Prostate Cancer Treatment

Prostate Cancer Treatment

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    Watchful waiting for prostate cancer can be an effective and reasonable treatment strategy, especially for an older man who has a slow-growing, early-stage tumor and/or who has other serious health problems that require treatment more urgently or that make treating the prostate cancer too risky. Watchful waiting may be recommended for men in whom the risks of treating prostate cancer outweigh the benefits.

    If you choose watchful waiting, your doctor will closely monitor you to be sure your prostate cancer is not growing or spreading. During a period of watchful waiting, the doctor may order PSA (prostate-specific antigen) blood tests, rectal examinations and ultrasound exams to monitor the tumor carefully. If the tumor remains small, your Gleason score (a grade reflecting presence and pattern of cancer cells) remains low, and you are not experiencing any symptoms, you can usually continue with watchful waiting. If you begin to have symptoms or tests show the cancer is starting to progress, you can start treatment at that point.
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    If you have prostate cancer you should call your doctor if you cannot urinate, you have trouble starting to urinate or controlling your urine flow, or you have symptoms of a urinary infection including:
    • blood or pus in your urine
    • back pain just below your ribcage
    • pain in your groin or abdomen
    • fever
    • chills
    • body aches
    • painful urination
    You should also call your doctor if you experience any of the following symptoms:
    • pain when you ejaculate
    • pain in your back or hips
    • pain that isn't relieved by medication
    • vomiting or feeling nauseated
    If you are having chemotherapy to treat your prostate cancer, you may be at risk for developing anemia (too few red blood cells and consequently, low oxygen in your blood). You should call your doctor if you are experiencing the following symptoms of anemia:
    • You feel too tired to get out of bed for more than a 24-hour period.
    • You feel confused.
    • You feel dizzy, or you lose your balance and fall.
    • You have chest pains.
    • You have trouble breathing.
    If your prostate cancer is being treated with radioactive seed implantation, you should call your doctor if you experience the following symptoms.
    • You produce less than 5 ounces (a little more than half a cup) of urine or are unable to urinate at all in a six-hour period.
    • You feel increased pressure in the lower abdomen.
    • You have a fever of 101 degrees Fahrenheit or higher.
    • You have chills.
    • You have persistent bleeding, redness and/or a yellowish discharge at the implant insertion site.
    • You are experiencing problems using a catheter.
    Other types of treatment for prostate cancer may also cause symptoms that mean you should call your doctor. Talk to your doctor before and during your treatment to make sure you know when you need to call for help.
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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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.