Prostate Cancer; When Watchful Waiting is the Answer

Patients are used to asking the question, “When do we starting treating it and what type of treatment will we use?”. But with prostate cancer in many cases the answer could be “We’re not going to treat it.” The “wait and see” approach may well be the right option for your prostate cancer.

Watchful Waiting/Active Surveillance

Also called “active surveillance” the term “watchful waiting” describes one way to “treat” prostate cancer. It is used to describe cases where the prostate cancer patient has opted to refuse surgery, radiation, hormone therapy, and any other medication to treat the prostate cancer. Instead of treatment doctors will rely on prostate-specific antigen (PSA) tests and digital rectal exams (DRE) to monitor disease progression. If and when one of these tests show that the cancer is progressing, at that time other more active treatment options may be considered.

Certain types of prostate cancer can be very slow to progress; some men who have it will never experience any symptoms or problems. Occasionally the disease can actually be less damaging than the treatment. Prostate cancer can be monitored regularly with frequent testing — about every six months — and without surgery or radiation. According to a large, long-term study of nearly 800 men with prostate cancer, the risk of dying from a “low-risk” tumor is similar whether you choose observation or treatment.

Are You a Good Candidate for Watchful Waiting?

Not all patients are good candidates for watchful waiting. Younger men or men who have aggressive prostate cancer are often recommended to take a more proactive approach to treatment, but older men who are concerned about side effects — commonly, impotence and incontinence —may want to consider watchful waiting.

The following are other factors that can indicate whether watchful waiting is a viable treatment method for a prostate cancer patient:

Early stage diagnosis. The earlier the stage at diagnosis, the more time a prostate cancer patient may have in determining what treatment plan is best.
Short life expectancy. If a man has a life expectancy of less than five years for other medical reasons he may opt for watchful waiting.
Having another serious health condition. If a patient is struggling with another disease or health condition, they may not want to proceed with surgery or radiation for prostate cancer at the same time.
Gleason score. When the cancer is not aggressive and is slow to progress, a man may have a low Gleason score. This patient may consider watchful waiting as an option.

Caring for a Partner With Prostate Cancer

How to Care for a Partner With Prostate Cancer

The whole world can seem to change in an instant when a you find out that your partner has been diagnosed with prostate cancer. Both of you will probably feel overwhelmed, and afraid. It will most likely be a confusing time for both of you.

The Best Thing to do is to Learn What to Expect

You both should take steps to educate yourself about the disease. In this case knowledge can certainly be power. There are many possible side effects of both the cancer and the types of treatments that you should be prepared for. These can include:

A man can be rendered infertile due to prostate cancer treatment, whether it be surgery or radiation therapy. For partners that want to have children after treatment, if is recommended to investigate options such as sperm banking pre-treatment.

Sex life changes.
It is common for men to experience erectile dysfunction (impotence) after treatment for prostate cancer. It may be temporary or permanent depending on the treatment.

Changes in urination/bowel issues.
Lack of control/urinary incontinence can be a common after prostate cancer treatment. Bowel issues such as diarrhea can be long-term effects of some kinds of radiation therapy.

Hormonal changes.
Numerous side effects can occur from the hormone therapy used to treat prostate cancer. These side effects can include weight gain, and muscle loss, fatigue, low sex drive, hot flashes, and brittle bones.

Subtle hormonal changes could be evident as well including memory and multi-tasking difficulties. For example, hormone deprivation therapy can potentially have some subtle, cognitive (thought process) effects in the men prescribed this treatment. The knowledge you can gain about the types of side effects that can occur, and what you can do about them, can empower you and help you and your partner know when/how to take action.

Prostate Cancer Caregiving: More Tips
Your partner will need you to be there to listen. Make sure to encourage him in his treatments by going to doctor’s appointments, treatment sessions, and tests. Make sure that he knows that you want to be a part of this process with him. You are the best person to encourage him to look forward to the life he can enjoy once his treatments are completed and successful.

You Are Important Too
Some find it helpful to join a group for caregivers of prostate cancer patients. It can be a good place to share your experiences with others.

Erectile Dysfunction and Prostate Cancer

Erectile Dysfunction and Prostate Cancer

Sexual function is an important topic but one that men might not put at the top of their priority list after receiving a diagnosis of prostate cancer. Many men fear impotence as a side effect of the treatment/disease.

