USEFUL READING

  1. Should I be screened for prostate cancer? PSA and DRE

    • You may have seen recent reports saying that there is no value in mass screening of men for prostate cancer. This was the result of two controversial studies in the USA that showed very little difference in the outcomes for men who were tested and those who were not. The USA PLCO and PIVOT studies have been criticized for their short duration and contamination of results.
    • The European ERSPC study, in contrast, found over a 20% reduction in deaths in the men who were tested with PSA and DRE, followed up for 14 years. They also found 40% more locally advanced and metastatic cancer in the men not tested.
    • A Scandinavian randomized, controlled trial with 15 years of follow-up showing that radical prostatectomy resulted in a sustained 38% decrease in prostate cancer–specific deaths.
    • USA data shows that since the widespread use of PSA testing began in the early 1990s, there has been a 40% decrease in prostate cancer deaths and a 75% decrease in advanced disease at initial diagnosis, which is attributed, in large part, to PSA screening and improvements in treatments.
    • What to do? Talk to your doctor! Prostate Cancer Canada recommends having a baseline PSA test done about age 40, then regular testing later, decided in consultation with your doctor. Men of African heritage, or whose father or brother had prostate cancer are considered to be at higher risk, so make sure your doctor is aware of this if it applies to you. Many doctors recommend ending regular testing about age 70-75, or when life expectancy is 10 years or less.
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  2. Doctor puts on a glove and says "Drop your pants and bend over..." Yikes!!

    • Digital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectum and feels the prostate to check for anything abnormal. It lasts less than a minute, and doesn't feel much different than a bowel movement. It could save your life, so just do it. Try asking a woman to describe the pelvic exams and mammograms that they have to endure; men have it easy.
      Digital Rectal Exam
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  3. PSA and⁄or DRE abnormal? Now what? What is a biopsy?

    • TRUS biopsy If your PSA test or digital rectal exam raise your doctor's suspicions you may be referred to a urologist. The urologist may at some point suggest that you get a biopsy of the prostate. This is done by inserting an ultrasound probe into your rectum so they can see an image of the prostate while thin hollow needles are used to collect 8-16 samples. The doctor performing the test will give you all the details, but here are the basics:
    • You will probably be given a prescription for antibiotics, do not skip them; you do not want an infection down there. You may be advised not to take any aspirin since it can cause worse bleeding.
    • Biopsy is usually done at a hospital, so arrive on time to park, find the right office, and get the paperwork done. Usually there is no need to have someone accompany you, unless you want.
    • Usually a few men are booked in to the same time slot, then taken one at a time to the ultrasound room. The procedure only takes about 15-20 minutes. If you are first, you might be done in an hour. If last, it could be more than two hours. Bring a book.
    • The doctor will tell you to try to relax (of course he is not the one with a probe stuck up his butt). You will be given a local anesthetic so that it will not hurt when the needle biopsies are taken, just a little uncomfortable.
    • The needle gun makes a sound like a staple gun as each sample is taken, try not to jump. It will soon be over.
    • It's over; get dressed and leave. You may want to have a towel to sit on in your car, just in case you leak a little blood. For the next few days or weeks you will see blood in your urine and stool; do not worry about it unless it gets worse. It should get better every day. Your semen will be an ugly rust colour for a few weeks, but gradually clear up.
    • Read the information they give you about possible side effects or infection. Contact your doctor if any problem. It can take a couple weeks for the pathology report to be done; you will get the results at your next appointment with the urologist.
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  4. I've got prostate cancer, how bad is it? The numbers:

