How is prostate cancer treated?

If you’re diagnosed with prostate cancer, what’s your prognosis? The prognosis for prostate cancer depends on a number of factors, but in general it is quite good, as it doesn’t spread as quickly as other more aggressive forms of the disease. In some cases, prostate cancer may not even need treatment.

“Prostate cancer is a very curable cancer,” says Dr. Peter Black, an urologist active in the Men’s Health Initiative of BC. “Only one in six men who get it dies from it. That is, in part, a reflection of the long course that prostate cancer takes; it’s a slowly-developing disease.”

The prostate gland is a small organ found in males, and one of its main functions is to help produce semen. The prostate is located right under the bladder and in front of the bowel, and the urethra runs through it, which is why many men with prostate cancer experience urinary problems.

See below for prostate cancer treatment options:

Active Surveillance

Active surveillance, also called “watchful waiting,” involves monitoring a patient closely, without starting any other type of prostate cancer treatment. However, this doesn’t mean just ignoring the disease; active surveillance will include regular PSA testing and digital rectal exams, and the patient may have to make dietary and lifestyle changes.

Surgical Removal of the Prostate

Also called a “radical prostatectomy,” surgical removal of the prostate gland may be done by open surgery or laparoscopic surgery through small incisions.

Radiation Therapy

Radiation therapy is the most common prostate cancer treatment option. “We use either external beam radiation, where the radiation waves are targeted at the prostate from the outside, or brachytherapy, where we put little radioactive seeds into the prostate,” says Dr. Black.

There are fewer side effects after external beam radiation, and you won’t need anesthesia, but seed therapy can be done in just one visit, and higher doses of radiation can be used.

Could you benefit from PSA testing?

Incontinence in Prostate Cancer Surgery

Prostate cancer is the most common male cancer, and one in six in men will develop the disease in his lifetime( Prostate cancer starts in the cells of the prostate gland, which is part of the male reproductive system. Read more about the prostate and prostate cancer here.

Urinary incontinence can be caused by many different things, and is a common problem, especially among older adults. Incontinence can also be caused by prostate cancer surgery, although this is not usually a symptom.

“Incontinence is actually quite uncommon after radical prostate surgery,” says Dr. John Warner, a urologist active in theMen’s Health Initiative of BC. “Seventy-five percent of patients have excellent urinary control and don’t require any pads, while 25% of patients have some degree of incontinence, but the vast majority it’s either one pad or less. A very small number, less than 5%, have total incontinence.”

If a man has a prostate surgery called a radical prostatectomy, there are two approaches: retropubic and perineal. During a retropubic prostatectomy, an incision is made above the pelvic bone, in the lower part of the stomach. If a man has a perineal prostatectomy, an incision is made through the perineum, which is located in front of the anus.

“The degree of incontinence is based on the patient but it’s also based on the physician,” says Dr. Warner. “The experience of the physician will impact a large amount on the incontinence of the person.

The greater the experience of the surgeon, the greater the chance that that patient is going to have excellent urinary control.”
In most cases, urinary incontinence after prostate cancer surgery resolves over time, with most men regaining urinary control within one to three months. Men can improve urinary control by practicing Kegels, which are pelvic muscle exercise that strengthen the pelvic floor. Kegel exercises are beneficial both before and after prostate cancer surgery.

“Discussing urinary incontinence is a very difficult thing for patients to do,” says Dr. Warner. “However, they shouldn’t be shy, and they need to make an appointment with their family physician or their urologist. There are many things that can be done both in the management of this problem and in the treatment of the problem, but until the physician knows and understands what the issue is, it’s difficult to proceed.”

Incontinence after Prostate Surgery

Urinary incontinence after prostate surgery is one of the potential side effects of prostate cancer surgery. The prostate gland affects urination because it sits right below the bladder, and surrounds the urethra. When urine is formed in the kidneys, it flows down the ureters, which are two thin tubes that empty into the bladder. The process of urination is controlled by the urinary sphincter, which tightens and closes around the neck of the urethra and the bladder. Urinary incontinence can occur when the urinary sphincter is damaged during prostate surgery.

“Statistics show that after radical prostate surgery most people have some degree of incontinence for the first few weeks after the catheter is removed,” says Dr. John Warner, a urologist active in the Men’s Health Initiative of BC. “Incontinence will continue to improve for up to a year to 18 months after the surgery.”

Urinary incontinence is usually a temporary condition that resolves itself within one to three months. The rate for complete continence 18 months after surgery is about 93%. (Walsh et al 2000). Only a very small percentage of men will have long-term or permanent incontinence.

Dr. Warner has the following tips for men following prostate cancer surgery:

  • Make sure you keep your bladder empty
  • Watch your fluid intake and monitor how much caffeine and alcohol you take in
  • Most importantly, do Kegel exercises before, during and after the operation to improve the control of urine.

Kegel exercises are done by tightening and clenching the pelvic muscles, and if performed regularly, they can strengthen the pelvic floor and the external sphincter, which is responsible for holding urine.

“If the incontinence is there, it’s best to discuss it with your urologist and understand what the mechanisms are that are causing it,” says Dr. Warner. They can give you some options to try.”

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