Prostate Cancer Treatment; Why Erectile Dysfunction May Occur As A Result

The side effect of impotence may be a result of the treatment options for prostate cancer which may include surgery or radiation. Both of these two treatment options can affect the nerves surrounding the prostate that enable a man to have an erection.

One of the primary reasons for impotence as a side effect is that the prostate gland surrounds the base of the bladder and the base of the penis, and consequently nerves that are related to both sexual function and urinary function can be damaged either by the prostate cancer cells themselves or by the treatment. An impact on these nerves is fairly common; it all depends on where the cancer is located.

In a radical prostatectomy, the nerves may be removed or they may become damaged. In some occasions even when there is no nerve damage, impotence may still occur in men who have had surgery to treat prostate cancer. In these cases it could be that the veins and blood vessels in and around the penis have sustained damage during surgery, which can affect the ability to have an erection.
When undergoing radiation therapy, prostate cancer patients may experience damage to the blood vessels to the penis, and therefore issues with impotency may occur over time.

Which Men Are Affected?

Your age, sexual health and the type of treatment that you received can all determine wow likely you are to become impotent following prostate cancer treatment.
Younger me (40 to 49) and those men who have had healthy erections before prostate cancer treatment are more likely to be able to achieve erections after treatment. Men with tumors that have grown beyond the prostate are more likely to experience erectile dysfunction.

The risk of impotence is much lower if the patient has nerve-sparing surgery. However, if the nerves are damaged during this type of surgery, many men may still experience some temporary erectile dysfunction for 2 to 18 months afterward.

What You Can Do About Erectile Dysfunction

A strong relationship with your partner in addition to patience and the passing of time can help improve your sexual health after prostate cancer treatments. Most men feel anxious and worried about this side effect, but doctors should be counseling patients and advising them that the nerves around the prostate require time to heal.

Studies have shown that couples counseling can be of great help to men after prostate cancer treatment. There are also several medications and devices that may help:

• Prescription medications. A number of prescription medications that can be taken orally, including such brand names as Levitra, Cialis and Viagra. These drugs help to increase blood flow to the penis. They work best in prostate cancer patients who still have healthy nerve bundles on each side of the prostate.

• Medication injections. To help increase blood flow and stimulate an erection there are medications that can be injected into the side of the penis. Once a doctor shows you how to administer them the injections can be given at home by a partner.

• Surgical implants. Some men choose a permanent penile implant that can be surgically inserted in the penis to facilitate erections.

• External devices. A pump attached to a tube that covers the penis and creates a vacuum is an option. This stimulates an erection by increasing blood flow to the penis. For a short period of time s ring may also be placed on the penis to maintain an erection.

It is important to note that not every man who gets treated for prostate cancer will experience erectile dysfunction. Men should talk with their doctor about treatment options and medical devices and drugs that can be used post-surgery.
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African-American Men; Prostate Cancer Risk

Men of all ages should be concerned about and aware of the signs of prostate cancer. It’s recommended that men talk to their doctors about when they should be screened based on their family history and other risk factors. Early screening is especially important if a man has one or more risk factors and is at an increased risk of developing prostate cancer.

Statistically it is a fact that men of African-American descent are at a higher risk of developing prostate cancer than white men. 19 percent of black men, almost one in five — will be diagnosed with prostate cancer. Five percent of that group will eventually die from the disease. Prostate cancer is the fourth most common reason for death in African-American men.

The risk for prostate cancer in African-American Men is greater, but how much greater?

No one is certain of the reasons why black men are at an increased risk of developing and dying from prostate cancer. In part this group is more likely to die from prostate cancer in part because of delayed diagnosis and also because of limits in access to treatment. One recent study suggests that there may be a genetic link.

If there is a family history of prostate cancer for an African-American man, their risk increases dramatically. Those with an immediate family member who had prostate cancer have a one in three chance of developing the disease. This risk rate increases to 83 percent if two immediate family members have had the disease.

It’s so important to have early prostate cancer screening, and here is why:

By the time noticeable symptoms of prostate cancer appear, the cancer is likely in an advanced state so early prostate cancer screening is of utmost importance. The changes of recover increase the earlier the prostate cancer is caught.

