Frequently Asked Questions By Patients
On this page you can find the most frequently asked questions about prostate cancer. Answers to them were elaborated by Professor Kliment from Department of Urology; Jessenius School of Medicine; Comenius University; University Hospital in Martin and were published in a booklet Prostate Disorders: Prostate Carcinoma; Benign Prostatic Hyperplasia; Prostatitis.
I was diagnosed with prostate cancer by my urologist. I suppose a treatment decision should be done by an experienced specialist. Do I have a right to ask the experienced specialist about his opinion on prostate cancer treatment?
Prostate cancer is a serious condition and treatment decision making is very responsible act. Usually, physician without a sufficient experience with prostate cancer treatment can ask for consultation in a centre or clinic, which have experience with prostate cancer treatment. If you have any doubt about proposed treatment you are entitled to consult it in this centre. This approach is used worldwide regularly.
I have undergone transurethral resection of prostate due to prostate cancer. Can this surgical procedure accelerate a course of prostate cancer?
Transurethral resection of prostate in patients with prostate cancer is performed with the aim to improve voiding disorders and to enable complete emptying of urinary bladder. It is done under spinal or epidural anaesthesia and the procedure can be repeated. There was no evidence of higher risk of possible dissemination of malignant cells during this procedure with subsequent development of distant metastases until now. Generally speaking, transurethral resection of prostate does not affect further course of prostate cancer.
I have advanced prostate cancer. Hormonal treatment: orchiectomy* or administration of injections of LHRH** analogue, was offered to me. Which of these two forms of treatment is better?
Both treatment options are equal; there is no difference in effectiveness. Both alternatives decrease the blood concentration of male gonadal hormone (testosterone) to the same required level. Orchiectomy is simple surgical procedure; it represents one-time and permanent treatment. Administration of LHRH analogue injections is necessary to be repeated regularly. Choice of a particular type of treatment depends on patient preference considering the recommendation of urologist.
* Orchiectomy – a surgical procedure in which testicles are removed; it is the surgical form of castration.
**LHRH – Luteinising Hormone-Releasing Hormone; a type of hormone therapy for prostate cancer.
I have serious mental problem since I knew about my diagnosis of prostate cancer, I am scared and I expect the worst. Does any help exist for me?
The information about diagnosis of prostate cancer is for everybody shocking in the first moment and it leaves trace in a mental condition. Fear, concern over future, depression are more prevalent feelings as well as the tendency to assess the health condition in the most pessimistic way. The most important is to abandon usually irrational thoughts in this period and rather consult your condition and get exact information about the disease. Prostate cancer, despite individual differences, is slowly growing tumour with progress which is possible to affect. If the diagnosis was done early, curable treatment is possible as well as normal further living. It is necessary to discuss all the aspects of the disease and all your questions and problems with urologist. When you understand your disease, you can reduce mental tension and regain your mental balance.
I am treated for prostate cancer by hormonal treatment for longer time. Hot flushes are very unpleasant adverse effect of such treatment. How is possible to eliminate them or at least to reduce their seriousness?
Hot flushes are unpleasant adverse side effect of hormonal treatment in most patients. They can be of minor grade and cause only mild discomfort, but also very intense with profound sweating that requires changing of clothes. There exist some drugs which can reduce an intensity and rate of hot flashes. It is also appropriate to adjust a diet, reduce spicy foods, exclude smoking, reduce the consumption of coffee and beverages containing caffeine. It is also recommended to avoid situations which can induce hot flushes.
I have undergone brachytherapy for prostate cancer. Does radiation used in this approach affect sperm?
Sperm production continues after implantation of radioactive seeds into the prostate glands and the possibility of sperm cells disability exists. Thus, we recommend to avoid a fertilization of your partner in 18 months following brachytherapy. The quantity of sperm expressively decreases after brachytherapy and there is a low probability that patient can preserve fertilization ability. In case of younger patient with ambition to have children in future, there is possibility to preserve sperm in a sperm bank before brachytherapy.
I am on treatment of prostate cancer for a longer period of time. I have been offered to participate in a clinical trial. Should I participate in it?
