Prostate Cancer Treatment Options Omaha | Adult & Pediatric Urology

Prostate Cancer Treatments

What are Prostatitis and Chronic Pelvic Pain Conditions?

Prostatitis* and chronic pelvic pain conditions are painful but common. While these conditions are not the end of the game, they can put any player on the sidelines.

Researchers estimate that 1 in 10 men get prostatitis-like symptoms.

What causes prostatitis and chronic pelvic pain conditions?

Prostatitis means inflammation of the prostate. Some prostatitis is caused by bacteria. It can be acute and come on suddenly. It can also be chronic, and keep coming back. Chronic pelvic pain conditions have similar symptoms but do not seem to be caused by bacteria. For some men, the cause of their prostatitis or chronic pelvic pain is not known.

What is the game plan to treat prostatitis and chronic pelvic pain conditions?

The treatment is different for the different types of prostatitis disorders. It is important to make sure other health problems are not causing the symptoms. Problems such as inflammation of the urethra or bladder, urinary tract infection (UTI), an enlarged prostate, and cancer have similar symptoms. To help make an accurate diagnosis, several types of tests are useful. These include a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). A DRE is where your health care provider feels your prostate for anything abnormal.

A prostate infection can raise your PSA level. Your health care provider may also test samples of urine and prostatic fluid for signs of inflammation and infection. These samples may help the urologist find out whether the problem is inflammation or infection. These samples may also help the urologist find out whether the problem is in the urethra, bladder, or prostate. The urologist may use cystoscopy — passing a small telescope through the urethra to see inside the urethra, prostate, and bladder. The urologist may also order urine flow studies. These tests help measure the strength of your urine flow and any blockage caused by the prostate, urethra, or pelvic muscles.

The options for treating prostate cancer often depend on the type of prostatitis a man has.. For many men with prostatitis, the urologist may give antibiotics. Depending on his symptoms, a man may receive other treatments as well. While prostatitis may place you on the sidelines, it is not life-threatening. Treatments are available once you are diagnosed.

For more information on prostatitis, visit UrologyHealth.org/Prostatitis.

What is Enlarged Prostate?

The prostate may become larger and start to cause problems as a man ages. An enlarged prostate is also known as benign prostatic hyperplasia (BPH)*. The prostate of a 50-year-old man is about the size of a walnut or golf ball. But a prostate can grow to almost the size of a baseball or more. As the prostate enlarges, it can squeeze the urethra. This can cause some men to have lower urinary tract symptoms (LUTS).

Who is at risk for enlarged prostate?

Aging is the biggest known risk factor for an enlarged prostate. Family history, obesity, and high blood sugar may also be risk factors.

How is an enlarged prostate diagnosed?

The American Urological Association (AUA) designed a series of questions to find out how often symptoms occur. The AUA Symptom Score, on the previous page, allows men to rate their symptoms so their doctors can understand how bad they are.

When a health care provider checks a man for an enlarged prostate, he or she takes an in-depth health history. He or she may also ask questions from the AUA Symptom Score. The provider does a physical exam, along with a digital rectal exam (DRE). The health care provider will often do a urine test called a urinalysis for a man with an enlarged prostate. The provider may also run other tests, including a PSA blood test.

When should a man see a doctor about an enlarged prostate?

A man should see his health care provider if he has any of the symptoms mentioned on the previous page. Also, he should see a provider right away if he has blood in his urine, has pain or burning with urination, or is not able to urinate. Your health care provider may refer you to a urologist. An enlarged prostate is not cancer and cannot lead to cancer. Still, both problems can happen at the same time. So whether their prostate is enlarged or not, men should talk to their health care providers about whether PSA testing is right for them.

What is the game plan to treat enlarged prostate problems?

As men age, enlarged prostates can get worse. Knowing if you have an enlarged prostate can help your game plan. An enlarged prostate can lead to bladder damage, infection, and even kidney damage.

One way to tackle an enlarged prostate can be to use prescription drugs. If drugs do not work, some minimally invasive options or minor surgery may help relieve symptoms. If symptoms do not improve after treatment, men should talk with a urologist who specializes in prostate issues to see if their problems may have a different cause.

