Posts Tagged ‘prostate cancer treatment’

"Do not look where you fell, but where you slipped." - African Proverb

  • No symptoms…does it matter?
  • Low PSA…does it mean no cancer?
  • Big prostate…means cancer?
  • Small prostate means no cancer?
  • Surgery better than radiation?
  • Proton better than regular “ole” radiation?
  • Age over 75-is surgery best?
  • Do you have a higher incidence of impotence with cryosurgery?
  • Why do they only do Proton on the well-mod prostate cancer in terms of the “favorability” of prostate cancer?
  • High PSA means prostate cancer?
  • You have a biopsy of your prostate cancer because of a high PSA…and it is negative…was the biopsy unnecessary?
  • Can you die of prostate cancer?
  • Can you have it before the age of 50?
  • Are all urologists the same?
  • Are all surgeons the same?
  • Will surgeons only recommend surgery?
  • What is the Gleason’s score?
  • If the guy at your church had seeds for his cancer is that the best treatment for you?
  • Are all prostate biopsies that have cancer the same?
  • Are all prostate cancers the same?
  • Does everyone that has surgery become impotent?
  • Does everyone that has radiation preserve their potency?
  • What is HIFU?
  • What is NanoKnife?
  • If you have trouble voiding does that mean you have prostate cancer?
  • When do you think the male should begin having PSAs and rectal exams?
  • Is prostate cancer hereditary?
  • Do blacks have prostate cancer more or less often than others?\
  • Does Avodart cause cancer of the prostate?
  • Can a dog smell prostate cancer in a man’s urine?
  • What is a Free PSA? How can you use it in the treatment decision-making?
  • If your friend had a particular treatment and did well, if you have the same treatment by the same doctor does that mean you will do well?
  • Is it smart to have anything other than prostate removal for prostate cancer if you are 50 or so and in good health? Hint: Think years at risk.
  • Why is years at risk, your physiologic age important in your decision?
  • What is the Partin table?
  • If there is cancer in your lymph nodes can you be cured with radiation or surgery?
  • What is the Prostatic Acid Phosphatase and how can it help you and your doctor?
  • If your Free PSA is very high indicating that you have a low likelihood of prostate cancer..does that mean you won’t have prostate cancer on biopsy?
  • Why do men get infections after a prostate biopsy?
  • What is the difference in a “autopsy evaluation of the prostate” and “twelve cores taken at the time of a prostate biopsy?”

Do you have others? I am tired for now but have probably hundred others that I will add from time to time. Comment won’t you? Mr. Cass…I bet you have a few to add.

From my book, “What was thought to be a simple disease of old men becomes after diagnosis  a potentially lethal disease with a very difficult treatment decision scenario for the newly diagnosed prostate cancer patient to consider.”

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he that can take advice is often better off than he that gives it....

“A old man don’t need his testicles….but they do tend to dress a fella out!”

A previous Prostatediaries hormone discussion and history of “androgen deprivation”

More about hormones and prostate cancer from a previous post

When I was a urology resident at the Medical College of Georgia in the late 1980’s if a man had prostate cancer that had spread to his bones…quess what we did to treat it? At the V.A. there we did orchiectomies under local in the urology clinic. I bet I did several hundred.

Most of a man’s testosterone comes from the testicles…a small portion comes from the adrenal glands. On looking back, those patients did quite well and it was a very cost effective way to treat metastatic prostate cancer. I don’t remember those patients complaining of hot flashes like the patients of today who have most commonly had one of the LHRH agonists. Same net effect of lowering testosterone but done in a different way. The orchiectomy removes the testicles and the body’s ability to produce the hormone, the LHRH drugs tell the brain to stop producing leutinizing hormone which in turn tells the testicles to stop making testosterone.

I do about one orchiectomy a year for metastatic prostate cancer. So patients have read about it and request it. Most however want to keep the testicles and take a shot. In some cases Casodex, an anti androgen, can be used instead of an LHRH agonist. Sometimes it is a patients choice.

Since LHRH agonists will cause a bump up for about 2 weeks in testosterone and possibly worsen the bone pain associated with prostate cancer in the bone…Casodex can be given for a couple of weeks to blunt that effect and then stop it.

Total androgen ablation uses both Casodex and a LHRH agonist.

