Prostate Cancer Experience Research Articles

From early detection to rehabilitation in the community: reading beyond the blog testimonies of survivors' quality of life and prostate cancer representation.

BackgroundSurvivors’ testimonies can reveal much about men’s experiences of prostate cancer and impacts on their quality of life (QOL) during the clinical trajectory of the disease. These survivors’ shared thoughts and views were hypothesized to reflect salient features of their lived social representation of prostate cancer.ContextWe explored the content of testimonies posted by men to a public blog hosted by a French national prostate cancer patients’ association. The study question, “What do French bloggers’ testimonies reveal about their lived experiences with prostate cancer, especially regarding their quality of life in community settings, that underpin their social representation of prostate cancer?” guided the exploration and analysis of the textual data. The aims were to better understand men’s experiences and predominant thoughts and views, to elucidate patients’ behaviours, and to enlighten medical policy and practice.PurposeExplore issues of QOL as reported by French prostate cancer survivors in a public blog by: (a) identifying the salient aspects and issues of the experience of living with prostate cancer from the perspective of survivors; and (b) analyzing the content in the posted testimonies regarding perceived and lived impacts of prostate cancer on QOL.MethodsA critical ethnographic study guided the selection of textual data from 196 male bloggers’ testimonies about prostate cancer posted in the period from 2008 to 2013. Media content analysis method was undertaken on blog testimonies, framed by a multidimensional conceptual framework of QOL.ResultsTestimonies focused mainly on medical care and rehabilitation, recovery, health education and self-care, as well as on a global vision of prostate cancer and its impacts on personal views of manhood and masculinity. The language used indicated that political, educative and compassionate discourses were intertwined to create a complex representation of the experience and effects of prostate cancer; this multi-faceted representation can inform the public and professional debate about men’s capacity to provide emotional support and problem-solve within a community of interest.ConclusionFindings, while based on data limited to mostly one-time entries to a French blog, contribute to understanding a unique, collective expression of men’s lived experiences of prostate cancer. These anonymous survivors shared their varied reactions, ways of coping, and thoughts on needed change.

Tackling inequalities in cancer care and outcomes: psychosocial mechanisms and targets for change

Tackling inequalities in cancer care and outcomes: psychosocial mechanisms and targets for change

Ethnicity and the prostate cancer experience: a qualitative metasynthesis.

ObjectivesTo summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies.MethodsWe undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's “meta‐ethnography” approach, with a 2000‐2015 search of 7 databases.ResultsThirteen studies of men from US and UK BME groups were included. We explored constructs with BME‐specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping.ConclusionsThe prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.

The experiences of prostate cancer survivors: Changes to physical function and its impact on quality of life

Background/Aims: Quality of life plays a major role in prostate cancer research in relation to outcomes of treatment. Most studies conducted on patients with prostate cancer have used standardised psychometric instruments to evaluate the impact of treatment; few studies have taken an in-depth qualitative approach. There has been little consideration of the ways in which the prostate cancer experience impacts on daily life. The aim of this research was to understand the experience of prostate cancer survivors in relation to physical function and its impact on quality of life. Method: Semi-structured, in-depth interviews were conducted using seven participants who ranged in age from 44 to 80 years. Participants had received varying prostate cancer treatments and were between 3 months and over 7 years post-diagnosis. Results: Three main themes emerged: loss of masculinity, loss of control over daily activities, and age-specific perspectives. Changes to physical function included impotence, incontinence, fatigue and lymphoedema. Losses were multifaceted, leading to changes in self-perception, reduced participation in daily activities and a decreased quality of life. Conclusion: The impact of prostate cancer and its treatment led to decreased quality of life and desire to live. Identified changes in physical function and psychological wellbeing in prostate cancer patients highlighted the significance of younger men with prostate cancer, and their experience.

My advanced prostate cancer experience

Mr Flannigan gives a personal account of his diagnosis with prostate cancer and a vivid description of his experience of chemotherapy.

Management of advanced genitourinary tumors.

The management of advanced genitourinary tumors is rapidly evolving thanks to the clinical availability of several targeted drugs with different mechanisms of action. Among clinicians, in-depth knowledge of all the aspects of the disease, together with the capacity to interpret and accurately correlate clinical data and imaging findings, are strongly needed. Moreover, the optimization of treatment sequences might lead to better disease control with respect to prognostic categories, radiological monitoring and newer biomarkers. Among the genitourinary tumors, only few data are available on bladder, testicular and penile cancers. Our report is supported by scientific and clinical experience in renal cell carcinoma and prostate cancer.