When caught early, prostate cancer is highly treatable. Nearly 100 percent of men who are diagnosed with prostate cancer in its earliest stage will be alive five years later.

African American men should have prostate cancer screening at young age.

For African American men, routine prostate cancer screening should start at a young age; the American Cancer Society recommends that these men discuss testing with their doctor at age 45, or at age 40 if they have several close relatives who have had prostate cancer before age 65.

There are some different types of screening tests and those can include a prostate-specific antigen (PSA) blood test and/or a digital rectal exam (DRE). A family doctor can usually perform both tests.

The signs and symptoms of prostate cancer are important for all men to know. These symptoms can include urinating in the middle of the night, urinating more frequently than normal, and feeling like the bladder doesn’t completely empty. Also blood in the urine may be a sign of prostate cancer.

If men experience these symptoms it is important for them to talk to their doctor about diagnostic testing for prostate cancer.

When You Have Prostate Cancer Make Physical Activity a Priority

From improving your mood to helping you fight fatigue; physical activity can have lots of benefits when you have prostate cancer, from improving your mood to fighting fatigue. Physical activity doesn’t have to mean something of the level of running a marathon or climbing a mounting. There are many small ways to encourage yourself to get more active; move more. Talk to your doctor and ask for a good exercise plan that meets your personal needs.

Activity Can Help Ease Treatment Side Effects

For patients that are getting hormone therapy for their prostate cancer, exercise can help with some of the side effects, some of which can be similar to those that women get during menopause. Some of the potential problems with hormone therapy can be osteoporosis, hot flashes, issues with sexual libido and weight gain. Staying physically active can help minimize these side effects.

Physical Activity Can Improve Your Treatment Options

There are a wide variety of reasons to keep up your fitness level throughout your life, however for prostate cancer patients research suggests that physical activity activates certain genetic pathways in your body, which can help improve how well medicines work.

Try to Keep Your Weight To a Normal Level.

Researchers at Fred Hutchinson Cancer Research Center conducted a study that suggests the risk of dying from prostate cancer is more than double in obese men diagnosed with the disease, compared with men of normal weight. Men that are obese and have cancer that is limited to a specific area, have nearly four times the risk of their cancer spreading.

Activity Can Help You Beat Fatigue

Cancer treatments can often make patients feel tired. This is due to many factors including anemia, chemotherapy and radiation side effects, depression, and the cancer itself.

People often think that exercising when you are fatigued sounds counterproductive, but it is indeed a good way to combat fatigue. Researchers have proved that people with cancer who exercise regularly have 40%-50% less fatigue than those who don’t.

Activity Can Be a Mood Booster

Keeping your spirits up is easier when you are physically active. It’s a way to have control over your body in a good way. Exercise for prostate cancer patients can really help make them feel more positive.

What Activity Is Best For You?

Experts say that the ideal exercise/activity plan includes three parts: an activity like a brisk walk to get your heart pumping, strength training such as lifting weights to build muscle, and stretching to keep your muscles and joints limber.

For patients that weren’t physically active before their diagnosis, the advice is to start slowly. Each day just do a little more and a little more. Don’t strain yourself at the start of your new regime or you will just get discouraged. It’s fine to being with a simply 10-minute walk and work your way up slowly to a level such as 30 minutes, 5 days a week.

Your Relationship And The Effects Of Advanced Prostate Cancer

When a patient gets a diagnosis of advanced prostate cancer many things can change. One of those can be their relationship with their partner. There are ways to respond to this situation that can be helpful to the relationship.

What Can You Expect?

The statement “Knowledge is power” can be very apropos in this kind of circumstance. Understanding the physical and sexual side effects that could occur during or after prostate cancer treatment, will help couples be better prepared to handle them.

Your doctor can help you understand the symptoms a patient might experience and how to best manage them. It’s important that both partners understand this information.

It is very common for men who go through prostate cancer treatment have trouble getting or maintaining an erection in the first few months after treatment. On occasion these problems can be long-lasting.

Strong medicine is used in advanced prostate cancer including radiation, chemotherapy, surgery, and medications (including hormone therapy). Their side effects can include weight gain, lower libidos, fatigue and urinary incontinence. The side effects can be very upsetting to patients but there are many ways to help manage them.