    • If your biopsy shows that you have prostate cancer, you will be given three or four numbers that you should keep track of: your latest PSA number, the Gleason score, the cancer stage, and the number of biopsy cores showing cancer.
    • PSA TEST: Prostate specific antigen is present in small quantities in the blood of men with healthy prostates, but is often elevated in the presence of prostate cancer or other prostate disorders; such as an infection or benign prostatic hyperplasia (BPH).
      • There is no 'normal' PSA level. In the past a level of 4.0ng/ml and lower were considered 'normal'; but it has been found that some men with lower levels have cancer and some men with higher levels do not have cancer.
      • Typically your PSA level will increase with your age. As an example, someone at age 40 might have 2.5ng/ml, then 4.0 at age 60, then 6.0 at age 70; and not have prostate cancer.
      • Many men who have a level of PSA under 10.0ng/ml do not have prostate cancer. As the PSA levels increase above 10 ng/mL, the probability of prostate cancer increases dramatically.
      • Men whose PSA levels are rising rapidly have a higher risk of having an aggressive form of cancer.
    • GLEASON SCORE: A pathologist will examine the biopsy samples and if cancer is found, will assign the Gleason score. It is given as the sum of two numbers: the first number is the most common tumor pattern, rated 1-5; the second number is the second most common pattern, also rated 1-5. So the total score will be given as: 3 + 3 = 6. The total ranges from 2-10. Gleason 7 could be due to 3+4 or 4+3, the latter behaving more aggressively because the primary number is higher. The total Gleason score is divided to three groups according to the risk of progression and metastasis.
      • A low grade Gleason score is considered 2-6, where the cells tend to grow slowly and is therefore considered low risk. Your doctor may suggest a period of active surveillance before treatment is considered.
      • A moderate grade Gleason score is considered 7.
      • A high grade Gleason score is considered 8-10, where the cells tend to grow rapidly and pose a high risk to advance.
    • CANCER STAGING: Based on the tests done so far, the cancer will be assigned a stage, which is a best estimate of the risk of the cancer having spread beyond the prostate, and the probability of success if treated. The most common staging system is called TNM:
      • T0: no evidence of tumor
      • T1a: cancer is in no more than 5% of the tissue removed during an unrelated procedure.
      • T1b: cancer is in more than 5% of the tissue removed during an unrelated procedure.
      • T1c: cancer was found in a needle biopsy performed due to an elevated serum PSA

      • T2: the tumor can be felt (palpated) on examination, but has not spread outside the prostate
      • T2a: the tumor is in half or less than half of one of the prostate gland's two lobes
      • T2b: the tumor is in more than half of one lobe, but not both
      • T2c: the tumor is in both lobes but within the prostatic capsule

      • T3: the tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2)
      • T3a: the tumor has spread through the capsule on one or both sides
      • T3b: the tumor has invaded one or both seminal vesicles

      • T4: the tumor has invaded other nearby structures

      • NX: cannot evaluate the regional lymph nodes
      • N0: there has been no spread to the regional lymph nodes
      • N1: there has been spread to the regional lymph nodes

      • MX: cannot evaluate distant metastasis
      • M0: there is no distant metastasis
      • M1a: the cancer has spread to lymph nodes beyond the regional ones
      • M1b: the cancer has spread to bone
      • M1c: the cancer has spread to other sites
    • BIOPSY CORES: The number of biopsy cores that showed cancer cells, versus the total number of cores tested. If the urologist does not give you this information, just ask him.
    • SUMMARY: As an example, the author's numbers at diagnosis were: PSA 4.2, Gleason 3+3=6, Stage T2a, 3 cores cancer out of 12 tested; not too bad so just waited. Then a year later it was looking worse: PSA 6.2, Gleason 3+3=6, Stage T2c, 12 cores cancer out of 12 tested; time to get treated.
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  5. Treatment Options: Watchful Waiting

    • Not everyone agrees on the terminology, but many doctors would say there is a difference between watchful waiting and active surveillance. If your doctor proposes either course of action, make sure you understand what he/she means.
    • Prostate cancer treatments like surgery, radiation, and hormone therapy have serious side effects. Biopsy tests are unpleasant and do have possible side effects. Watchful waiting implies having no treatment to try to cure prostate cancer or tests to closely monitor it, but rather to wait for symptoms to occur, then treat the symptoms.
    • Frequently it is proposed for men who would not benefit from treatment, and in fact may be harmed by aggressive testing and treatments. As an extreme example: an 85 year old man in ill health with early stage prostate cancer would be expected to die from other causes. Aggressive testing or treatments might do more harm than good.
    • If the cancer does begin to progress and begins causing symptoms, there are medications such as hormone therapy that may slow the progression. There are also drugs to treat pain and urinary problems.
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  6. Treatment Options: Active Surveillance