Abstract C15: Using grounded theory to develop a model of prostate cancer care and survivorship for black men: The Florida CaPCaS study

Abstract The purpose of this study is to explore the experience of screening, diagnosis, treatment and survivorship of black men with prostate cancer using qualitative ground theory methodology. A sample of black men diagnosed with prostate cancer in 2010 was recruited via telephone screening from the Florida Department of Health cancer registry. The individuals recruited were purposively sampled for variation in country of origin (African, Caribbean, and US born) and other demographics. An open-ended interview guide about their prostate cancer experience, developed by our Community Advisory Board and revised by the scientific team, was used to conduct in-depth, face-to-face interviews of 2-3 hours in length. The interviews were scheduled at the convenience of the participant and conducted by a black male Community Health Worker in a private location in the community chosen by the participant. These steps were taken to assure maximum comfort for the participants to share their experiences fully. To date 14 interviews have been completed, with the goal of 60 interviews completed by the end of September, 2015. Data analysis consists of line-by-line coding of interview transcripts for themes that emerge from the interviews, followed by in-depth coding of constructs to be included in a grounded theory model of the prostate cancer experience for black men. Preliminary findings indicate emerging themes of trust of the health care providers, the impact of health literacy, views of active surveillance and watchful waiting, the importance of family support, and decisional regrets. Understanding the prostate cancer experience from the perspective of black prostate cancers survivors will help us to reduce the impact of the disease in this population. Citation Format: Mary Ellen Young, Folakemi T. Odedina, Christopher Williams, Deidre Pereira, Getachew Dagne, Eva Egensteiner, Lauren Gilbert, Kenneth Stokes, Christopher Hill, Esther Piervil. Using grounded theory to develop a model of prostate cancer care and survivorship for black men: The Florida CaPCaS study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C15.

The Clinical and Economic Impacts of Skeletal-Related Events Among Medicare Enrollees With Prostate Cancer Metastatic to Bone.

Approximately 40% of men diagnosed with metastatic prostate cancer experience one or more skeletal-related events (SREs), defined as a pathological fracture, spinal cord compression, or surgery or radiotherapy to the bone. Accurate assessment of their effect on survival, health care resource utilization (HCRU), and cost may elucidate the value of interventions to prevent SREs. Men older than age 65 years with prostate cancer and bone metastasis diagnosed between 2004 and 2009 were identified from linked Surveillance Epidemiology and End Results-Medicare records. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk for death associated with SREs were calculated by using Cox regression. HCRU and costs (in 2013 U.S. dollars) were evaluated in a propensity score-matched cohort by using Poisson regression and Kaplan-Meier sample average estimators, respectively. Among 3,297 men with prostate cancer metastatic to bone, 40% experienced ≥1 SRE (median follow-up, 19 months). Compared with men who remained SRE-free, men with ≥1 SRE had a twofold higher risk for death (HR, 2.29; 95% CI, 2.09-2.51). Pathological fracture was associated with the highest risk for death (HR, 2.77; 95% CI, 2.38-3.23). Among men with ≥1 SRE, emergency department visits were twice as frequent (95% CI, 1.77-2.28) and hospitalizations were nearly four times as frequent (95% CI, 3.20-4.40). The attributable cost of ≥1 SRE was $21,191 (≥1 SRE: $72,454 [95% CI, $67,362-$76,958]; SRE-free: $51,263 [95% CI, $45,439-$56,100]). Among men with prostate cancer metastatic to bone, experiencing ≥1 SRE is associated with poorer survival, increased HCRU, and increased costs. These negative effects emphasize the importance of SRE prevention in this population.

Modified Kegel exercise regimen following definitive and adjuvant prostate cancer radiotherapy.

e629 Background: 5-15% of patients treated with curative radiotherapy for prostate cancer experience some degree of urinary or fecal leakage. We hypothesized that a regimen of postradiotherapy perineal exercises would reduce this problem of sphincter dysfunction Methods: Upon completion of either conformal- or intensity-modulated radiotherapy to 76 Gy in 38 fractions (definitive) or 66 Gy in 33 fractions (postprostatectomy) patients were advised to commence a life-long program of daily perineal strengthening exercises. This consisted of a modified Kegel regimen for 5 minutes at a time, four times daily, and continued indefinitely. Patients have been monitored in regard to compliance and sphincter dysfunction at scheduled cancer clinic followup visits as well as by telephone survey. Results: 530 patients have been engaged in this postradiotherapy sphincter conditioning program. Parameters being analyzed are compliance with the regimen, frequency of exercise performance, urinary and fecal incontinence rates Conclusions: Pending the final tabulation of results the practical feasibility of such a prophylactic perineal exercise regimen as well as its impact on post radiotherapy sphincter integrity will be ascertained.