Intermittent therapy (I prefer this) will knock the PSA down and only regive the treatment if the PSA rises. This may be at the time the shot ran out but often times the shot will work much longer than the amount of time is was designed for. I have one patient whose PSA is down to a negligible amount and we are out 2 years from a 6 month shot.

So hormone therapy is used when prostate cancer is metastatic, and can be used in the elderly male who is not a candidate for “curative therapy.” Hormone therapy knocks it back…it does not cure prostate cancer.

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Podbean thoughts on “sapping up” all you can from everyone before you make your “decision.”

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if kisses were all the joys in bed, one woman another would wed....shakespear

Prostate cancer doesn’t mean no sex life

April 7 2011 at 11:15am
By Anna Hodgekiss

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iol life april 7 Andrew Lloyd Webber picREUTERS

Composer Andrew Lloyd Webber

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Composer Andrew Lloyd Webber last week revealed he’d been left impotent following prostate cancer surgery. He is one of 37,000 men who are diagnosed with the disease each year in the UK.

There are various treatment options available, but which is best and what are the implications for your sex life?

“There are three considerations when it comes to treatment,” says David Neal, professor of surgical oncology at Addenbrooke’s Hospital in Cambridge. “We need to remove the cancer, prevent urinary incontinence and preserve sexual function – and the majority of patients agree this is the order of importance.

“However, the key indicator of what your sex life will be after the operation is what it was like before. Remember also that sexual function may begin to wane naturally once a man reaches his 50s and 60s.”

John Anderson, vice president of the British Association of Urological Surgeons, agrees. “It’s important to look at the demographic of many men who get prostate cancer. It is typically a disease of older men and, in these men, erectile function is not always at its best anyway.

“Then there is the tumour itself; your risk of impotence depends on the extent of the disease, which dictates how much treatment you will need.”

Your choice of surgeon is also “critically important – more so than the technique you undergo,” says Professor Neal. “You really want a surgeon who performs at least 80 to 100 procedures a year for your best chance of success on all fronts.”

Professor Roger Kirby, director of The Prostate Centre in London, says: “If the cancer was localised and the nerves were preserved, there is a good chance of regaining some sexual function.

“Many men find that things slowly begin to improve months, even years afterwards, as the nerves regrow.”

Here, with the help of the country’s leading prostate experts, we examine the pros and cons of each treatment and their possible effect on sex life.


The patient receives no treatment but is closely monitored every three to six months in case the cancer becomes more aggressive. “Many prostate cancers are slow-growing; we are getting much better at sorting the aggressive tumours from the slower growing ones,” explains Professor Kirby.

SUITABLE FOR: Low-risk, early-stage prostate cancer that is contained within the prostate. Patients with a Gleason score of six or less.

This measures the aggressiveness of the cancer from a tissue sample. A score of six and under is the least aggressive cancer; seven indicates a middle-ranking cancer; eight and above is the most aggressive.

WHAT IT INVOLVES: Regular hospital tests. These include a prostate specific antigen test to detect a protein linked to prostate cancer (rising levels could indicate the cancer has become more serious), digital rectal examinations, magnetic resonance imaging (MRI) scanning and biopsies.

PROS: “It can be ideal for those men with low-risk prostate cancer who are happy to defer treatment unless absolutely necessary,” says Mr Anderson.

“And more and more men are opting for this over treatment,” says Professor Kirby. “Of the 37,000 men diagnosed with the disease each year, only around a third will die from it.”

CONS: Some men may become anxious about their cancer changing. Occasionally, the cancer may change or grow faster than expected.

EFFECT ON SEX LIFE: The best outcome of all the options – there is no risk of damage to the nerves that assist sexual function. “The problem is, the nerves that enable a man to become aroused are very close to the prostate – this is why surgery can cause problems,” explains Professor Neal.


The most common type of surgery to remove the prostate gland and some surrounding tissue.

SUITABLE FOR: Cancers with a Gleason score of six and above which have not spread beyond the gland, with the patient being relatively fit and healthy.

WHAT IT INVOLVES: A two to three-hour operation where the prostate is removed following a 6-7cm incision in the lower abdomen under general anaesthetic.

PROS: “The aim is to remove the cancer completely,” says Mr Anderson. “If this is successful, and the cancer has not spread outside the prostate, it will return you to normal life expectancy.”

CONS: Overnight stay in hospital with greater risk of bleeding and a longer recovery period.