    • Active surveillance involves the close monitoring of the cancer; it may be a good choice for men with low-risk prostate cancer in an early stage, that is unlikely to spread soon. Consideration should be given to your overall health, your age, and the stage and Gleason score of your cancer.
    • The surveillance will probably include frequent PSA tests and digital rectal exams, prostate biopsy as needed, or even further tests such as CT or MRI scans.
    • Why do it? Prostate cancer is frequently slow growing, therefore most men who have prostate cancer will end up dying of some other cause, including old age. Also, most treatments have a risk of unpleasant side effects such as incontinence, erectile dysfunction, bowel problems, etc. You may want to delay that til later.
    • How long? Some men continue on active surveillance for many years. In other cases the tests indicate the cancer is beginning to spread and needs to be treated. There is also the psychological stress that comes from having cancer, and not doing anything about it.
    • Dr. John Lewis and his research team at the University of Alberta are making good progress on a test that would determine which men have a more aggressive cancer that should be treated. This could potentially save other men whose prostate cancer isn’t as serious from unnecessary treatment, and make watchful waiting and active surveillance less stressful.
    • A period of active surveillance gives you some time to consider when to seek treatment, and what kind of treatment. This is a good time to seek the guidance and support of your doctors, family, friends; and of course us: Edmonton's Prostate Cancer Support Group. Many of our members have been in a similar situation, and can offer helpful insights.
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  7. Treatment Options: Radical Prostatectomy (surgery)

    • Radical prostatectomy is surgery to remove the prostate and part of the urethra. It is used when the cancer is thought to be contained within the prostate, or sometimes if it has only spread a little to the area just outside. The seminal vesicles and lymph nodes may also be removed. Surgery is not commonly used for men with advanced cancer, since it may not be possible to remove all of the cancer.
    • Surgery may not be suitable for older men or those with other health problems, because of the increased risks of surgery and anesthesia. Overweight and obese men are more likely to have problems during and after surgery; it would be worthwhile to lose weight and increase fitness before the operation.
    • Advantages:
      • If the cancer is completely contained within the prostate, surgery will be able to remove all of it.
      • Your removed prostate gland will be sent to a pathologist for testing. A report of 'negative margins' means cancer did not extend to or past the edge of the incision. A report of 'positive margins' means cancer spread beyond the edge of the incision and further treatment such as radiation may be required. The surgeon should have the pathology report for you at your next appointment.
      • PSA tests are a good indication of whether the operation was successful at removing all of the cancer. The PSA level should be below 0.1ng/ml or 0.01ng/ml; depending on the test used, that is below the detection limit of the test. You will continue having PSA tests done on a regular basis.
      • If your PSA level is higher, or starts to rise again after surgery, other treatment options will be considered.
    • Disadvantages:
      • There are risks associated with any major surgery.
      • A hospital stay is required, usually 2-4 days. It will take a while to recover. Pain is usually not severe. You will return from the hospital with a urinary catheter installed. This allows the urethra time to heal and is usually kept in for 1-3 weeks. You will be given a 'leg bag' so you can be mobile. Wear loose pants and nobody will notice it.
      • There is a risk of erectile dysfunction, incontinence, or other urinary problems; which may be temporary or permanent or require other treatments.
      • The prostate is removed and connection to the testicles is cut, so there will be no fluid ejaculated at orgasm. You will not be able to father any more children.
      • see below Side Effects: urinary problems, sexual dysfunction.
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  8. Treatment Options: Brachytherapy