EORTC trial 22991: Results of a phase III study comparing 6 months of androgen suppression and irradiation versus irradiation alone for localized T1b-cT2aN0M0 prostate cancer.

22 Background: Up to 30% patients irradiated for intermediate- or high-risk localized prostate cancer experience relapse biochemically within 5 years. We assessed if biochemical disease-free survival (BDFS) is improved by adding 6 months of androgen suppression (AS) – twice 3-month depot LHRH-agonist to primary irradiation (RT) for intermediate or high risk localized T1b-cT2a N0M0 prostate cancer. Methods: 819 patients staged cT1b-c with PSA ≥ 10 ng/ml or Gleason ≥ 7 or cT2a (UICC TNM 1997) N0 M0 with PSA ≤ 50 ng/ml were randomized between RT or RT+ADT. Centers elected one dose of prostate irradiation: 70, 74, or 78 Gy. Irradiation of pelvic nodes was left to the discretion of each institution. The trial aimed to show an increase of +7.5% in 5-year BPFS (HR=0.714) with 80% power. This requires 274 events in intent-to-treat analysis. HRQoL was assessed by EORTC QLQ-C30+PR25 (ClinicalTrials.gov NCT00021450). Results: Patients were 70 y old in median, 88% had WHO PS 0, 74.8% were intermediate risk, and 24.8% high risk. In the RT arm, 407/409 received RT, in the RT+ADT, 403/410 received RT+ AS and 3 RT. Six patients refused treatment. After a median follow-up of 7.2 years, 201 and 118 events for BPFS were observed in the RT and RT+ AS arm. RT+ AS improved BPFS compared to RT (HR=0.53, CI: 0.42-0.67, P<0.001) irrespective of the radiation dose (heterogeneity P>0.1). The 5-y BPFS increased from 69.3% to 82.5%. Clinical PFS was also statistically significantly improved (205 events, HR=0.63, CI: 0.48-0.84, P=0.001, +7.9% at 5 years). Late genitourinary toxicity was reported by 5.9% vs. 3.6% of the patients, on RT+ AS and RT, respectively (p=0.14), whereas 27.0% vs 19.4% reported severe impairment of sexual function (p=0.010). Overall HRQoL did not differ between the groups. Hormonal treatment symptoms, sexual activity and functioning scales are clinically significantly impaired by AS at month 6 and year 1; from year 2 no marked difference is seen. Conclusions: The addition of 6 months of medical castration to primary irradiation improves BPFS and PFS in intermediate- and high-risk localized T1b-cT2a N0M0 prostatic carcinoma with no persistent detriment on HRQoL or sexual function. Clinical trial information: NCT00021450.

"What should happen before asymptomatic men decide whether or not to have a PSA test?" A report on three community juries.

To elicit the views of well informed community members on the ethical obligations of general practitioners regarding prostate-specific antigen (PSA) testing, and what should be required before a man undergoes a PSA test. Three community juries held at the University of Sydney over 6 months in 2014. Forty participants from New South Wales, of diverse social and cultural backgrounds and with no experience of prostate cancer, recruited through public advertising: two juries of mixed gender and ages; one all-male jury of PSA screening age. In contrast to Royal Australian College of General Practitioners guidelines, the three juries concluded that GPs should initiate discussions about PSA testing with asymptomatic men over 50 years of age. The mixed juries voted for GPs offering detailed information about all potential consequent benefits and harms before PSA testing, and favoured a cooling-off period before undertaking the test. The all-male jury recommended a staggered approach to providing information. They recommended that written information be available to those who wanted it, but eight of the 12 jurors thought that doctors should discuss the benefits and harms of biopsy and treatment only after a man had received an elevated PSA test result. Informed jury participants preferred that GPs actively supported individual men in making decisions about PSA testing, and that they allowed a cooling-off period before testing. However, men of screening age argued that uncertain and detailed information should be communicated only after receiving an elevated PSA test result.

Course and Moderators of Hot Flash Interference during Androgen Deprivation Therapy for Prostate Cancer: A Matched Comparison

