Prostate Cancer Treatment

Prostate Cancer Treatment

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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    To reduce your anxiety about active surveillance of prostate cancer, you may benefit from talking to other men who are on active surveillance and educating themselves about how they deal with it. Stress management, meditation, yoga and exercise can also help reduce your anxiety. Reading about it and understanding the data about its safety is important so you can reassure yourself. It's also very important that your spouse is on board and educated about the condition and treatment approaches. This is called "a couple's disease" because the impact of treatment often affects the spouse.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    If you’re on active surveillance of prostate cancer, there may be reasons to seek treatment. Some centers will recommend treatment based on the rate of change in your prostate-specific antigen (PSA) level. Some centers don't look at that because PSA can rise for a variety of reasons, including benign growth of tissue. One way to address that is to use medicines that can stop benign growth, like finasteride or dutasteride, so the PSA test is is more reliable. The other reason to seek treatment after being on active surveillance is an increase in your Gleason score. This is why a repeat biopsy is indicated at a year and perhaps yearly afterward or every other year. Those are the two biggest triggers for going off active surveillance.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    One risk of active surveillance of prostate cancer is anxiety. Some men aren't comfortable with the idea of watching and waiting with cancer. Stress-reduction techniques can mitigate this, and doctors try to provide reassurance with regular biopsies and prostate-specific antigen (PSA) testing.

    The biggest risk men are worried about is that the cancer will spread beyond the confines of the prostate gland and result in death. That has not been a major concern in most of the studies to date. Research suggests that suggested that there is perhaps a 1% increased risk in death in men who seek treatment after active surveillance of prostate cancer compared with those who seek immediate care.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    Some doctors recommend software that helps people make decisions about their prostate cancer treatment. The software allows you to enter your prostate-specific antigen (PSA) level, your Gleason score and other things that determine your risk for death and side effects. It also does an interview, where you go through the different side effects of treatment and observation, and you get to express your preferences through a simple choice exercise. People are then seen in a clinic with a report that suggests the top three evidence-based choices that are consistent with their preferences. The report also informs doctors what these preferences are, so they can make sure to address what's specifically important to that particular man.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    There are several reasons doctors may stop active surveillance of prostate cancer. Active surveillance may be stopped when a man's prostate-specific antigen (PSA) level rises or if the Gleason score on a repeat biopsy gets worse. Doctors might also stop active surveillance if there's a change in the rectal exam or if a person just tires of the routine of surveillance. In most programs, between 20% to 30% of men will come off active surveillance at some point and seek definitive management. The time range of that is often two or three years.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    The protocols for active surveillance of prostate cancer vary by center. However, they all involve regular prostate-specific antigen (PSA) and prostate exams every four to six months, and a prostate biopsy every year or every other year. Many centers ask a person to have a repeat biopsy before he enters active surveillance to make sure a more aggressive cancer wasn't missed on the first biopsy.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    The criteria for active surveillance of prostate cancer include having low-risk or maybe intermediate-risk prostate cancer, which is partially defined by a man’s Gleason score. Doctors also look at prostate-specific antigen (PSA) level. Most programs have a PSA of 10 or less as a criteria for entry. In addition, doctors use tumor volume and a physical exam as criteria for active surveillance of prostate cancer.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    There are efforts to reduce side effects of prostate cancer treatment. Robotic surgery results in less blood loss and is associated with excellent outcomes in terms of urinary and sexual function. Radiation therapy is also being modified to more accurately target the prostate and avoid some of the side effects.
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    ASimon J. Hall, MD, Urology, answered on behalf of The Mount Sinai Health System
    Is impotency always an outcome of prostate cancer surgery?

    Impotency is not always an outcome of prostate cancer surgery. In this video, Simon Hall, MD,  a urologist at The Mount Sinai Medical Center and director of the Deane Prostate Health and Research Center, discusses what factors increase the risk.

     

     

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    ASimon J. Hall, MD, Urology, answered on behalf of The Mount Sinai Health System
    What are the main side effects for prostate cancer treatment?

    Impotency and incontinence are common side effects of prostate cancer treatment. In this video, Simon Hall, MD,  a urologist at The Mount Sinai Medical Center and director of the Deane Prostate Health and Research Center, discusses the side effects.