EFFECT ON SEX LIFE: A quarter to a third of men will lose sexual function due to damage to the surrounding nerves and small blood vessels responsible for erections. “In men who have good function beforehand, there is on average a 66 to 75 percent chance they will be able to perform afterwards,” says Professor Neal. “But remember that it takes a good 12 to 15 months to recover from prostate surgery. Pretty much everyone is impotent straight after.”

“It’s fair to say that a man in his 50s has a better chance of retaining function than a man in his 70s,” adds Professor David Gillatt, director of the Bristol Urological Institute.

Nerve-sparing prostate surgery is where the surgeon tries to avoid damaging the two nearby bundles of nerves that control erections, explains Mr Anderson. It may be possible if the cancer has not spread too far. Studies show that for every ten men with both nerve bundles spared, between three and eight regained erections.


The prostate gland is removed through tiny cuts in the abdomen rather than one large one. This is the treatment Andrew Lloyd Webber had.

SUITABLE FOR: A similar group to open surgery, but is becoming the preferred method for many surgeons.

WHAT IT INVOLVES: There are two methods – by hand or using a Da Vinci robot (a relatively new technique). The surgeon makes five or six small cuts in the abdomen and inserts a camera through a tube that magnifies everything ten-fold.

Tiny instruments go through the other holes and the operation takes two to three hours. In robotic surgery, the camera used is 3D and high-definition, explains Professor Prokar Dasgupta, of Guys and St ThomasÕ Hospital, who pioneered robotic surgery in the UK eight years ago.

PROS: “As with many types of keyhole surgery, there is a quicker recovery time, less pain, bleeding and scarring,” says Professor Kirby (who has performed more than 800 robotic removals). ÔBecause the structures can be seen so much more clearly, robotic surgery should be more effective than open prostatectomy, but this needs confirmation from long-term studies.

“I believe it’s the best way to treat prostate cancer and have abandoned open surgery because of this.”

Professor Dasgupta adds: “The cancer control is good and we can often spare the nerves responsible for continence.”

CONS: Similar long-term risks of impotence and incontinence problems with manual keyhole as for open surgery but robotic operations, with an experienced surgeon, may dramatically reduce this.

EFFECT ON SEX LIFE: “We find that many younger patients recover their potency very quickly after robotic surgery,” says Professor Dasgupta.


High-energy X-ray beams are directed at the prostate gland to eradicate the cancer cells by stopping them from dividing and growing.

SUITABLE FOR: Older patients and those with more aggressive locally advanced cancer with a Gleason score of seven or above; patients health conditions that make them unfit for surgery.

WHAT IT INVOLVES: The most common type is 3D conformal radiotherapy. This directs beams to fit the size and shape of the prostate while helping to avoid damaging the healthy tissue around the prostate.

The new intensity-modulated radiotherapy can deliver different doses of radiation, meaning less risk to surrounding tissue.

PROS: Painless and requires neither general anaesthetic nor overnight hospital stays.

CONS: Daily trips to hospital for seven weeks. “There is always the danger with leaving the prostate inside the body that some residual cancer may remain,” says Professor Kirby. “Radiotherapy can also cause an irritated bladder and bowel – many patients complain they feel the urge to ‘go’ all the time,” explains Professor Gillatt.

EFFECT ON SEX LIFE: Sexual dysfunction rate is the same as after surgery: between a quarter and a third of men will be impotent. “However, with surgery the body recovers over time,” says Professor Neal, “whereas radiation damage can continue occurring for two to three years after the treatment.”


Tiny radioactive seeds – the size of a grain of rice – implanted in the prostate emit radiation to the surrounding tissue, destroying cancer.

SUITABLE FOR: Men with smaller and localised tumours that are low-medium risk (Gleason grade seven). Not suitable for those with large prostates or men with urinary problems, as it will make the problem worse. High-dose brachytherapy may be offered for higher risk cancers, but this is not widely available.

WHAT IT INVOLVES: The seeds are inserted via needles close to the tumour, with an epidural or under sedation. (They remain in the body permanently, becoming inactive after eight to ten months.)

PROS: “Treatment is rapid, taking just two days,” explains Professor Neal.

Because the radiation doesnÕt travel very far in the body, the healthy tissue around the prostate gland gets a much smaller dose of radiation and so may cause less damage to bladder and urethra resulting in fewer incontinence problems.

CONS: “It can cause problems with urination if the prostate swells – a common side-effect of this treatment,” explains Professor Gillatt. (The prostate surrounds the urethra, the tube that delivers urine out of the body, like a doughnut.)

