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The USMD Prostate Cancer Center Blog
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February 16th, 2012
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Prostate Cancer Recurrence
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Your Options Should Prostate Cancer Return
Our goal at USMD Prostate Cancer Center is for all of our cancer patients to remain cancer free for the remainder of their lives. Despite the best treatment available, this is not always a reality. It’s perfectly natural for a patient to wonder if every cancer cell was eliminated during treatment and to wonder if the disease could return. If disease does recur, additional or alternative forms of treatment are typically available.
What is the recurrence rate?
Fortunately, due to advancements in screening and treatment, the recurrence rate of prostate cancer is diminishing. Most recurrences become evident within the first 6-7 years after treatment. Disease may be locally recurrent (within the prostate or prostate bed), regional (in lymph nodes) or distant (in bones or elsewhere).
How can I be sure the cancer has not returned?
Despite recent criticisms, a Prostate-Specific Antigen (PSA) Test remains a valuable tool for screening and follow up after treatment. After treatment, a persistently rising PSA after treatment may indicate recurrent disease, which may initiate further work up and evaluation.
What findings are associated with a higher risk of recurrence?
A combination of the tumor size or extent, Gleason score and PSA is used to place patients into 3 categories (low, intermediate and high) that are directly correlated with the risk of developing recurrent disease.
What if there is a rising PSA or other sign of a potential recurrence?
Your USMD PCC physician will determine the appropriate course of action. Typically, this will involve further evaluation, which could include prostate biopsy, CT scan or other imaging to determine the nature and extent of recurrent disease. On many occasions, patients present with a rising PSA, and are found to have an infection and no recurrence of cancer.
On the other hand, if a patient is found to have a recurrence after initial treatment, the appropriate salvage treatments will be discussed in detail.
Peter LaNasa, M.D ., is a board certified radiation oncologist and the Director of Radiation Oncology for USMD Cancer Center.
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February 2nd, 2012
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Salvage Therapy: What Does It Mean for Prostate Cancer Patients?
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One of the most underutilized therapies in the battle against prostate cancer is called salvage therapy. This name can conjure up all kinds of images. But let's get to what this treatment really is and how it helps treat the prostate cancer patient.
Salvage therapy for prostate cancer is technically defined as any therapy utilized to cure cancer after a failure of the initial treatment. This can be salvage radiation, salvage radical prostatectomy, salvage cryoablation and salvage HIFU. Salvage radiation is perhaps the most commonly utilized of all the modalities, and it is most commonly used for patients with a localized recurrence of cancer in the bed of the prostate after a radical prostatectomy. Salvage radiation is most commonly recommended in two instances: 1. If the patient comes in with a rising PSA after surgery with a positive margin (cancer at the margin of the prostate seen once the prostate has been removed), or 2. Cancer that has spread locally outside of the prostate is confirmed after analyzing the prostate upon removal. Although the cure rate can be as high as 70 percent, it is imperative that these patients are treated early before the cancer has a chance to spread to distant areas. The most ideal candidate has a PSA less than 0.2.
Salvage prostatectomy continues to remain an option for select men after radiation, cryoablation or HIFU, but continues to remain a complex surgery. It is often more difficult in men after radiation therapy because the tissue surrounding the prostate becomes scarred from radiation and increases the side effects such as impotence and incontinence. This continues to evolve, however, as radiation techniques become more precise and in select patients, this may be a reasonable option to remove any persistent cancer by removing the prostate.
Salvage HIFU destroys the prostate by heating and destroying the prostate. This is currently under investigation in the United States as a possible contender for patients with recurrent cancer after radiation therapy. This is not approved by the FDA and therefore must be part of a clinical trial within the confines of the United States. Because of the minimally invasive nature of this procedure, the data continues to evolve as to whether this will be a viable option for patients with recurrent prostate cancer.
Salvage cryoablation continues to remain the most common procedure for men with recurrent prostate cancer after radiation therapy or hormonal therapy and even for men with recurrent cancer after HIFU and Cryoablation. The procedure involves freezing and thawing the prostate, destroying the prostate and any cancer within the prostate. This is a technically challenging procedure offered at USMD Prostate Cancer Center. Unfortunately, salvage cryoablation continues to remain underutilized as a treatment option. One study has estimated that less than 10 percent of eligible men were even aware that such an option existed. With the development of third generation cryoablation technology and variable probes to individualize the length of the ice balls to treat the prostate, the side effects associated with salvage cryoablation have also significantly decreased. Salvage cryoablation continues to remain one of the best FDA approved minimally invasive options for men with recurrent localized prostate cancer.
In summary, there is hope for men with a rising PSA after initial treatment for prostate cancer. If the cancer is confined to the prostate or to the prostate bed, there is still an excellent chance for cure. If you or someone you know has a rising PSA after a previous treatment for prostate cancer, educate them to the options and refer them to USMD Prostate Cancer Center. If caught early enough, time truly will be on their side.
For more information about any or all of the salvage therapies utilized for recurrent prostate cancer, please schedule a consultation by calling USMD Prostate Cancer Center at 1-888-PROSTATE (776-7828) or visit the website at www.usmdpcc.com.
