professional sex therapist can help you and your partner find ways to improve your sex life. It may also be helpful to join a support group where you can talk with others who share your experience.
Prostate Cancer Foundation: “Erectile Dysfunction.”
UCLA Urology: “Prostate Cancer: Dealing with Erectile Dysfunction.”
Albaugh, J. Reclaiming Sex & Intimacy After Prostate Cancer: A Guide for Men and Their Partners. Anthony J. Jannetti, Inc., 2012.
Harvard Prostate Knowledge: “Achieving orgasm after radical prostatectomy.”
What Kind Of Treatment Will I Need
There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.
The treatment thats best for you will depend on:
- Your age
- Any other health problems you might have
- The stage and grade of the cancer
- Your feelings about the need to treat the cancer
- The chance that treatment will cure the cancer or help in some way
- Your feelings about the side effects that might come with treatment
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Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
Stress Related To Prostate Cancer Recurrence
Patients diagnosed with recurrent cancer may experience many of the same feelings experienced earlier when first diagnosed with cancer. Shock, disbelief, anxiety, fear, grief and a loss of control are all common emotions. Feelings of betrayal, anger that it could happen more than once, anger directed at the doctor for not curing the cancer the first time or anger at themselves are common and normal responses to what can be an especially difficult experience. Many people with recurrent cancer also experience self-doubt about their original treatment decisions or choices after treatment. It is important that the doctor/psychologist make the patient understand that the choices the doctor made at the time of original treatment were based on the information available then, and possibly the best at that time.
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Questions You May Want To Consider Asking Your Doctor Include:
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
- What type of treatment do you recommend for my prostate problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long would it last?
- Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
Uk Guidelines For Keyhole Surgery
The National Institute for Health and Care Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the prostate but they must:
- tell people having the surgery about the risks and benefits
- monitor people closely
- collect information about any problems people have and report on them
Researchers are looking into whether keyhole surgery is as good as open surgery.
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.