Complications Of Prostate Cancer Treatment Research Articles

Cardiovascular Complications of Prostate Cancer Treatment.

Treatment of prostate cancer (PC) is a rapidly evolving field of pharmacology research. In recent years, numerous novel therapeutics that improve survival and ameliorate disease control have been approved. Currently, the systemic treatment for prostate neoplasm consists of hormonal therapy, chemotherapy, immunotherapy, radiopharmaceuticals, targeted therapy, and supportive agents (e.g., related to bone health). Unfortunately, many of them carry a risk of cardiovascular complications, which occasionally pose a higher mortality threat than cancer itself. This article provides a unique and comprehensive overview of the prevalence and possible mechanisms of cardiovascular toxicities of all PC therapies, including state-of-the-art antineoplastic agents. Additionally, this article summarizes available recommendations regarding screening and prevention of the most common cardiac complications among patients with advanced cancer disease.

How informed is our consent? Patient awareness of radiation and radical prostatectomy complications.

To evaluate patient's recall of pretreatment counseling for radical prostatectomy and radiation therapy for the treatment of prostate cancer. A retrospective review of all patients presenting to our reconstructive urology clinic for the management of the complications of prostate cancer treatment was conducted over 24 months. Patients treated with only surgery or radiotherapy were included in the study. Patients were asked a standard series of questions to assess their recall of their pre-prostate cancer treatment counseling. We identified 206 patients that met inclusion criteria. Of those, 153 underwent radical prostatectomy and 53 patients received radiation therapy. Median age at presentation was 72 years in the surgery group and 75 in the radiation therapy group. Mean time since treatment was 8.8 years in those that recalled being counseled and 9.9 years in those who did not (p=0.21). In the surgery group, the adverse effects experienced by 119 (77.8%) patients recalled, and counselled were related to the risk of treatment. In the surgical patients that had records with documentation of pretreatment counseling, 41/48 (85.4%) endorsed recall. In the surgery group, 117 (76.5%) stated that their treating physician was aware of their complication. In the radiation group, 5 patients (9.4%) endorsed recall (p<0.0001). In the subgroup of radiation patients with documentation of pre-treatment counseling, no patients endorsed recall. In the surgery group, 117 (76.5%) patients stated that their treating physicians were aware of their complication, while in the radiation group, only 16 (30.2%) of treating physicians were aware of the complications (p<0.0001). Patient recall of potential complications of prostate cancer treatment is poor. It's unclear if this is secondary to poor recall, selective memory loss or inadequate counseling.

Five-year downstream outcomes following prostate-specific antigen screening in older men.

Despite ongoing controversies surrounding prostate-specific antigen (PSA) screening, many men 65 years or older undergo screening. However, few data exist that quantify the chain of events following screening in clinical practice to better inform decisions. To quantify 5-year downstream outcomes following a PSA screening result exceeding 4.0 ng/mL in older men. Longitudinal cohort study in the national Veterans Affairs health care system. In total, 295,645 men 65 years or older who underwent PSA screening in the Veterans Affairs health care system in 2003 and were followed up for 5 years using national Veterans Affairs and Medicare data. Among men whose index screening PSA level exceeded 4.0 ng/mL, we determined the number who underwent prostate biopsy, were diagnosed as having prostate cancer, were treated for prostate cancer, and were treated for prostate cancer and were alive at 5 years according to baseline characteristics. Biopsy and treatment complications were also assessed. In total, 25,208 men (8.5%) had an index PSA level exceeding 4.0 ng/mL. During the 5-year follow-up period, 8313 men (33.0%) underwent at least 1 prostate biopsy, and 5220 men (62.8%) who underwent prostate biopsy were diagnosed as having prostate cancer, of whom 4284 (82.1%) were treated for prostate cancer. Performance of prostate biopsy decreased with advancing age and worsening comorbidity (P < .001), whereas the percentage treated for biopsy-detected cancer exceeded 75% even among men 85 years or older, those with a Charlson-Deyo Comorbidity Index of 3 or higher, and those having low-risk cancer. Among men with biopsy-detected cancer, the risk of death from non-prostate cancer causes increased with advancing age and worsening comorbidity (P < .001). In total, 468 men (5.6%) had complications within 7 days after prostate biopsy. Complications of prostate cancer treatment included new urinary incontinence in 584 men (13.6%) and new erectile dysfunction 588 men (13.7%). Performance of prostate biopsy is uncommon in older men with abnormal screening PSA levels and decreases with advancing age and worsening comorbidity. However, once cancer is detected on biopsy, most men undergo immediate treatment regardless of advancing age, worsening comorbidity, or low-risk cancer. Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA screening.