EFFECT ON SEX LIFE: “Some doctors say this has a lower risk of impotence, but the evidence is not there,” says Professor Neal.

And, adds Professor Gillatt, just like conventional radiotherapy, the effects on sexual function may take time to appear.


A relatively new treatment that heats and destroys cancer cells in the prostate.

SUITABLE FOR: A minority of men for whom loss of potency is their paramount concern. May also suit men unhappy with active surveillance, or older men unsuitable for surgery.

WHAT IT INVOLVES: A probe inserted into the rectum passes ultrasound waves through the wall of the back passage and into prostate gland. The ultrasound energy causes the prostate cells to heat up, destroying both the healthy and cancerous cells.

PROS: Can focus on certain parts of the prostate gland where the cancer is, potentially avoiding damage to other nearby organs and nerves responsible for sexual function. No scars, and can be performed as a day case. If unsuccessful, it is still possible to undergo surgery or radiotherapy at a later stage.

CONS: Widely considered an experimental treatment Ñ no long-term results have been published yet, says Mr Anderson. Professor Neal adds: ÔThe concern with HIFU is that it focuses a beam on the prostate and burns selected areas where the cancer is. But there may be other areas of cancer in the prostate that do not appear on an MRI scan and therefore may not be treated.Õ

EFFECT ON SEX LIFE: More evidence is needed.


Controls testosterone, the male hormone that fuels prostate cancer cell growth.

SUITABLE FOR: The gold standard for patients with advanced prostate cancer that has spread beyond the gland and is untreatable using surgery.

WHAT IT INVOLVES: Drugs called LHRH analogues, such as Zoladex, are given as an injection every one or three months, depending on the dose. There are also anti-androgen tablets such as Casodex, taken daily that stop testosterone from reaching the cancer cells.

PROS: While not a cure, hormone therapy can be a lifelong treatment. It slows tumour growth, reduces symptoms and shrinks the cancer. For this reason it’s also commonly used before radiotherapy and sometimes afterwards to help improve the effects of treatment.

CONS: Testosterone is important for bone health; by reducing it, this raises the risk of osteoporosis.

EFFECT ON SEX LIFE: “Treatments such as LHRH analogues destroy your sex drive,” says Professor Kirby. “They lower libido because they lower testosterone, the driving force behind it.” However, taking anti-androgen tablets may allow a man to preserve his hormone levels – or at least stop his libido being quite so battered – as they don’t actually stop testosterone being produced, says Mr Anderson. – Daily Mail

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i can tell you a lot about you by knowing who you love.....

Had to get that “moustache dreadful picture of my hair off the main page of the previous post. A nurse of mine asked,” Are those plugs?”

The answer to the question posed above: Drum roll please……

  • Yes you can have sex the morning of a prostate biopsy
  • Yes sex before a PSA will make it higher
  • No a rectal exam won’t make the PSA higher
  • Yes you can have sex after a biopsy
  • No it won’t hurt your wife
  • Yes there will be blood, to what degree varies
  • Yes, when the color of the semen turns rusty looking (old blood and iron) it is about to stop
  • No, repeated biopsies of the prostate hurt it or “make it leak”
  • Yes…to all the wifes out there….good try on another reason to postpone sex but having had prostate biopsy isn’t one of them….no extra charge to all the men out there

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what did mr bullet say to mrs bullet? "we're going to have a BB"

Companies, media organizations join Georgia Prostate Cancer Coalition to launch pledge campaign

4. December 2010 04:54

Prostate cancer is a serious health concern in Georgia. According to the American Cancer Society, the state of Georgia ranks 11th in number of estimated deaths per capita from the disease. In an effort to raise awareness about prostate cancer and ensure more men commit to be informed and screened, several companies and media organizations have joined the Georgia Prostate Cancer Coalition in launching a pledge campaign.

The Georgia Prostate Cancer Coalition, RC Cancer Centers and the Georgia Department of Community Health along with the Atlanta Hawks, Atlanta Thrashers, UPS, CR Bard, WXIA Television, Morehouse School of Medicine, KISS 104.1 Radio and WSB Radio are supporting this initiative to increase prostate cancer awareness throughout the state of Georgia.