Dr. Bevan-Thomas, M.D.
Medical Director of USMD Prostate Cancer Center
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February 2nd, 2012
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Sex Life After Prostate Cancer Treatment
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You just received the news from your doctor, “You have prostate cancer.” A ton of questions flood your mind. What now? How will this affect me? How will this impact my sex life? You may have received information about robotic surgery, cryotherapy, radiation treatment or High Intensity Focused Ultrasound (HIFU). After treatment, your physician assures you that things are progressing normally, but you still worry. It has been several months since your surgery, and yet you are not able to achieve a full erection. Don’t give up hope. While nerve-sparing radical prostatectomy has significantly improved the likelihood that you will regain erectile function, recovery time can vary. Some men may recover their ability very rapidly; others may take a couple of years. What affects my erectile function after treatment?
Regaining sexual and erectile function after treatment usually depends on several important factors: - Age of diagnosis.
- Sexual and erectile function prior to prostate cancer.
- The stage of cancer.
- The type of treatment required to cure the cancer.
What can be done to rehabilitate my erectile function?Oral Medications. Oral medications such as Cialis, Viagra or Levitra are recommended to improve blood flow and stimulate the nerves. Studies show that consistent, regular use of these oral medications can help men regain sexual and erectile function sooner. A Vacuum Device. A vacuum device also may be prescribed as part of the rehabilitation process. The vacuum device fits over the penis and draws blood into the penis, causing the vessels in the penis to fill with blood, just as they would during a normal erection. Once an erection is achieved, usually two minutes after beginning, the user slips off a tension ring from the bottom of the vacuum and places it around the base of his penis to keep the blood from exiting. The resulting erection can be sustained for about 30 minutes. Routinely, for men undergoing erectile rehabilitation, men are recommended to keep the penis full for a minute and then release the vacuum for a minute and repeat this 5 times. This helps drive blood into the penis, stretching the penis and minimizing any scarring which could occur while the nerves are recovering. The benefits of using a vacuum device are the lack of serious side affects and the ability to achieve erection whenever you desire. The disadvantages involve the pause in intimacy it brings during operation, and the occurrence of penile feeling that is sometimes described as “not normal.” Regardless, the vacuum device remains a good option for post-prostate treated men needing erectile rehabilitation. Injection Therapy. Injection therapy involves self-injection with medication that dilates the blood vessels and improves blood flow to the penis. Papaverine, Phentolamine, and Prostaglandin E-1, also known as “trimix,” or Caverject (Alprostadil), are the medications used and can lead to an erection within minutes. While the thought of injecting your penis might cause you terror, most men who are shown how to properly inject themselves are surprised to learn that the pain, if any, is very minimal. The erection lasts from 30 minutes to 2 hours. Injections should be limited to several times per week to minimize risks of scars or penile damage. The most serious complication of penile injections is priapism, a painful condition where the erection persists for longer than 4 hours and does not go away. Implants. For men who continue to have long-term problems with sexual function after the above treatments have been tried, implants can offer hope for the recovery of their sexual lives. There are two types of penile implants. - The non-inflatable implant. This semi-rigid implant is placed in the penile shaft, leaving the penis in a permanent state of stiffness. In intimate moments the implants allow the penis to be simply bent upward for an erection, and pushed down when not in use. This implant is the simplest surgical process and less expensive of than the inflatable implant. Some men have commented that it has an abnormal feel and appearance. Post implant surgery recovery times are a bit longer with this procedure than with the inflatable implant. It remains an option for men facing erectile dysfunction following post-prostate surgery when previous rehabilitation efforts have failed.
- The inflatable implant. The 3 piece penile implant has become the gold standard surgery for men interested in penile surgery to regain erectile function. This device allows the penis to be flaccid or pumped to an erect state. Compact hollow tubes are implanted within the penis. A pump is implanted in the scrotum, and when squeezed it releases fluid from a small container located in the lower part of the abdomen. This fluid is transferred from the container to the inflatable cylinders, which then expand the penis to erection. To stop the erection, a valve at the top of the pump is squeezed, and the fluid returns to the abdominal reservoir, causing penile flaccidity. This is the most common penile implant surgery done in the United States and has a patient satisfaction rate above 90%.
Talk to UsThere is hope. We know that many men are uncomfortable about talking openly concerning sexual function. Rest assured that your USMD Prostate Cancer Center doctors are aware of this and are prepared to guide you in this discussion and answer any questions you might have regarding your sex life before and after your prostate cancer treatment. Dr. Bevan-Thomas, M.D.Medical Director of USMD Prostate Cancer Center
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December 14th, 2011
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Androgen Deprivation Therapy's Effect on Mortality: A Comment on the Fox News Report
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According to a Fox News report, current research suggests:
For men with aggressive prostate cancer, hormone-targeted therapy [androgen deprivation] cuts the overall risk of death, according to a new review of past studies.It also does not increase the chance that men will die from cardiovascular disease, which some research had suggested might be the case, researchers reported in the Journal of the American Medical Association on Tuesday (read more).