Posterior urethral complications of the treatment of prostate cancer

• To review the less common and not widely discussed, but much more serious complications of prostate cancer treatment of: urethral stricture, bladder neck contracture and urorectal fistula. • The treatment options for patients with organ-confirmed prostate cancer include: radical prostatectomy (RP), brachytherapy (BT), external beam radiotherapy (EBRT), high-intensity focussed ultrasound (HIFU) and cryotherapy; with each method or combination of methods having associated complications. • Complications resulting from RP are relatively easy to manage, with rapid recovery and return to normal activities, and usually a return to normal bodily functions. • However, after non-surgical treatments, i.e. BT, EBRT, HIFU and cryotherapy, these same problems are more difficult to treat with a much slower return to a much lower level of function. • When counselling patients about the primary treatment of prostate cancer they should be advised that although the same type of complication may occur after surgical or non-surgical treatment, the scope and scale of that complication, the ease with which it is treated and the degree of restoration of normality after treatment, is altogether in favour of surgery in those for whom surgery is appropriate and who are fit for surgery.

Differential Diagnosis of Overactive Bladder in Men

We determined the differential diagnosis of concomitant pathological conditions in men with overactive bladder symptoms. We performed an observational, descriptive study to elucidate the differential diagnosis in men with overactive bladder symptoms using a previously validated overactive bladder symptom questionnaire. All patients provided an extensive history, completed the self-administered questionnaire and a 24-hour voiding diary, and underwent physical examination, 24-hour pad test, uroflowmetry, post-void residual urine measurement, cystoscopy and urodynamics. Selection criteria were developed to assign cases to a category, including idiopathic overactive bladder, benign prostatic enlargement, benign prostatic obstruction, neurogenic bladder, bladder cancer, prostate cancer treatment complications, urethral stricture, bladder stones and bladder diverticulum. Of 122 men who met selection criteria for overactive bladder detrusor overactivity was identified in 99 (79%) on urodynamics. The differential diagnosis was benign prostatic enlargement in 40 men (32%), benign prostatic obstruction in 27 (22%), complications of prostate cancer treatment in 25 (20%), neurogenic bladder in 13 (11%), urethral stricture in 7 (6%), idiopathic overactive bladder in 6 (5%), bladder stone in 2 (2%), bladder cancer in 1 (1%) and bladder diverticulum in 1 (1%). Overactive bladder is a complex diagnosis with many underlying, contributing urological pathologies. It should be considered a symptom complex and not a syndrome. Knowledge of the differential diagnosis in men with overactive bladder symptoms would hopefully provide clinicians with a diagnostic rubric to more specifically treat such patients with improved success.

Management of Complications of Prostate Cancer Treatment

Prostate cancer is the most commonly diagnosed noncutaneous cancer in men in the United States. Treatment of men with prostate cancer commonly involves surgical, radiation, or hormone therapy. Most men with prostate cancer live for many years after diagnosis and may never suffer morbidity or mortality attributable to prostate cancer. The short-term and long-term adverse consequences of therapy are, therefore, of great importance. Adverse effects of radical prostatectomy include immediate postoperative complications and long-term urinary and sexual complications. External beam or interstitial radiation therapy in men with localized prostate cancer may lead to urinary, gastrointestinal, and sexual complications. Improvements in surgical and radiation techniques have reduced the incidence of many of these complications. Hormone treatment typically consists of androgen deprivation therapy, and consequences of such therapy may include vasomotor flushing, anemia, and bone density loss. Numerous clinical trials have studied the role of bone antiresorptive therapy for prevention of bone density loss and fractures. Other long-term consequences of androgen deprivation therapy may include adverse body composition changes and increased risk of insulin resistance, diabetes, and cardiovascular disease. Ongoing and planned clinical trials will continue to address strategies to prevent treatment-related side effects and improve quality of life for men with prostate cancer.