Some men for example who experience erectile problems after treatments may be able to get erections with the help of medications, injections, or surgeries (such as penile implants).

Extra Affection Can Help

At a stressful time like this it’s important to focus on your relationship as a couple. Kisses and hugs and physical touch are good ways to keep the feeling of being connected. Even extra eye contact can help couples feel more in touch with each other.

Intimacy Can Come in Many Forms

During and after treatments sex may have to take a backseat and that’s to be expected. There are many ways to be sexual and couples just have to be open to new ways of looking at this issue.

There Are Pros Who Can Help

A couple’s therapist can help you and your partner if you are having trouble with sexual or emotional closeness when you’re dealing with cancer. Many men are reluctant to see a therapist, but it can be an important part of the whole treatment process/plan.

Keep The Faith It Will Get Better

Even you and your partner struggle with your relationship at times, patients need to realize that in the majority of cases it does get better and their relationship with their spouse does not have to deteriorate. In fact, when asked after treatment is finished, many couples say that dealing with prostate cancer has made their relationship stronger than ever.

Making the Choice: Advanced Prostate Cancer Treatments

Today patients have many choices on how to treat their advanced prostate cancer. There are many new therapies that have been approved by the FDA in the last few years and more are in development for the future. It can be challenging to decide which treatment to choose.

When patients are deciding on their course of action there a many important things to consider.

What are the Possible Side Effects?

As patients weight their options they need to consider their quality of life. It’s important to discuss the risks and benefits of each possible treatment with your doctor. Ask them to tell you about any side effects that medications may have both long term and short term.

Some drugs have risks such as muscle weakness or nausea. It is important to weigh those side effects against the benefits of that particular drug.

Take a Good Look at the Costs

Don’t hesitate to ask your doctor about the cost of certain treatments. Doctors understand that patients are very worried about the cost of care. Your doctor might not initially bring up the subject, but you can initiate the conversation by saying something like “Is there any way I can get an estimate on the costs of my cancer treatment before we start it?” Your doctor should be glad to help address these valid concerns.

Consider Your Family History

Doctors always ask whether prostate cancer runs in the family. And for good reason. The family history can influence the treatment plan that they suggest for you. For instance, a study published in The New England Journal of Medicine determined that more than 10% of men with advanced prostate cancer have a genetic mutation that raises the chance of having cancer.

Schedule of Treatment

You need to carefully consider how the treatment you choose affects might your daily routine. Questions like these are very relevant:
• Will I need to leave work/take vacation time early to get treatment?
• What will the arrangements be for transportation to get to and from the treatment center?
• If you have a caregiver, determine whether the treatment works with their job and schedule.

There is no treatment available, no matter how advanced it is, that will work if you don’t stick to it/remain compliant to the schedule. Some treatments have schedules that are more flexible than others so discuss that with your doctor.

Carefully Factor in Any Additional Health Problems You May Have

Many times your overall health will determine how well you handle a particular treatment. 66 is the average age of prostate cancer diagnosis in the U.S. Men with advanced prostate cancer are on average, about 10 years older when they get diagnosed. During your mid 70’s and later, patients are more likely to have long-term health conditions like diabetes and heart disease. These conditions can complicate cancer treatment.

Determine the Level of Your Personal Support Network

When you need treatment for prostate cancer, ask for help and support. Tell your family and friends and let them give you some assistance. That kind of help can be invaluable. You can also hire reliable staff that can be of aid. Your doctor or a staff member at the clinic may know about local organizations that offer discounted home care services.

Eating Right is Especially Important When You Have Prostate Cancer

Cancer treatments can cause side effects. These side effects are often more pronounced when patients are not eating enough and/or are not eating the right foods. Prostate cancer patients need to maintain good nutrition to feel their best and have the most energy possible. Here are some strategies to improve your diet:

Set a goal to meet your basic calorie needs.

For a cancer patient, the estimated calorie needs can be determined by multiplying their weight x 15 calories a pound (if their weight has been stable). If the patient has lost weight another 500 calories per day can be added. Example: A person who weighs 150 lbs. needs about 2,250 calories per day to maintain his or her weight.

Plenty of protein is recommended.

To rebuild and repair damaged and normally aging body tissue, protein can be an important factor. The estimated protein needs are 0.5 to 0.6 grams of protein per pound of body weight. Example: A 150-pound person needs 75 to 90 grams of protein per day.