USMD Prostate Cancer Surgeon, Dr. Bevan-Thomas commented on the article stating:
Just like any medication, there are associated side effects. Androgen deprivation therapy certainly does have significant side effects, however this is a very interesting study which does show that there is not a significant increase in the mortality for patients on androgen deprivation therapy. Basically, shutting the testosterone down will increase a patient's response to specific therapies such as radiation. In addition, androgen deprivation therapy also plays a vital role for patients with recurrent prostate cancer. I think this is an excellent paper that should alleviate some of our fears that androgen deprivation therapy does increase a patient's mortality. It should be accentuated, however that androgen deprivation therapy does have other side effects and the risk/benefits should be discussed with their physician.
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October 6th, 2011
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USMD PCC Open House Wrap-Up
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We are excited about another successful USMD Prostate Cancer Center Open House! Saturday, September 24, we had our biggest turnout in the history of USMD Prostate Cancer Center to celebrate our third annual Open House. USMD Prostate Cancer Center spokesperson, Hall-of-Famer Bob Lilly, was on-hand, signing autographs and taking photos with fans and patients. DFW radio personality Jody Dean paid us a visit as well.
USMD Prostate Cancer Center surgeons led attendees on tours of our central facility in south Arlington on the campus of USMD Hospital. Visitors could even enjoy a hands-on experience with the daVinci robot! This is always such a great event, and we look forward to another fun, entertaining and educational Open House next year!
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April 14th, 2011
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Coping with Prostate Cancer
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Being diagnosed with prostate cancer or any type of cancer can bring an onslaught of new emotions. Anger, confusion, sadness, denial, self-loathing, all of these are common emotions we see at USMD Prostate Cancer Center when patients are initially diagnosed with prostate cancer. We remind our patients that they are not alone; close to 200,000 men face this diagnosis yearly, and when diagnosed early, the options for treatment are many, and recovery rate is very high.
At USMD Prostate Cancer Center, we have treated prostate cancer for thousands of men in the Dallas / Fort Worth Metroplex, hundreds of men from around the United States and literally from all over the world. They come from many different backgrounds and walks of life. Through these many treatments, the following three-step response protocol has proven highly effective to help our patients to process the thoughts and emotions that arrive with a diagnosis of prostate cancer.
Education
We’ve all heard the saying “Knowledge is Power,” and this adage especially holds true when it comes to prostate cancer as well. The more you know about your condition and what can be done for your particular diagnosis of prostate cancer, the more mentally prepared you will be to make the right decisions for your health. At USMD Prostate Cancer Center, our physicians place a major emphasis on the role of education as this is the first and foremost way to gain a sense of control over your prostate cancer. We spend time with patients and their families, answering questions and explaining our expert recommendations to treat and defeat prostate cancer.
Support
As men, we often consider emotional support or “leaning on someone” to be a sign of weakness. It is inherent in our chemistry; we want to be the independent, self-sufficient, the alpha male. But the truth is, prostate cancer doesn’t care how macho of a man you are. Think about it: General Colin Powell, Robert De Niro, even James Bond himself, Roger Moore, they have all fought and defeated prostate cancer. You can too.
My point is that being diagnosed with prostate cancer has nothing to do with how tough or “manly” you are, and as such, it’s absolutely acceptable (and highly recommended) to gain emotional support from those close to you. Just as knowledge can be a supportive mechanism as you fight prostate cancer, having your loved ones and friends close and involved in the treatment process will strengthen you AND those around you, all at the same time.
At USMD Prostate Cancer Center, we have special staff members called “Patient Navigators” who are an additional source of emotional support for our patients. They are helpful, friendly, caring team members who are dedicated to our prostate cancer patients and their families every step of the way through the procedure. One of our Navigators will be assigned to your case and will be your liaison between your physicians, you and your family for whatever you may need during your time with USMD Prostate Cancer Center.
Take Action
Once you are armed with knowledge and support, take action. Work with your doctor to make a plan and initiate it. At USMD Prostate Cancer Center, we offer virtually every treatment option for prostate cancer in our Dallas / Fort Worth location: Robotic surgery, radiation therapy, cryotherapy and HIFU. This is what makes USMD Prostate cancer center a true center of excellence. We know and understand that there is more than just one way to treat prostate cancer. Some patients will do fine with just surgery or radiation, however others may need a combination of treatments to obtain the best results. Depending on your type and stage of prostate cancer, your physician will guide you through the procedure and treatment plan to help you win your fight against your cancer. Providing everything you will require to treat you for prostate cancer at one facility is not only more convenient for our patients, it allows us as doctors to tailor the treatment protocols specifically for each patient, increasing your opportunity to defeat prostate cancer and return to a normal, active life.
Remember, prostate cancer is not a death sentence. It is a serious condition however and nearly 30 thousand men die from prostate cancer annually. We continue to work on early detection to further decrease the number of prostate cancer deaths occurring each year. Become educated, get support, and take action. Hundreds of thousands of men have successfully undergone treatment for prostate cancer and gone on to live long, fulfilling lives. This is precisely our goal for each of our patients at USMD Prostate Cancer Center. Click here to learn more about our center and to schedule your visit. I look forward to meeting you.
—Dr. B-T
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