“Male Lumpectomy”: Focal Therapy for Prostate Cancer Using Cryoablation

The introduction of breast-sparing surgery (ie, "lumpectomy") revolutionized the management of breast cancer. The use of lumpectomy showed that quality of life could be optimized without compromising treatment efficacy. Complications of prostate cancer treatment, including impotence and incontinence, adversely alter the male self-image similarly to the way the loss of a breast does for a woman. Traditional thinking holds that prostate cancer is multifocal and therefore is not amenable to focal treatment. However, histopathologic findings from published data have indicated that up to 25% of prostate cancers are solitary and unilateral. Furthermore, the significance of minute secondary cancers might be minimal. These observations raise the question of whether certain patients can be identified and treated with a limited "lumpectomy." In this study, focal cryoablation has been used to ablate the area of known cancer as determined by staging biopsies. The serum prostate-specific antigen (PSA) concentration was obtained every 3 months for 2 years and every 6 months thereafter. American Society for Therapeutic Radiology Oncology (ASTRO) criteria for PSA recurrence were used. A total of 55 patients with > or = 1 year of follow-up had undergone focal cryoablation. Follow-up ranged from 1 to 10 years (mean, 3.6 years). At the original transrectal ultrasound biopsy, the mean and median numbers of cores taken were 9.9 and 10 (SD, +/- 3.5), respectively. Mean and median numbers of positive cores were 1.8 and 1 (SD, +/- 1.3), respectively. Of the 55 study patients, 52 (95%) had stable PSA levels with no evidence of cancer despite a medium to high risk for recurrence in 29 patients. All biopsy findings were negative among the 26 patients with a stable PSA level who had undergone routine biopsy at 1 year. No local recurrence was noted in treated areas. Potency was maintained in 44 (86%) of 51 patients. Of the 54 patients without previous prostate surgery or radiotherapy, all were continent. These preliminary results indicate that "male lumpectomy"--in which the prostate tumor region itself is destroyed--preserves potency in most patients and limits other complications (particularly incontinence) without compromising cancer control. Additional studies and long-term follow-up are needed to confirm that this treatment approach could have a profound effect on prostate cancer management.

Rationale for a “Male Lumpectomy,” a Prostate Cancer Targeted Approach Using Cryoablation: Results in 21 Patients with at Least 2 Years of Follow-Up

Prostate cancer in men raises many of the same issues that breast cancer does in women. Complications of prostate cancer treatment, including impotence and incontinence, affect the self-image and psyche of a man no less than does the loss of a breast in a woman. We present a pilot study in which 21 patients were treated with a focal cryoablation procedure. Focal cryoablation was performed using biplane transrectal ultrasound if the tumor was confined to only one prostate lobe. Preoperative PSA values were recorded. Cryoablation was planned to encompass the area of known tumor. PSA values were obtained every 3 months for 2 years and every 6 months thereafter. Potency and continence status was obtained at the same intervals. Routine biopsy was obtained at 1 year. Twenty-one patients had focal cryoablation. Follow-up ranged from 24 to 105 months with a mean of 50 months. Twenty of 21 (95%) patients have stable PSA values with no evidence for cancer, despite 10 patients being at medium to high risk for recurrence. All patients biopsied (n = 19) were negative for tumor. Potency was maintained in 17 of 21 patients (80%). No other complications, including incontinence or fistula formation, were noted. These preliminary results indicate a "male lumpectomy," in which the prostate tumor region itself is destroyed, appears to preserve potency in a majority of patients and limits other complications, without compromising cancer control. If these results are confirmed by further studies and long-term follow-up, this treatment approach could have a profound effect on prostate cancer management.

Complications of prostate cancer treatment: spectrum of imaging findings.

The imaging appearances of prostate cancer are well described in the radiology literature, but little has been written about the detection and appearance of the complications of therapy for this disease. The most frequently used treatments for prostate cancer are surgical therapy (eg, radical retropubic prostatectomy, radical perineal prostatectomy), radiation therapy (eg, brachytherapy, external-beam radiation therapy, three-dimensional conformal radiation therapy, intensity-modulated radiation therapy), and cryoablative therapy, each of which may lead to complications with characteristic imaging appearances. Possible complications include lymphocele formation; injuries to the ureter, rectum, and urethra; prostatic necrosis; vesicourethral anastomotic leak and stricture; urethral stricture, necrosis, and fistula; radiation proctitis; transient bladder outlet obstruction; radiation-induced urethritis; urinary incontinence; and erectile dysfunction. With improvements in surgical techniques and advances in technology, complications of therapy for prostate cancer are decreasing but still occur with sufficient frequency to warrant familiarity on the part of radiologists. Knowledge of the diverse spectrum of these complications and their characteristic radiologic features facilitates prompt diagnosis and treatment.