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  • midlifelove 10:13 am on October 18, 2009 Permalink | Reply
    Tags: alprostadil injections, , , , nerve-sparing technique, , prostactectomy, , prostate surgery, , risk factors, Rudy Guiliani, , 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 9:42 am on October 14, 2009 Permalink | Reply
    Tags: Arnold Palmer, Colin Powell, , , Harry Belafonte, , , Nelson Mandela, nerve-sparing surgery, , prostate cancer treatments, , risks of prostate cancer treatment options, Robert de Niro, Rudy Guiliani, surgery,   

    Prostate Cancer and Impotence 

    Prostate Cancer1It could be one of those random quiz items – what do Robert de Niro, Rudy Guiliani, Nelson Mandela, Arnold Palmer, Harry Belafonte and Colin Powell have in common?

    The answer is that all of them have had prostate cancer, been treated in a variety of ways, (from surgery to radiation to hormone therapy), survived to tell the tale and with a couple of exceptions (mainly de Niro) have been willing to talk publicly to encourage other men to get tested.

    In Rudy Guiliani’s case that openness included acknowledging the issue that is still only reluctantly discussed by many men when facing up to prostate cancer – impotence as a possible side effect of treatment.

    During divorce proceedings in 2001 Mr Guiliani said he had been impotent for a year as a result of his prostate cancer treatments (hormone therapy followed with radiation in implanted pellet form and 25 external radiation treatments).

    Outcome Can’t Be Predicted

    Temporary or permanent impotence can affect up to 70 per cent of men with prostate cancer, and doctors says as of now there is no way to determine who will be affected or for how long after treatment. Even in the best conditions, 10 per cent of patients may be impotent afterwards.

    Andrew Penman, chief executive of the Cancer Council of NSW, (Australia) says doctors who suggest testing younger men PSA levels to identify possible cancers must also tell them at the first interview about ”flow-on issues.”

    It 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.

    Treatment Options & Risks

    • Hormonal therapy – Testosterone is either reduced or its uptake blocked. Erectile dysfunction and a loss of desire usually occur after two to four weeks of treatment.
    • Surgery – The prostate and surrounding cancerous tissue are removed. If nerve-sparing surgery is used, erectile function can return within the first year. Recovery of erectile function after a non-nerve-sparing surgery is unlikely, but possible.
    • Radiation – The tumour area may be blasted with external beam radiation, more tightly targeted for proton radiation, or implanted with radioactive pellets for continuing therapy. ED is the most common complication and usually occurs six months after treatment.
    • Observation – Often called “watchful waiting,” this strategy may be appropriate in some cases where disease progression is slow.

    How Effective Are Oral Erectile Dysfunction Drugs?

    • Following surgery Web MD reports that as many as 60 to 70 per cent of men who have had nerves spared on both sides of the prostate will regain erections. Results are less favourable for men who have had a single nerve spared or no nerves spared.
    • Following radiation therapy Overall, 50 to 60 per cent of men regain erections with Viagra following radiation for prostate cancer. However, current data are rather limited, especially for patients treated with radioactive seed implants.
    • Hormone therapy Specialists at the Cleveland Clinic find that men treated with hormone therapy do not respond well to any erectile dysfunction treatments, including Viagra, but data are limited.

    Can I Use Herbal Supplements?

    There is continuing research into natural ingredients that may be of benefit for prostate health, including saw palmetto and the tomato-based active substance lycopene. Tribulus terrestris in herbal supplements like Herbal Ignite is NOT recommended without doctor’s approval because it stimulates testosterone levels which may be counter-productive to treatment.

    Prostate cancer survivor Jim Tucker’s Prostablog contains a comprehensive section on natural ingredients and therapies which is regularly updated.

     
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