After prostate surgery, some men leak during sex | Reuters

Incontinence during sex is a long-lasting problem for roughly one in eight men who have had their prostate removed due to cancer, a study of more than 1,400 patients has found.

via After prostate surgery, some men leak during sex | Reuters.

This article describes that some men will have loss of urine during sexual intercourse.  This usually happens during climax.  The article refers to this problem as climacturia.  I have seen men that recover normal erectile function, but have this problem of leaking urine during intercourse.  It usually improves with time but not always.  I have not kept accurate statistics on this problem, but have a feeling that it is less with robotic surgery for my patients.

Radiotherapy and Short-Term Androgen Deprivation for Localized Prostate Cancer — NEJM

Among patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a PSA level of 20 ng per milliliter or less, the use of short-term ADT for 4 months before and during radiotherapy was associated with significantly decreased disease-specific mortality and increased overall survival. According to post hoc risk analysis, the benefit was mainly seen in intermediate-risk, but not low-risk, men. Funded by the National Cancer Institute; RTOG 94-08 ClinicalTrials.gov number, NCT00002597.

via Radiotherapy and Short-Term Androgen Deprivation for Localized Prostate Cancer — NEJM.

 

This study revealed a reduction in overall survival at 10 years and disease-specific mortality at 10 years.  Patients studied were low and moderate risk prostate cancer patients receiving radiotherapy as definitive therapy.

Only the moderate risk patients were shown to have a benefit.

Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial.

INTERPRETATION: 6 months of neoadjuvant androgen deprivation combined radiotherapy is an effective treatment option for locally advanced prostate cancer, particularly in men without nodal metastases or pre-existing metabolic comorbidities that could be exacerbated by prolonged androgen deprivation.

via Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial..

 

This study shows that men that are undergoing radiation therapy for prostate cancer had a benefit by adding 6 months of hormonal therapy compared to no hormonal therapy.

Statins make radiation more effective at curing prostate cancer, study suggests

Statins Make Radiation More Effective at Curing Prostate Cancer, Study Suggests

ScienceDaily (Mar. 25, 2011) — Men with high-risk prostate cancer who take statin drugs commonly used to lower cholesterol while receiving radiation therapy are less likely to have their cancer return than patients who do not take these medications, according to a study published in the March issue of the International Journal of Radiation Oncology•Biology•Physics, an official journal of the American Society for Radiation Oncology (ASTRO).

via Statins make radiation more effective at curing prostate cancer, study suggests.

Statins are a class of cholesterol lowering medicines that have been shown to prevent many diseases including heart disease.

There have been studies that show a benefit in prostate cancer prevention and recurrence rates.

A friend of mine, and in my opinion the world’s leading authority on clinical applications of supplements and medicines for prostate cancer prevention, Dr. Mark Moyad, is in the process at looking at statins in patients on active surveillance for prostate cancer to see if it will slow the progression of disease in these patients.

Better patient counseling needed on post-RP erectile function – – UrologyTimes

Acting on anecdotal evidence, Dr. Nelson and his co-authors, Peter Scardino, MD, and John P. Mulhall, MD, assessed the erectile function of 250 men average age, 59±8 years pre- and post-radical prostatectomy. Of the men with baseline erectile function scores ≥24 mild to no dysfunction, about one-third 32% regained function; however, well over half 60% required medication to do so. Only 13% of men reporting mild to no dysfunction prior to prostatectomy reported returning to full baseline function at 24 months without medication.

via Better patient counseling needed on post-RP erectile function – – UrologyTimes.

This study from Memorial Sloan Kettering points out that it is important to explain to patients that the ability to achieve an erection  is less after surgery.   Many factors account for a patients ability to recover erectile function including, age, preoperative function, sexual activity, the type of nerve sparing that can be performed (based on the amount of cancer), skill of the surgeon, type of surgery (open vs. robotic), and other factors.

I try to give an estimate of the probability of the ability to get erections after surgery with and without PDE5 medicines (viagra, levitra, cialis) for each patient.

Added Radiation to ADT May Improve Survival – Renal and Urology News

Men with locally advanced prostate cancer (PCa) have a better chance of survival when they add radiation therapy (RT) to their hormone therapy, according to research presented at the 52nd annual meeting of the American Society for Radiation Oncology.

via Added Radiation to ADT May Improve Survival – Renal and Urology News.

This is another study that finds a survival advantage in adding radiation therapy to hormonal therapy in advanced prostate cancer.  Traditionally, urologists treated these patients with hormonal therapy only since radiation was not curative.

Newer studies are showing that external beam radiation added to hormonal therapy helps people live longer.  I think this is because radiation therapy is safer than it was in the past and treating the primary tumor may help prevent future metastases.

Dutasteride Slows Prostate Cancer Progression – Renal and Urology News

ORLANDO—Dutasteride, a drug widely prescribed for treating benign prostatic enlargement, lowers the risk of prostate cancer PCa progression in men undergoing active surveillance for the disease, researchers concluded.

via Dutasteride Slows Prostate Cancer Progression – Renal and Urology News.

Dutasteride has been used for BPH and is thought to help reduce the risk of developing prostate cancer.  This study also supports its use for men on active surveillance.  The medicine is mostly used for the treatment of benign enlargement of the prostate and can have sexual side effects in a small percentage of men.

MedWire News – Oncology – PCA3 predicts prostate tumor volume and could indicate AS suitability

MedWire News: Prostate cancer patients urinary prostate cancer antigen 3 PCA3 scores are strongly indicative of tumor volume, and could be a useful marker of suitability for treatment with active surveillance AS, study findings show.

via MedWire News – Oncology – PCA3 predicts prostate tumor volume and could indicate AS suitability.

I have been using PCA3 tests to estimate tumor burden for men choosing active surveillance for about 2 years.  I also check a PCA3 test after some time for men on active surveillance.  The values that are considered to be significant will need to be studied.

FDA committee votes down 5-ARIs for prostate cancer risk reduction – – UrologyTimes

“Although the REDUCE trial demonstrated a risk reduction in a large number of men, the committee chose to focus on a small number of high-grade cancers and determined that this class of drugs is inappropriate for prostate cancer risk reduction, even in the population of men with elevated PSA and previous negative biopsy,” added Dr. Gomella, a co-investigator of the REDUCE trial. “This decision will certainly reduce the enthusiasm for further large-scale, long-term studies of any prostate cancer chemoprevention or risk-reduction strategy.”

via FDA committee votes down 5-ARIs for prostate cancer risk reduction – – UrologyTimes.

This was a disappointing study for me.  Medications such as avodart and proscar have been shown to reduce the risk of prostate cancer.  Early studies revealing a higher percentage of high grade cancers have existed.  These studies were based on biopsy specimens only, which often understage cancer.

Other studies that looked at patients who had removal of the prostate have not revealed a higher incidence of high grade cancers in patients on these medicines.

I will inform patients that the FDA did not approve the indication of prostate cancer reduction for avodart and proscar (finasteride).  I think may patients will still opt for the medication.  Patients with large prostates will also have the benefit of a reduction in BPH symptoms.

 

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