      brachytherapy seeds
    • Brachytherapy is the delivery of radiation internally by either permanently implanting low dose seeds or temporary insertion of high dose needles. It is generally used for men with lower grade cancer that is thought to be contained within the prostate.
    • Generally the insertion of the radiation seeds may done on an out-patient basis, or only one night hospital stay. It can be done under general anesthesia, epidural, or spinal.
    • Between 50 and 120 radioactive seeds are implanted in the prostate. They are smaller than a grain of rice and are inserted through a needle. The needles are inserted through your perineum (between your testicles and anus). 20-30 needles will be used, depending on the size of the prostate.
    • Advantages:
      • Shorter hospital stay, faster recovery. You will be very sore where they put in all those needles, but that can be handled with pain medication.
      • Less damage to nearby nerves and blood vessels than external beam radiation.
      • Current data indicates that for low-risk disease, brachytherapy, external beam radiation, and surgery have similar success rates, controlling disease in about 80%-95% of the cases, with little evidence to support the use of one treatment over the other.
    • Disadvantages:
      • It will be some time before you will know if the treatment was successful. PSA tests will be done regularly to track whether the cancer returns, but they can be erratic for the first year or two after treatment; therefore not giving a clear picture what is happening.
      • Depending on the type of seed used, the radiation half-life is 16-80 days. At 6 months they will still be emitting 1/8th to 1/64th the original radiation. It will take 1-2 years for the radiation to dissipate completely. For a few months after treatment you should not let a child or pregnant woman sit on your lap or next to you for prolonged periods.
      • Air travel: The brachytherapy seeds are made of radioactive material encased in titanium. Titanium usually does not set off airport metal detectors. However, some airports also are using radiation detectors which may be able to detect the low levels of radiation emitted for a few months after the procedure. Ask your doctor.
      • In some jurisdictions, if you should die from any cause within two years of the brachytherapy, your body cannot be cremated; because of the radioactive seeds. This may be of concern for some religions.
      • Rarely some radioactive seeds may move out of the prostate, and be flushed out with your urine or ejaculate. Therefore it would be best to use a condom for sex for a while, and do not pee in the woods. Your radiation oncologist can tell you when the radiation will decay to a safe level.
      • see below Side Effects: urinary problems, sexual dysfunction, bowel problems.
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  9. Treatment Options: External Beam Radiation Therapy

    • External beam radiation therapy (EBRT) uses high energy beams to treat prostate cancer. The beams are directed at the prostate gland from outside the body. They damage the cancer cells and stop them growing, while allowing many healthy cells to recover.
    • EBRT is sometimes given as an added therapy either before or after brachytherapy. It is also used after prostatectomy surgery if your PSA level does not go to a minimum level and stay there.
    • Advantages:
      • Radiotherapy has none of the risks of surgery and having a general anaesthetic.
      • You can carry on with many of your usual activities while you are having treatment. Each treatment only lasts a few minutes, repeated every weekday for 6-10 weeks.
      • It can be used on patients not suited or unfit for surgery.
      • The treatment is painless, although you may develop a 'sunburn' around the treatment area.
    • Disadvantages:
      • You may be given hormone therapy before or after the treatment to shrink the prostate. There are a number of side effects of the hormone therapy, most temporary.
      • It will be a while before you know how successful the treatment was. This is determined by your PSA level, which may take as long as two years to fall to its lowest level.
      • Small chance of the radiation causing other cancers to develop years later, but this is rare.
      • Some of the side effects will not develop until 1-2 years after the treatment, leaving you in suspense.
    • Side Effects: Temporary painful urination or ejaculation, tiredness, skin irritation, bowel irritation; these tend to go up and down during the treatment. Regular exercise can help improve the tiredness. Long term problems can include sexual dysfunction, urinary incontinence or blockage, bowel problems, or bleeding.
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  10. Treatment Options: HIFU, High Intensity Focused Ultrasound