“Specifically, we are encouraging every man who is over the age of 40 in Georgia to speak to his doctor and take the pledge to get screened for prostate cancer,” said Frank Catroneo, Georgia Prostate Cancer Coalition Board Member. “Our goal is to have 10,000 men in Georgia pledge to have the conversation with their doctors and/or be screened between now and April 20, 2011.”

M. Rony Francois, MD, MSPH, PhD, Director, DCH Division of Public Health and State Health Officer said, “I look forward to the potential that this pledge campaign holds in increasing the number of men who talk to their doctor about prostate cancer screening.”

To encourage prostate cancer discussions and screenings, the Atlanta Hawks and the Georgia Prostate Cancer Pledge committee will provide two tickets to several Atlanta Hawks home games, starting with the December 7th home game versus the New Jersey Nets, to the first 2,000 men who commit to being screened for the first time. Men can visit http://www.hawks.com or http://www.GeorgiaProstateCancerPledge.com to make their screening pledge and redeem their complimentary tickets online.

There will be a number of activities and events to help educate men and their loved ones, and to bring awareness to the serious health impact of prostate cancer for all concerned. The events will culminate in April with a prostate cancer symposium, a golf tournament, a motorcycle ride, video testimonials of survivors and much more.

Michael Holton, president and COO of RC Cancer Centers, which specializes in the ProstRcision treatment for prostate cancer said, “Throughout the campaign, we will be offering free of charge PSA screenings for men over 40 years old, who have not been diagnosed with prostate cancer or previously treated for this disease. They can be screened at any one of our five locations in Georgia. For screening locations, visit http://www.RCCancerCenters.com.”

Current data available from Georgia Department of Community Health, the Centers for Disease Control and the American Cancer Society show:

•Prostate cancer is the leading cause of cancer among Georgia males and accounts for 28 percent of all new cancer cases among males each year.

•Nationally, about one in six men will be diagnosed with prostate cancer during his lifetime and more than two million men in the United States have been diagnosed with prostate cancer at some point and are still alive today.

•Other than skin cancer, prostate cancer is the most common cancer in American men and the second leading cause of cancer death, behind lung cancer.

“It is crucial for men to maintain an ongoing relationship with their healthcare provider as the risk for prostate cancer will vary from person to person,” said Roland Matthews, M.D., from Morehouse School of Medicine and Director of Georgia Cancer Center for Excellence at Grady Health System.

A prostate screening PSA (Prostate Specific Antigen) is a simple blood test which will not define a man’s prostate cancer status, but provides the basis for men to start the right conversations with their doctor. When prostate cancer is detected early, it is a very curable disease.

SOURCE The Georgia Prostate Cancer Pledge Committee

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orators become dumb… when beauty speaketh-shakesphere

Okay…one more time. 

  • sex drive is called libido and is dependent on testosterone
  • testosterone is not affected by removing the prostate
  • testosterone is produced by the testicles and gets into the body through the blood stream independent of the prostate
  • potency is the ability to get an erection
  • an erection after prostatectomy is a function of sparing the nerves
  • a prostatectomy does not affect the testicles or the level of the males hormones or testosterone
  • it is possible to have a very high libido and not have the ability of having an erection (which can happen after any treatment of prostate cancer)
  • fertility is the ability to have children which is unrelated to potency or libido…but will go away with a prostatectomy but may not with radiation of the prostate

So…In answer to the search question…Sex drive or libido which is hormonally driven… will not change after a prostatectomy. Now…a prostatectomy or any treatment of the prostate had an emotional hit or consequence…that too can affect libido or drive……it’s complicated……

When a man has a vasectomy or a prostatectomy his sex drive or libido, which is dependent on the male hormone testosterone, does not change. Testosterone is produced by the testicles and released into the blood stream and subsequently not affected, or its blood level diminished, by either procedure.

What is wrong with the terminology in the following urology joke? 

One of the oldest Urology jokes around involves a man coming to the Urology clinic for a vasectomy all dressed up in a tuxedo. When asked,” Why the formal attire?” he responds,” If I am going to be impotent, I’m going to look impotent.”

The answer and the  problem with this joke, as explained in the bullets above, is that a vasectomy makes you sterile (no sperm), it has no affect on potency. Potency refers to erectile function which is independent of fertility (which is what a vasectomy affects). I mention this because it is misconceptions like these which abound within the male population, and contribute to the “perfect storm” of delayed diagnosis alluded to earlier in this book. It is still a cute joke however.


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