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  • midlifelove 10:13 am on October 18, 2009 Permalink | Reply
    Tags: alprostadil injections, , , , nerve-sparing technique, Paul Holmes, prostactectomy, , prostate surgery, , risk factors, , , sildenafil, treatments and risks, tumor,   

    Prostate Cancer – the Most Risky Treatments 

    treatmentIt’s a topic that has made it into the story lines of 30 Rock and Boston Legal, but it’s still a “touchy” subject men are reluctant to talk about. That’s the risk of temporary or permanent erectile dysfunction from prostate cancer treatment.

    Temporary or permanent impotence can affect up to 70 per cent of men with prostate cancer, and only a few high profile men – among them Rudy Guiliani in the US and broadcaster Paul Holmes in New Zealand  – are willing to publicly acknowledge the issue, even when they talk about prostate cancer.

    Whether a man retains good sexual function very much depends on a range of factors, including the size and aggressiveness of the tumor, the patient’s age, lifestyle, and overall health, and the treatment option chosen.

    It’s impossible for a doctor to predict ahead of treatment what the outcome for an individual is likely to be.

    Risk Factors Assessed

    But here is a rundown on the treatment options and the risk factors involved:

    Surgery (Radical Prostatectomy)

    The first US nationally representative study to evaluate long-term outcomes after radical prostatectomy concluded that impotence occurs far more frequently than previously reported.

    Those who have so-called nerve-sparing surgeries have better results than those whose surgeries affect the nerves around the prostate. Some evidence also suggests that sexual function rates might improve if the nerve-sparing prostate surgeries also spare the ducts that carry semen.

    • Some degree of erectile dysfunction occurs right after surgery to remove the prostate, regardless of whether the technique that tries to spare the nerve that controls erections is performed or not.
    • If the nerve-sparing technique is used, recovery from erectile dysfunction may occur within the first year following the procedure. Recovery of erectile function after a non-nerve-sparing surgery is unlikely, but possible.
    • One study shows erectile dysfunction rates of 66% for nerve-sparing prostatectomy versus 75% for non-nerve sparing surgery at one year after the surgery. The use of vacuum devices or drugs such as Viagra after surgery once the body has healed may improve the quality of erections and speed the return of normal sexual function.
    • Some studies suggest that impotence after prostate surgery may in part be due to injury to the smooth muscles in the blood vessels. Early treatments to maintain penile blood flow, particularly alprostadil injections, may helpful in restoring erectile function. In one study, men administered injections every other night for six months. They then started taking sildenafil (Viagra) three months after surgery. At six months, 82% of these men achieved penetration compared to only 52% of men who took Viagra only. The vacuum pump may serve a similar purpose as the injections.

    Radiation

    Loss of erectile function is the most common long-term complication of radiation therapy.

    • The onset of erectile dysfunction following radiation therapy is gradual and usually begins about six months following the treatment.
    • Although it is generally believed that radiation poses a lower risk for impotence than does surgery, studies have reported similar rates after three years. Experts suggest radiation injures the blood vessels and so leads to erectile dysfunction over time.
    • Some studies report a lower risk for impotence from brachytherapy, a radiation technique that involves the implantation of radioactive seeds compared to external-beam radiation. Still, there have been very few studies that have lasted more than two years. One five-year study reported a high long-term rate of impotence (53%) with brachytherapy, which is close to that of standard externally administered radiation. Early use of alprostadil injections and Viagra may help these men as well as those who had surgery.

    Drug Treatments

    Prostate cancer medical treatments commonly employ androgen-suppressive treatments, which cause erectile dysfunction.

    • When hormone therapy is used, erectile dysfunction may occur approximately two to four weeks after the start of therapy. A decreased desire for sex also occurs.
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  • midlifelove 10:45 am on September 17, 2009 Permalink | Reply
    Tags: , , , , , Paul Holmes, , PSA test, ,   

    Getting Real About Prostate Cancer 

    Prostate CancerBroadcaster, olive oil producer and P campaigner Paul Holmes has a simple prescription for getting the best out of life after prostate cancer; “Live to the full and laugh a lot.”

    Since he was diagnosed in 2003 with the cancer that affects as many men as breast cancer affects women, Paul has been a slightly reluctant poster boy for what he says is seen as an “old man’s disease.”

    But he says “it’s time men told other men they need to simply do one thing – get themselves checked.

    “The difference between breast and prostate cancer can be seen in the death rates; while breast cancer rates have declined in the last ten years, prostate cancer rates have risen.

    Life Changes After Cancer

    In a Sunday Herald column to mark the Prostate Cancer Foundation’s Blue September awareness campaign last year he noted: “Life changes after breast cancer, just as life changes after prostate cancer.

    “While women have gone out and made their sisters aware of breast cancer, men have failed to make their brothers as conscious of the dangers and prevalence of prostate cancer.”

    He says undoubtedly the biggest impact prostate cancer has had on his life is the prolonged and sometimes humiliating treatment required, and “the loss of sexual function, or indeed, any desire.”

    Says Paul: “After the hormone and radiation treatments, one ceases to even think about sex. Sexuality completely disappears. This would put strain on many a relationship, fortunately not on mine, though it changes things and you cease to wonder how it has.”

    Staying Alive Without Sex

    As Paul told New Idea; “It was a choice between staying alive and healthy and not having sex, or not having treatment. Well, the choice is a no-brainer, isn’t it?

    “But that doesn’t mean that a person is not still a man. You know, I’m still competitive, ambitious and professional. I still love my family. And there was only one priority – you have got to get that cancer out of your body. Everything else is secondary.”

    Paul and his wife Deborah had only just started living together when he was diagnosed, but they’ve weathered the storms and married a year later.

    They point out that not all men lose sexual ability, and there are several options available in assisting with restoring sexual function.

    Treatment Options

    The severity of the erectile dysfunction – and whether it is temporary or permanent – depends on the type of surgery, stage of cancer, and the type of treatment.

    One study shows erectile dysfunction rates of 66% for nerve-sparing prostatectomy versus 75% for non-nerve sparing surgery at one year after the surgery. The use of vacuum devices or drugs such as Viagra after surgery once the body has healed may improve the quality of erections and speed the return of normal sexual function.

    Loss of erectile function is the most common long-term complication of radiation therapy. But its occurrence decreases when more sophisticated treatments, like radioactive seed implants (brachytherapy), intensity-modulated radiotherapy (IMRT), and 3-D conformal radiotherapy, are used.

    Men’s Awareness Growing

    Five years on from his diagnosis Paul says men are now much more aware about prostate cancer.

    “My own prostate cancer and the ensuring publicity might have helped a little. Certainly there is now much more knowledge and many men approach me for advice. Any cancer is freaky and worrying, but I sense there is no longer any reluctance to be open with others about prostate cancer.”

    If there was one thing he’d like to get across to NZ Prime Minister John Key it’s the need for a national campaign to alert men to the need to get prostate cancer checks annually.

    “Every time men get a blood test over the age of 40, the doctor should probably tick the box for a PSA test. Men have a responsibility to get themselves checked.”

    Keeping a Healthy Prostate

    A low-fat, high-fiber diet, reducing stress and getting regular exercise can all help safe guard prostate health, research shows. Dietary supplements like Quup, containing herbs like saw palmetto and active ingredients like lycopene (from tomatoes) can also be beneficial.

     
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