Urology, P.C. Oncology cLINIC
MORE INFORMATION COMING SOON!
Bladder cancer is cancer that begins in the bladder. A person with bladder cancer has one or more tumors (lumps) made up of
abnormal and unhealthy cells. Bladder cancer is characterized as either non-muscle invasive bladder cancer or muscle invasive bladder cancer.
• Non-muscle invasive bladder cancer (NMIBC) is cancer that grows only in the thin tissue on the inside surface of the bladder. With NMIBC, the bladder muscle is not involved and the tumor does not spread outside the bladder. There are several options for treatment.
• Muscle invasive bladder cancer (MIBC) is a cancer that spreads into the thick muscle deep in the bladder wall. It is a serious and more advanced stage of bladder cancer. MIBC should be treated without delay.
Treatment choices will depend on cancer staging and how much the cancer has grown. Treatment also depends on patient’s general health and age. Your urologist will stage and grade your cancer and discuss how to manage your care, depending on your risk. Risk may be low, intermediate or high.
- Bladder Installations for Cancer
Prostate cancer is a disease that affects the cells of the prostate. It occurs when the normal process of cell growth within the prostate becomes abnormal. Like many cancers, the cause of prostate cancer is unknown. What is known is that it is more common as men age, in African-American men and in men with a family history of the disease. Its growth may also be enhanced by the male sex hormone testosterone.
ADVANCED PROSTATE CANCEr
Advanced Prostate Cancer or “Castrate Resistant Prostate Cancer”- This is the stage of prostate cancer when some of your prostate cancer cells have stopped responding to hormonal therapy as indicated by a rising PSA level. During this stage men may have new complaints of pain, fatigue, or an increase in urinary symptoms. Imaging scans are needed to determine whether the cancer has spread to other parts of the body. Additional treatment is required to help slow the cancer’s growth. However, hormone injections are still need as this medication is still effective in treating some of the prostate cancer cells.
treatment options for prostate cancer and advanced prostate cancer
- Watchful Waiting
- This option consists of close observation of the cancer with no active treatment. This is based on the knowledge that prostate cancer is usually a slow-growing cancer and that most people who have prostate cancer die of something else.
- Active Surveillance
- This option is similar to watchful waiting. The difference is that with this strategy, if the cancer showed signs of progression, a potentially curative treatment such as surgery or radiation would be done.
- A radical prostatectomy is the removal of the entire prostate, the seminal vesicles, the tissue immediately surrounding them and some of their associated pelvic lymph nodes. The surgery can be done using 1 of 3 techniques: a retropubic open prostatectomy (incision in lower abdomen), a perineal open prostatectomy (incision between the scrotum and anus), or a robotic prostatectomy (4 or 5 very small “port” incisions in the abdomen). As with all operations, there may be short-term and long-term complications so it is imperative that you understand risks and benefits. A discussion to be had with your physician.
- Radiation Therapy
- External Beam Radiation Therapy
- External beam radiation therapy is delivered in small daily doses to the prostate, 5 days a week over a course of 6 to 8 weeks. The radiation is aimed at the prostate from many different angles to minimize damage to the surrounding normal structures, such as the bladder and rectum.
- Brachytherapy therapy is performed under anesthesia, usually as an outpatient case or as an overnight stay. The prostate is examined under ultrasound, measurements are entered into a computer and a treatment plan is generated. Needles are then used to place radioactive seeds into the prostate tissue by inserting them through the skin between the scrotum and anus (perineum).
- External Beam Radiation Therapy
- Cryotherapy also known as cryosurgery involved placing probes into the prostate, through an approach that is similar to that of brachytherapy. These “cryoprobes” are placed into the prostate through the skin of the perineum under the guidance of transrectal ultrasound. Argon gas is then used to create an “iceball” which results in instant cell death within the predefined area. Ultrasound monitoring of cryoablation, combined with the use of temperature monitoring thermocouples, prevents freezing injuries to the surrounding, normal tissues.
- Hormonal Therapy
- Hormone therapy decreases the testosterone (male hormone) levels that your body produces. This is similar to a “chemical castration”. By lowering your testosterone levels hopefully the cancer will slow down in growth. This alone does not cure you of your cancer. The hormone shots can be used alone or in combination with radiation therapy. Often times your physician will provide the hormone shots for a period of time during and after radiation therapy to help improve your outcome for cure.