    • HIFU uses a precise beam of ultrasound from a probe inserted up the rectum to destroy prostate tissue by heating. Ultrasound imaging or MRI is used to guide the probe. The treatment usually lasts 1-3 hours, under general or spinal anesthesia. A catheter will be inserted and remain for 1-3 weeks.
    • The procedure is licensed to be used in Canada, but is only done in a few locations. None of the provincial governments generally pay for the procedure, considering it to still be an experimental operation.
    • Advantages:
      • Shorter hospital stay, faster recovery. It is usually done as an out-patient procedure.
      • It can be used as a secondary salvage procedure if a radiation procedure has failed to control the cancer.
      • HIFU can be repeated if the first treatment failed to control the cancer; although this seems to increase the incidence of incontinence and sexual dysfunction.
    • Disadvantages:
      • It is only available in a few locations. It is very expensive, over $20,000, may not be paid by Alberta Health.
      • HIFU has only been in common use for prostate cancer for about 15 years. There have only been a few studies of its effectiveness beyond five years followup.
      • A small study done in France using the 2nd generation Ablatherm™ device found a high rate of biochemical failure (rising PSA levels) after 5 years of followup. Overall, 67.9% experienced oncological failure. BJUI journal abstract.
      • A 2009 review of HIFU done by Cancer Care Ontario determined that "HIFU cannot currently be recommended as an alternative to accepted curative treatment approaches for localized prostate cancer." This was based on finding that HIFU is not as effective at controlling prostate cancer as surgery or radiation. CCO Recommendations.
    • Side Effects: urinary problems, sexual dysfunction, bowel problems.
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  11. Treatment Options: Cryotherapy

    • Cryotherapy uses freezing and thawing to kill the cancer cells in the prostate. This is done with 4-10 needle probes inserted into the prostate from the perineum (between the testicles and anus). Cold gas is circulated through the probes until the prostate is frozen, then warm gas is circulated to thaw it out. The process is repeated at least once. General anesthesia is commonly used.
    • Warm liquid is circulated through a catheter inserted in the urethra during the procedure to keep it from freezing.
    • It has only been in use for a few years, therefore there is a lack of good data and studies of its effectiveness. It is only available in a few locations.
    • Advantages:
      • Cryotherapy can be used as a salvage treatment if radiation or HIFU have failed to kill all of the cancer in the prostate.
      • Shorter hospital stay, faster recovery. Usually only one night or less stay in hospital is required.
      • Cryotherapy involves less invasive surgery than some other treatments, with little blood loss.
    • Disadvantages:
      • The effectiveness of cryotherapy seems to be similar to HIFU, with reported results less successful than surgery or radiation. Advances in technique are improving the results. BJU article.
      • Some urologists may insert a suprapubic catheter through the abdomen above the penis into the bladder to drain urine. This is done so that the urethra is not harmed during the healing process, and may remain in place for 1-3 weeks. Other urologists may use a normal urethral catheter.
      • There is a greater risk of side effects if you have already had radiotherapy or brachytherapy to treat prostate cancer. This is because these treatments may have already caused some damage to the tissues surrounding the prostate gland
      • The 2006 USA registry of outcomes showed a high rate of sexual dysfunction after cryotherapy: of the patients potent at the time of therapy only 25.2% had returned to intercourse but only 8.8% were able to do so without any pharmaceutical or device assistance. Advances in technique have improved the outcomes since then, but it still remains a problem.
    • Side Effects: urinary problems, sexual dysfunction, bowel problems. Short term bloody urine, pain and bleeding where the needles were inserted, and difficulty or discomfort passing urine.
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  12. Treatment Options: Hormone Therapy