For more information on BPH, visit UrologyHealth.org/BPH

Who is at Risk for Prostate Cancer?

While prostate cancer is rare before age 40, the risk grows with age. About 1 in 7 men in the United States faces a diagnosis of prostate cancer in his lifetime. African-American men and men with a family history of prostate cancer are more likely to be diagnosed.

One in 5 African-American men will be diagnosed with prostate cancer in his lifetime. African-American men are also twice as likely to be diagnosed with more deadly forms of the disease.

About 1 in 3 men whose fathers or brothers had prostate cancer will be diagnosed. Your risk grows if two or more close relatives have been diagnosed, or if they were diagnosed before age 55.

Men may be able to decrease their risk of prostate cancer if they eat a diet low in animal fat and high in fruits and vegetables. Most doctors agree that, if you do things that are heart-healthy, you will also help keep your prostate healthy. Eating right, exercising, keeping to a healthy weight, and not smoking can improve men’s health and help them stay in the game.

What are the symptoms of prostate cancer?

In the early stages, prostate cancer usually causes no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Thus, it is vital to talk to your health care provider when you have urinary symptoms.

Things to watch for include frequent urination, being unable to urinate, pain or burning with urination or weak urine flow. Blood in the urine or semen and painful ejaculation can also be symptoms. Pain in the hips, pelvis*, lower back or upper thighs that don’t go away can be symptoms of later-stage prostate cancer. So can loss of appetite and/or weight.

How do you screen for prostate cancer?

Screening is when you test for a disease even if you have no symptoms. The prostate-specific antigen (PSA) blood test is the main method for screening for prostate cancer. Your health care provider may also do a digital rectal exam.

What is PSA?

PSA is a protein made only by the prostate gland. Remember, a high level of PSA can be a sign of other prostate diseases, not just prostate cancer.

For more information about prostate cancer stats and symptoms, visit KnowYourStats.org/Resources.

What is the PSA test?

This blood test measures the level of prostate-specific antigen (PSA) in the blood. Very little PSA is found in the blood of a man with a healthy prostate. Keeping your opponent’s score low is the name of the game. A low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. One possible cause of a high PSA level is enlargement of the prostate.

Inflammation of the prostate, called prostatitis*, is one more possible cause. Prostate cancer is the most serious cause of a high PSA result. Talk with your health care provider about whether the PSA test is right for you. If you decide to get tested, be sure to talk about changes in your PSA score with your provider. This can help you stay on top of your game.

What is the DRE?

During a DRE, the health care provider puts a lubricated gloved finger into the rectum. He or she feels for abnormal shape or thickness in the prostate. The DRE can help the provider find prostate problems.

Is Prostate Cancer Screening Right for You?

The choice to be screened for prostate cancer is a personal one. Before you decide to have a PSA test, talk with your health care provider about your own risk for prostate cancer and your personal preferences for screening. Also, talk about the benefits and risks of testing.

Should  I be screened for prostate cancer? 

Men should talk to their health care providers about their prostate cancer risk and whether PSA testing is right for them.

You are at higher risk and may want to talk to your doctor about prostate screening before age 55 if you:

  • are African-American, or
  • have a family history of prostate

If you are not at higher risk, men aged 55 to 69 benefit most from screening.

Does a high PSA mean I have prostate cancer?

Not necessarily. Less than one-third of high PSA results are caused by prostate cancer. If a PSA is high or DRE is not normal, your doctor may repeat your PSA or do further testing.

A prostate biopsy* (tissue sample) is the only way to know for sure if you have cancer. The biopsy removes small pieces of prostate tissue. A pathologist (a doctor who identifies diseases by looking at them under a microscope) looks at the prostate tissue to see if cancer is there. If cancer is seen, the pathologist will also “grade” the tumor. The grade tells the tumor’s aggressiveness — that is, how quickly it is likely to grow and spread.