- Prostate Biopsy results show High Grade PIN (Prostatic Intraepithelial Neoplasia)
- Provenge (Sipuleucel-T)is Immunotherapy to treat prostate cancer. Your own immune cells are removed, modified and re-infused into your body to fight your cancer. There are 6 total appointments, broken into three cycles that include: An appointment for blood cell removal at the Red Cross in Omaha (Leukapheresis) followed 3 days later by an appointment for cell re-infusion at our office. This can be completed in 5-6 weeks. A special type of IV catheter may be need to be placed for the duration of this therapy.
- Oral Medications
- Several oral medications are available that assist with treatment of prostate cancer. Xtandi (enzalutamide), Erleada (apalutamide) and Zytiga (abiraterone acetate). These medications act in slightly different ways to prevent prostate cancer cells from growing and spreading. One medication may be more appropriate for you than another based on your particular medical history. They are very expensive medications, but assistance may be available from cancer foundations. Additional information will be provided about administration if your medical provider prescribes this for you. A common side effect is fatigue
- Xofigo (Radium 223)is a once a month injection (given for 6 months) used to help with pain and symptoms associated with metastatic disease (for cancer that has spread to your bones). This will have little to no effect on PSA level but has shown in clinical trial to improve survival, and may help with discomfort. This IV injection takes about 15 minutes to administer, and is given by a nuclear medicine physician, here in our facility. The most common side effect is diarrhea, lasting 1-2 days.
- Chemotherapy is the use of medicines or drugs to stop the growth of cancers. It is not generally a part of the treatment of localized prostate cancer. If interested in this option, a referral to an oncologist would be required.
- Palliative Care
- Palliative Care is an option where you elect to receive minimal cancer therapy and allow the disease to slowly progress. Treatments or medications would be to treat pain or other side effects of the cancer. Your provider may refer you to a hospice organization as needed.
- Watchful Waiting
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis is a condition that occurs when new bone does not keep up with breakdown of old bone, causing bone strength and density to be weakened. Osteopenia is a condition where bone density is lower than normal, this is a precursor to osteoporosis.
Some people are more at risk for development of Osteoporosis or Osteopenia: Women, people of advanced age, Caucasian or Asian, family history of Osteoporosis, and small body frame size. People who smoke, who have excessive alcohol consumption, or who have a sedentary lifestyle have increased risk. Someone who has low calcium intake, is underweight, has stomach absorption problems, or requires long-term steroid use has higher risk. Some medical conditions of the thyroid, parathyroid, adrenal glands, or cancer can cause or worsen bone loss.
*The hormone medications used to treat prostate cancer can cause or worsen bone density.
Osteoporosis can result in bone fractures (especially spine and hip fractures), loss of height, and stooped posture. Bone fractures have the potential to cause pain, death, or disability.
Osteoporosis Prevention/Treatment strategies include:
*Weight bearing exercise: Walking, jogging, stair climbing or skipping rope are good weight bearing exercise. These types of exercise should be done 30 minutes daily. Additional exercises, like yoga or weight lifting, may strengthen muscle and aid in balance.
*Healthy diet: Get plenty of protein in your diet through meat, soy, nuts, legumes, eggs, and dairy.
* Calcium & Vit D: 1,200 mg of calcium and 800 IU Vitamin D are needed for bone health-through dietary intake or supplements. Dairy products, Dark leafy green Veggies, soy products, calcium fortified cereal or juice are all sources of
Calcium. Vitamin D is absorbed from exposure to the sun.
*Every 2 year DEXA scan- A special type X-ray performed to measure bone mineral density
*Medications used to prevent fracture, and build bone: (these require baseline labs-Calcium & Creatinine, and dental clearance prior to starting)
*Xgeva– Subcutaneous injection (120 mg) once every 4 weeks to prevent skeletal-related events for patients that have bone metastases from cancer
*Prolia– Subcutaneous injection (60 mg) once every 6 months to treat bone loss due to hormone ablation
*Fosamax– An oral medication taken once weekly
*Zometa– An IV medication (4 mg) given every 4 weeks
Many cancer types have a hereditary component. Meaning you may have inherited genes from your parents that contain a mutation, which increases the risk you may develop cancer. Other times cancer is sporadic with an unknown cause. With prostate cancer, 5-10% of cases are due to inherited genetic mutations. A greater percentage (15-20%) are patients with a strong family history, but no detectable genetic mutations.