    • Hormone therapy slows the progression of prostate cancer by stopping the production of testosterone or keeping it from reaching the prostate. A variety of drugs are used, either by injection or pills.
    • A permanent form of hormone therapy is the surgical removal of the testicles. It is not done very often, but may be appropriate for an older patient who chooses not to undergo other treatment.
    • It is also sometimes used in order to shrink the size of the prostate before performing another treatment, such as brachytherapy, external radiation, HIFU or cryotherapy.
    • Advantages:
      • Hormone therapy alone will not get rid of your prostate cancer but it can keep it under control for many months or years.
      • Some research has suggested that a combination of hormone therapy and radiotherapy may be more effective then either therapy alone in men with locally advanced disease.
      • Hormone therapy may be a life-long treatment for many men with prostate cancer that has spread to other parts of the body (advanced or metastatic prostate cancer). It treats prostate cancer wherever it is in the body.
      • There are a number of different drugs available. If you have problems with one drug, or it stops working for you, you can switch to a different one. Sometimes you may be given more than one type of drug.
      • Intermittent hormone therapy may be used once your PSA level is lowered. It involves stopping the drugs until the PSA starts to rise again, then resuming them. This gives you a break from the side effects.
    • Disadvantages:
      • It is difficult for doctors to accurately predict how long hormone therapy will keep your cancer under control.
      • Hormone therapy requires frequent monitoring, PSA tests, drug dose adjustments or changes. For many men it will be a life-long treatment.
      • Long list of side effects.
    • Side Effects: Many side effects, most of them temporary while taking the drugs. Hot flashes, loss of sex drive, erectile dysfunction, tiredness, loss of muscle mass, weight gain, breast enlargement, irritability, dry skin, depression, osteoporosis, increased LDL cholesterol, testicle shrinkage, loss of body hair.
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  13. Side Effects: Urinary Incontinence, too much Continence

    • Many of the treatments for prostate cancer have the risk of causing urinary problems. Your doctor may have explained it to you, and even shown you a diagram. Many men are not aware that they have two valves controlling urination: the internal and external urethral sphincters. The one at the bottom, the external sphincter, operates separately from the top one. This arrangement allows us to have an ejaculation without peeing at the same time. The smooth muscle sphincter at the top forms the neck of the bladder, and continues down along the urethra. To explain it better, we have a very simplified diagram:
    • prostate anatomy
    • Radiation,HIFU, and Cryotherapy:
      • The causes of incontinence after treatment with radiation, HIFU, and cryotherapy are similar, although when and how often they occur is different.
      • During the course of radiation treatments some men experience a burning sensation while urinating, difficulty urinating, or blood in the urine. Usually this will clear up after the treatment is finished, but let your doctor know it is happening or if it is not improving.
      • Incontinence (urine leakage) may happen several months or even years after treatment. This can happen because the sphincter has been damaged and is not working properly. (see diagram above)
      • You may experience difficulty urinating caused by the buildup of scar tissue or narrowing of the urethra. There are simple procedures to clear the blockage, or possible drug treatments. If you cannot urinate at all, and are filling up, this is an emergency; call your doctor or go to the ER.
      • After radiation treatment there develops a lot of scar tissue in the prostate, therefore you will probably produce less semen or have a dry orgasm. In a few cases the ejaculation may go in reverse up to the bladder, when the internal sphincter has been damaged, or there is too much scarring in the prostate (retrograde ejaculation).
    • Radical Prostatectomy (surgery):
      • When the prostate is removed by surgery (see diagram above), the bladder is pulled down and reconnected to the urethra. Some or all of the sphincters may have been removed. That leaves only the lower external sphincter to control urine, and the muscle or nerves may have been damaged.
      • During the surgery a urinary catheter will be inserted, to be left in place for 1-3 weeks. When you go to get it removed, take along some pads or incontence underwear; most men will leak for a while. If you cannot urinate at all, and are filling up, this is an emergency; call your doctor or go to the ER.
      • Incontinence varies widely among men treated with surgery. It may be just a few drops occasionally, or total incontinence. For most men it gradually gets better over the span of months or 2 years. Keep your urologist fully informed what is happening, there are treatments available if it does not improve.
      • Some doctors consider Kegel exercises one of the most effective ways of controlling incontinence without medication or surgery. Ask your doctor or nurse, or check out Kegel Exercises for Men.
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  14. Side Effects: Sexual Dysfunction