Possible benefits of a PSA test:

  • A normal PSA test may put your mind at
  • A PSA test may find prostate cancer early before it has
  • Early treatment of prostate cancer may help some men slow the spread of the
  • Early treatment of prostate cancer may help some men live

Possible risks of a PSA test:

  • A normal PSA result may miss some prostate
  • Sometimes the test results suggest something is wrong when it isn’t (a “false positive”). This can cause unneeded stress and
  • A “false positive” PSA result may lead to an unneeded prostate
  • Positive PSA test may find a prostate cancer that is slow-growing and never would have caused you

Possible risks of  biopsy  and  treatment:

Biopsies can cause side effects of bleeding and infection. Treatment of prostate cancer can also cause side effects. Erection problems, urine leakage or bowel problems can occur.

What are some of the Prostate Cancer Treatment Options?

Active surveillance

This is where your doctors watch your cancer closely with regular PSA (and other) tests. Most prostate cancers never become life-threatening, so not all men need treatment right away. Active surveillance is a good choice for men with no symptoms and slow-growing cancer. If your cancer is not expected to grow very quickly, this choice can give you years with a good quality of life. It is also a good choice for older men and men who have other serious health issues.

Radiation therapy

This uses high-energy rays to kill cancer cells. Radiation can be used as a primary treatment for prostate cancer treatment (in place of surgery). It can also be used after surgery if the cancer is not completely removed or it returns.

Imaging tests are run to find the exact location of the tumor. Then one of two kinds of radiation therapy are used. Brachytherapy (where small, radioactive “seeds” are placed inside in the prostate) is the most common internal radiation. External beam radiation is where the prostate is treated with targeted rays from outside the body.

Radical Prostatectomy (RP)

This is a surgery that removes the prostate, the seminal vesicles, nearby tissue, and some of the lymph nodes. Cancer cells may be scattered throughout the prostate gland. Because of this, the whole prostate must be removed.

There are several ways to perform an RP. The surgeon can go in through the lower abdomen (retropubic open). The surgeon can go in between the scrotum and the anus (perineal). He/She can also do laparoscopic surgery (with several small incisions for the use of tube-like instruments) with or without robotic assistance.

Cryotherapy

This freezes the prostate to kill cancer cells. During cryosurgery, your doctor places small needles into the prostate. Cold gas is placed into the needles, freezing the prostate tumor and nearby tissues. After each freezing process (there are usually two), the tissue is able to thaw. This repeated freezing and thawing cycle kills the cancer cells.

Hormonal therapy

Uses drugs to lower or block testosterone and other male sex hormones. This can stop or slow the growth and spread of prostate cancer.

Chemotherapy

These Prostate Cancer Treatment drugs may kill prostate cancer cells that have spread. Hormone therapy and chemotherapy can be used to reduce prostate cancer growth and/or to reduce prostate cancer-related symptoms.

Doctors are looking at new, more targeted treatments for prostate cancer. One newer treatment currently in use is Immunotherapy. This treatment boosts the ability of the immune system to fight prostate cancer.

What is the game plan after prostate cancer treatment?

After Prostate Cancer Treatment, you may feel like you ran into the end zone while scoring the game-winning touchdown. You may feel very emotional and even overjoyed. You could also feel anxious with thoughts of recurrence (your cancer returning).

Whatever you’re feeling, talk to your doctor about any issues you may have. That lets you work together as a team. By now, you know your stats about the disease, and you’ve built a solid game plan with your doctor. So it’s time to plan out your defense for any side effects of treatment.

Life After Prostate Cancer

Now you have finished treatment, and it is time to begin thinking about the postseason. Incontinence* is when you cannot control your urine. After prostate cancer treatment, you may leak or dribble urine. While this is very common, being incontinent can affect your physical and emotional healing.

What kinds of incontinence are there?

There are several types of incontinence. Stress incontinence (SUI), the most common, is when urine leaks when coughing, laughing, sneezing or even exercising. It is caused by problems with the muscular valve that

keeps urine in the bladder (the bladder sphincter). Prostate cancer surgery or radiation may harm the muscles that form this valve or the nerves that keep the muscles working. Overflow incontinence happens when you are not able to empty the bladder fully. You may find yourself taking longer to urinate, and when you do, you get a weak stream of urine. This can occur because your bladder outlet is blocked or narrowed by scar tissue. Men with overactive bladder, or urge incontinence, have a sudden need to urinate even when the bladder is not full. This can happen with or without urine leakage. Mixed incontinence is a blend of stress and urges incontinence with symptoms from both types. While uncommon, some men can experience continuous incontinence – not being able to control urine at any time.