The best sources of protein include foods from the dairy group (8 oz. milk = 8 grams protein) and meats (meat, fish, or poultry = 7 grams of protein per ounce), as well as eggs and legumes (beans).

Make sure to stay hydrated.

In general, people should take in between 30 and 50 ounces of fluid daily to prevent dehydration. (That’s 1 to 1.5 liters). Fluids can come in many types including water, juice, milk, broth, and milkshakes, as well as gelatin, fruits, and salads. The need to stay hydrated becomes very important if you have treatment side effects such as vomiting or diarrhea.

Keep in mind that beverages containing caffeine do not count as much, because they may make you urinate out as much or more than you take in.

Get your vitamins.

If you are not sure you are getting enough nutrients it’s a good idea to take a vitamin supplement. A multivitamin that provides at least 100% of the recommended dietary allowances (RDA) for most nutrients is a good option.

Make an appointment with a dietitian.

You can get a great deal of help from a registered dietitian who can provide suggestions to work around any eating problems that may be interfering with proper nutrition (such as early feeling of fullness, swallowing difficulty, or taste changes).

A dietitian can also help you maximize calories and show you how to include proteins in smaller amounts of food (such as powdered milk, instant breakfast drinks, and other commercial supplements or food additives).

Facts About Prostate Exams: Who Should Have One and How it is Performed

Behind lung cancer, prostate cancer is the second leading cause of cancer death in men living in the United States.

1 in 7 men will get a diagnosis of prostate cancer in their lifetime according to the American Cancer Society. Prostate exams are commonly performed to help reduce the high numbers of deaths from the disease.

What is involved in a prostate exam?

Screening for prostate cancer involves looking for early signs of a disease in healthy people who do not have any symptoms. The aim of screening is to diagnose the disease at an early stage because the earlier it is diagnosed the easier it is to treat and therefore the more likely it is to be cured.

Who should get a prostate exam?

Men over the age of 50 are strongly advised to have at least an informed discussion with their healthcare provider about screening for prostate cancer.

The American Cancer Society recommends that the discussion about screening should take place for men in the following groups:
• 50 years of age – for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• 45 years of age – for men at high risk of developing prostate cancer. This includes African-Americans and men who have a father, brother, or son diagnosed with prostate cancer at a younger
than age 65.
• 40 years of age – for men with more than one first-degree relative who had prostate cancer at an early age.

What types of tests are available?

There are two main tests most commonly used to screen for prostate cancer. These are the digital rectal exam and the prostate-specific antigen test.

Neither test can confirm prostate cancer. However, they can reveal strong signs that a patient has a prostate problem and requires further testing such as a prostate biopsy.

Men who want to be screened should be tested with the PSA blood test. If a patient gives their consent, the digital rectal exam is usually conducted as an early part of the screening.

Having a digital rectal examination

A DRE is generally not painful and only takes a few minutes to complete.

The specialist will gently insert a lubricated, gloved finger into the rectum. The specialist will determine the size of the prostate and feel for bumps, soft or hard spots, and other abnormalities.

Prostate cancers often begin in the back of the gland, which may be felt during a rectal exam. If the prostate is enlarged, the patient may feel discomfort or mild pain during the exam.

If the doctor finds any areas of concern during the DRE, additional tests may be needed to examine them more closely.

Having a PSA test

The PSA test is a blood test used to detect prostate problems. It usually takes 14 days to get the results back. The test measures a protein called PSA that is made by the prostate gland. Some of this protein leaks into the blood and can be measured by doctors.

A variety of factors can affect PSA levels, such as age and ethnicity. Some prostate glands produce higher levels of PSA than others. In general, the higher the PSA level in the blood, the more likely it is that a prostate problem is present.

PSA levels also can be affected by some medical procedures, types of medications, an enlarged prostate or a prostate that is infected.

If the PSA level is normal, the healthcare specialist may leave further tests to the choice of the patient. They may decide to test the patient every 1-2 years.

If the PSA level is high, the specialist is likely to refer the patient for more tests. These tests might include an examination of the prostate gland and possibly a prostate biopsy.
The specialist will consider a number of factors such as the patient’s age, family history, ethnicity, body weight and previous medical history.