    • Many of the treatments for prostate cancer have the risk of causing erectile dysfunction. The chance of this happening to you depends on your own anatomy, the progression of the cancer, your current health and fitness, your current sexual fitness, the type of treatment chosen, and the skill of your medical practitioners.
    • What does my prostate have to do with erections? Not a lot; the problem is that the 2 sets of nerves that control erections and continence run alongside the prostate. They are not like 2 wires, but instead are a web of microscopic nerve fibers mixed in with a lot of blood vessels (the neurovascular bundle, NVB). Only a thin layer of tissue (fascia) is between the prostate and the NVB.
    • Surgery:
      • Prior to 1980 there was a very limited knowledge of the finer anatomy of the prostate and its associated muscles, nerves and blood vessels. Surgical prostatectomy often involved the cutting or removal of the nerves and muscles controlling erections and continence.
      • Over the last three decades great improvements have been made in the surgical technique involved; such that nerve-sparing surgery is now done commonly. It is now the norm in cases of low- or intermediate-risk cancer that does not extend outside the prostate. More research and improvements in technique are constantly being done.
    • Radiation:
      • External beam radiation and brachytherapy can cause erectile dysfunction for similar reasons. In order to deliver a killing dose of radiation to all of the prostate, it is necessary to ensure the radiation gets to the outer edges of the prostate. Unfortunately the nerves controlling erection are close enough that they will also receive significant radiation. There is no way to stop the radiation right at the edge of the prostate capsule.
      • Over the last three decades there have been huge advancements in equipment and technique that have improved the accuracy of brachytherapy seed placement and external beam aiming.
      • There have been research studies showing that patients treated with brachytherapy have fewer problems with sexual dysfunction than with other treatments; other studies show little difference between surgery and brachytherapy.
    • HIFU and Cryotherapy:
      • Somewhat similar to radiation, during treatment with HIFU or cryotherapy there is difficulty restricting the heat or freezing to just the prostate. It is inevitable that some damage will extend beyond the prostate capsule, although constant improvements are being made in accuracy of treatment.
      • A 2011 article in the Can. Urological Assn.Journal reported finding rates of erectile dysfunction ranging from 20% to 77% reported in various case studies of HIFU. At this point there are not many long term studies completed.
      • Studies of cryotherapy have reported high rates of erectile dysfunction ranging from 49% to 93% in the first year following treatment, with some recovery later. A 2008 study of case outcomes found successful intercourse was reported by 25.2% but only 8.8% without pharmaceutical or device assistance.
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  15. Side Effects: Bowel Problems

    • Radical prostatectomy surgery very rarely causes any bowel problems. Occasionally a surgeon may cause a nick or tear to the bowel, but it usually is repaired easily and does not cause long-lasting problems.
    • Radiation therapy can cause bowel problems such as diarrhea, bleeding, irritation, or urgently needing to have a bowel movement. This is because the bowel is very close to the prostate and gets exposed to some radiation. Most of these bowel problems tend to be mild and gradually get better over time; but sometimes these symptoms can happen months or years after treatment has ended. Bleeding is rare, but could be a sign of other problems, so it is important to inform your doctor if this is happening.
    • HIFU and cryotherapy can cause the same bowel problems as radiation, although improvements in technique and equipment have made this less of a problem.
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  16. Do you have more questions? Comments?

  17. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any health care decisions or for guidance about a specific medical condition.
What Now?

What Now, when your partner has prostate cancer

Your partner has just been diagnosed with prostate cancer. You’re probably a little scared and a lot confused. You likely have many questions. Is he going to be okay? What’s the best treatment option? How is this going to affect our relationship? How can I get the information I need?

To help you understand what’s happening and to give you what you need to navigate the next few weeks and months, BCS Group has created this booklet just for you. It will give you information and tools to help you communicate with your partner and create a plan together for treatment strategies, managing the treatment and living well during and following treatment.

Most importantly, you’ll get wisdom and advice from women who have been in your shoes and know what you’re going through right now. Also useful reading for male partners and other family and friends.

*Publication of this booklet is made possible by unrestricted educational grant provided by Sanofi.