Clinical trials compare standard treatment with a new therapeutic compound. In case of positive study results with a proven superior efficacy of the new treatment, such treatment usually becomes a standard option instead of the previous one. Clinical trials are necessary to achieve progress in prostate cancer therapy. You may obtain a possibility to be treated by potentially more effective treatment. The course of your malignant disease will be closely monitored during clinical study.
I am 60 years old and I noticed blood in my urine. It took only one day, since then my urine is clear. I have no trouble at all. Is an examination by urologist necessary?
Blood in urine observed while urinating is an important symptom. It can occur with prostate disease, but it can be also the symptom of bladder or renal cancer. Urological examination is essential in such cases. If not done, diagnosis of serious illness can be delayed.
I have overcome prostatitis in the past. Do I have higher risk to develop prostate cancer?
There is no explicit evidence until now that inflammation in prostate constitutes higher risk for development of prostate cancer.
I underwent prostate surgery for benign hyperplasia. Do I have to be worried about prostate cancer?
The surgical procedure for benign prostate hyperplasia, transurethral resection or open prostatectomy is based on ablation of enlarged part of prostate localized in the centre of the gland. Prostate cancer develops in 70% of cases in peripheral part of prostate gland which remains preserved after surgery for benign hyperplasia. Thus, surgery for benign hyperplasia does not protect patient from development of prostate cancer in the future.
Is it possible to diagnose prostate cancer by ultrasound examination?
It is not possible to diagnose prostate cancer by ultrasound examination. Ultrasound exam assists particularly in prostate biopsy by targeting different parts of prostate gland for sampling. Especially in early stages of disease ultrasound is not able to detect malignant focus. Similarly, other imaging techniques such as magnetic resonance imaging or computer tomography are not reliable for definitive diagnosis of prostate cancer. Prostate biopsy is always essential for confirmation of prostate cancer diagnosis.
I am 67, I have only mild voiding problems, but I suffer from pain in my back, pelvis and thoracic bones. Do I need urological examination?
Yes, urological examination is very important in your case even though you have no problems with urinating. Prostate cancer develops in some patients for a long period of time without any signs and symptoms; it can manifest itself by skeletal pain without any urinary disturbances. Instant appropriate disease diagnosis allows also immediate initiation of effective treatment.
I was diagnosed with prostate cancer. How serious is my disease and what is my prognosis?
This is very important question for every patient. Severity of the disease and closely related prognosis depend on multiple factors, which are helpful to predict prostate cancer development in future. These factors include in particular: appearance of cancer cells (level of dedifferentiation); tumour stage; general health status with associated ability of human body to defend against malignant disease; age; treatment efficacy.
Generally speaking, we can conclude that patients with prostate cancer limited to prostate gland (stage T1-T2), well differentiated cancer cells (Grade 1-2 or Gleason 2-7) are of a very good prognosis and most of them will not die from prostate cancer. Patients with higher stage of disease with spreading of cancer cells beyond a prostate capsule (stage T3-T4), poorly differentiated cancer cells (Grade 3 or Gleason 8-10) are of more unfavourable prognosis and there is substantial risk of disease progression in next 10 years despite the treatment. The patients with metastatic disease in bones and lymph nodes have the most unfavourable prognosis. However, there are still differences among them, e.g. patients with a low number of metastases are of better prognosis than patients with more numerous metastases.
It must be also emphasized that exact prediction of disease prognosis in any individual patient is not possible. Many factors influencing malignant disease are still unknown and also the body response of every patient to cancer is different
I am 51 years old and I read in newspaper about prostate cancer disease. I have no problems with urination but I am worrying about cancer. May I ask for preventive urological examination?
Preventive urological examination in men of age 50-75 years for early detection of prostate cancer is recommended. Favourable prognosis in patient with prostate cancer depends on diagnosis of disease in early stages when cancer is curable. As initial stages of malignant prostate disease are generally in progress without any signs and symptoms preventive examination is extremely important. To diagnose prostate cancer in time is the only chance to cure the patient in recent times. Detection of early stages of prostate cancer increased and mortality of prostate cancer declined in countries with extensive preventive programme.
Retrieved from: Kliment J. Ochorenia prostaty: Karcinóm prostaty; Benígna hyperplázia prostaty; Zápaly prostaty. 3. vyd. Turany: Európa UOMO Slovensko, 2018. 96 s. ISBN 978-80-973086-4-3.