Genetic testing can assist in guiding treatment, and it may indicate the need for earlier and more frequent screening to prevent cancer in a patient or their family members.
Current recommendations from National Comprehensive Cancer Network (NCCN) include genetic testing and possibly genetic counseling for patients with prostate cancer who have any of the following:
1. A positive family history of certain cancer types: Melanoma, endometrial, ovarian, breast, colorectal, gastric, bile duct, pancreatic, kidney, or prostate
2. High-risk prostate cancer (localized or metastatic)- Gleason score 8 or above
3. Intraductal prostate cancer histology
4. Metastatic prostate cancer- cancer has spread beyond prostate
5. Ashkenazi Jewish ancestry
If interested in facilities that offer genetic testing and counseling, please ask your provider.
A healthy diet may increase your energy levels and enhance your immune system. It is of great value to think about the foods you eat and to try to maintain a healthy weight. Healthy eating habits can improve your health and risks.
Healthy food choices may include:
- Plenty of fruits and vegetables
- High fiber foods
- Low fat foods
- Limited amounts of simple sugars
- Limited amounts of processed foods (especially processed meats like deli foods and bacon)
Because prostate cancer treatment can affect your appetite, eating habits and weight, it is of great value to try your best to eat healthy. If you have a hard time eating well, reach out to a registered dietitian/nutritionist (RDN). There are ways to help you get the nutrition you need.
Physical exercise may improve your physical and emotional health. It can also help you manage your weight, maintain muscle and bone strength and help manage side effects.
If approved by your doctor, you may want to exercise one to three hours per week. Cardiovascular exercise and strength/ resistance training may be good choices. This can include walking or more intense exercise. Physical exercise may help you to:
- Reduce anxiety
- Improve energy
- Improve self-esteem
- Feel more hopeful
- Improve heart health
- Reach a healthy weight
- Boost muscle strength
- Maintain bone health
Pelvic floor exercise may help men being treated for prostate cancer. The pelvic floor is a group of muscles and structures in your pelvis between your legs. The pelvic floor supports the bowel, bladder and sexual organs. They help with urinary and fecal functions as well as sexual performance. The muscles contract and relax, just like any other muscle in your body. Pelvic floor exercises can help with side effects like erectile dysfunction and urinary incontinence.
After treatment, some men feel relieved the cancer is gone. Many men may worry about cancer coming back (recurrence). If the cancer returns, you and your doctor will talk about next steps and make a plan.
Some men are upset by the side effects of treatment. Urinary and erection problems can feel like a loss of one’s usual self. Those feelings are normal and will get better as you learn to manage your side effects and see improvements. Whatever you are feeling, it is worth telling your doctor. Cancer is always stressful and a trained counselor may help you manage your mental health.
If you have a partner, be sure that your partner is a part of what you are going through. Couples cope better when they approach cancer treatment and the side effects of treatment as a team. If you do not have a partner, talk to a friend you trust about what you are going through. If you find you and your partner are not coping well, feel down or very anxious, it may help to talk to a counselor or a sex therapist to get support.
Prostate Cancer Support Group
Meets the second Thursday of every month
Bryan West Campus
Gregorius Conference Center
2300 S. 16th St.
Lincoln, NE 68502
For more information and to register, call 402-481-7900.
Zoom option available
www.ustoo.com (this is a different support group)
www.prostate.com (Prostate Cancer, BPH, Prostatitis)
www.cancer.org American Cancer Society
Lang, Paul. Prostate Cancer for Dummies. Wiley, John & Sons, Incorporated, 2003.
Marks, Sheldon. Prostate and Cancer. Perseus Books Group.
Marks, Sheldon. Prostate and Cancer: Family Guide to Diagnosis, Treatment, and Survival. Perseus Publishing, 2003