How long can incontinence last after treatment?

After surgery or radiation, improvement in urine control can take several weeks to several months. It varies from patient to patient, and your own healing could be quick or slow. You should talk to your doctor about what to expect after treatment.

What is the game plan to treat incontinence?

Treatment is based on many factors, such as what kind of incontinence you have and how much it affects you. While you may feel embarrassed, incontinence is common and can be treated. Many men regain full control and get back into the game.

Before and after treatment, you may be told to do Kegel exercises. This tensing and relaxing of certain pelvic floor muscles help strengthen your bladder control. Your doctor can refer you to a physical therapist who specializes in pelvic floor rehabilitation. They can teach you how to do these exercises the right way. You may also need to change your diet, liquid intake, or prescription drugs to help gain better control.

In the short term, your urologist may prescribe drugs to help you maintain better control. Your urologist may also suggest electrical stimulation of your bladder muscles and nerves. Additional surgery can be a long-term treatment option. A surgeon can inject collagen (a natural protein) into the

bladder opening and urethra to tighten the bladder sphincter. A small device called a urethral sling can be surgically implanted to tighten the bladder neck. Urologists can also implant an artificial sphincter to control urination.

If your incontinence is not managed with these options, talk with your urologist, and make a game plan. There is also a wide range of absorbent products that can help you cope with this issue.

What causes erection problems after prostate cancer treatment?

Nerves that are involved in an erection surround the prostate gland. Surgeries may harm nerve bundles that control blood flow to the penis, causing ED. While most surgeons will do a nerve-sparing procedure, saving the nerves from harm is not always possible. If cancer spreads around the nerves, they may need to be removed. If nerves are damaged, the brain can no longer send a clear signal to the penis to start an erection.

Also, there could be less blood flowing to the penis after treatment. During surgery, the blood vessels that bring blood to the penis to help it expand during arousal are harmed. While blood will still flow to the penis, it may not get erect enough for penetration.

How long can ED last after treatment?

Men can have ED issues for varying amounts of time. However, the ability to recover depends in part on the type of treatment. It also depends on whether you had erection problems before surgery. It is important to know that some men may recover full ability after surgery, but many men will not. If you are having trouble, do not feel embarrassed. Your doctor can offer you a variety of treatment choices for your playbook.

What is the game plan to treat erection problems?

To get the greatest benefit from the treatment plan, it is important to communicate clearly with your doctor. Equally important is clear communication with your partner, a vital member of your team.

Oral drugs are often the first line of treatment for ED. They can improve blood flow to the penis. Vacuum pumps are mechanical devices used to create an erection. Injections can be used to increase blood flow, which creates an erection. Your doctor can help you decide which choice is best for you. If ED continues, a permanent penile implant may be an option. This surgery places a device in the erectile tissue of the penis.

If any of these treatment options are needed, your urologist will help you decide on the best choice for a game-winning season. What is most important to remember is that there are options that can work for every patient. To reach better sexual health, have an open and honest talk with your doctor.

Prostate Cancer Wrap-Up

Prostate health is important for all men. Winning the battle against prostate diseases involves a team approach. Your urologist can be a solid head coach leading the way. Other health care providers, your family, and your friends make up the team to put you on the path to victory. When a prostate problem arises, be sure to huddle up with your entire team and move into formation. Keep your head up as you advance toward your ultimate treatment choice, leading to a cure … touchdown and the extra point!

ADULT PEDIATRIC UROLOGY & UROGYNECOLOGY

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From screening and prevention to treatment and recovery, our prostate cancer Omaha, NE & Council Bluffs, IA physicians will be there for you. Our team of dedicated physicians has been serving residents of Nebraska, Iowa, and South Dakota for more than 25 years.

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