Many men receiving androgen deprivation therapy for prostate cancer experience hot flashes. This study aimed to describe the course of hot flash interference with time in androgen deprivation therapy recipients relative to matched prostate cancer and cancer-free controls from before the start of androgen deprivation therapy to 12 months later. We also examined demographic, clinical and genetic predictors of the impact of androgen deprivation therapy on hot flash interference. Three groups were examined, including 60 patients with prostate cancer recruited before or within 21 days of starting androgen deprivation therapy, 83 age and education matched patients with prostate cancer treated with prostatectomy only, and 86 age and education matched men with no history of cancer. Participants provided blood samples and completed the Hot Flash Related Daily Interference Scale at baseline as well as 6 and 12 months later. Androgen deprivation therapy recipients reported increasing hot flash interference with time relative to controls (p <0.001). Group differences were evident at 6 and 12 months (all p <0.001) with androgen deprivation therapy recipients reporting greater hot flash interference than controls. Several genetic polymorphisms were found to predict greater increases in hot flash interference (all p <0.01), including polymorphisms on genes associated with vasoconstriction, immune function, neurotransmission and circadian rhythms. Androgen deprivation therapy recipients who were younger and had a lower body mass index at baseline also showed greater increases in hot flash interference with time (all p ≤0.01). This study, which is to our knowledge the first to prospectively examine hot flash interference in androgen deprivation therapy recipients, reveals that those with certain genetic polymorphisms, younger age and lower body mass index had greater increases in hot flash interference with time relative to controls.

Pathologic outcomes for low-risk prostate cancer after delayed radical prostatectomy in the United States

ObjectivesTo measure adverse pathologic outcomes following radical prostatectomy (RP) for men with low-risk prostate cancer in the United States based on time from diagnosis to surgery. MethodsWe extracted data from the National Cancer Database in 2010 and 2011 on 17,943 low-risk patients (Gleason score = 3+3, prostate-specific antigen <10ng/ml, and cT1–T2) who underwent RP. We identified men who delayed RP by>6 months after diagnosis and measured the effect of delayed RP on pathologic upgrading, upstaging, nodal metastases, and positive surgical margins. ResultsOverall, 16,818 underwent RP≤6 months, 894 at 6 to 9 months, 169 at 9 to 12 months, and 62 at>12 months from diagnostic biopsy. Furthermore, upgrading occurred in 43%, upstaging in 9%, positive surgical margins in 16%, and nodal metastases in 0.3% of men. Upgrading, upstaging, or nodal metastases occurred in 45% of men. On multivariable analysis, higher prostate-specific antigen (4.1–9.9ng/ml vs. 0.1–2.4ng/ml; odds ratio [OR] = 1.87, 95% CI: 1.66–2.10),>2 positive biopsy cores (OR = 1.68, 95% CI: 1.57–1.81),≥34% positive biopsy cores (OR = 1.28, 95% CI: 1.18–1.39), black race (OR = 1.16, 95% CI: 1.05–1.28), and time from biopsy to RP>12 months (vs.≤6mo: OR = 1.70, 95% CI: 1.01–2.84) each independently increased the composite risk of adverse pathology (all P< 0.05). ConclusionIn the United States, nearly half of men with low-risk prostate cancer experience at least one adverse pathologic outcome at RP. Delaying RP up to 12 months did not change the risk of adverse pathology. Men may safely use the time following their initial biopsy to consider management options and obtain a restaging biopsy, if recommended.

Burden of skeletal-related events in prostate cancer: unmet need in pain improvement.

Up to 75% of patients with prostate cancer experience metastatic bone disease, which leads to an increased risk for skeletal-related events (SREs) including pathological bone fracture, spinal cord compression, and hypercalcemia of malignancy. Our objective was to systematically review the literature on the impact of SREs on quality of life (QOL), morbidity, and survival with a primary focus on the impact of SREs on pain in prostate cancer patients. We searched PubMed, limiting to peer-reviewed English-language human studies published in 2000-2010. The search was based on the US Food and Drug Administration and European Medicines Agency definition of an SRE, which includes pathologic fracture, spinal cord compression (SCC), hypercalcemia of malignancy, and radiotherapy or surgery to bone resulting from severe bone pain. A total of 209 articles were screened, of which 173 were excluded, and 36 were included in this review. Patients with SREs had more pain and worse survival compared with no SREs. Pathologic bone fractures worsened QOL and were associated with shorter survival. Radiation therapy of SCC alleviated pain and improved morbidity. SCC was associated with decreases in patient survival. Radiation therapy and surgery to bone improved pain. Specific SREs are associated with worse outcomes, including increased pain, poorer QOL, morbidity, and survival. Treatment of SREs is associated with improved pain, although there remains a need for more effective treatment of SREs in prostate cancer patients.

The study of chemotherapeutic substances and combination of melatonin and methotrexate on the cellular culture of prostate cancer and clinical experience.

e22036 Background: Tumor chemosensitivity assay defined by an international group,is an ex vivo means of determining the cytotoxic potential of chemotherapeutic agents on malignant cells isolated f...

Psychosocial interventions to support partners of men with prostate cancer: a systematic and critical review of the literature.

Prostate cancer poses many challenges for both the man and his partner. Partners have reported a range of issues that impact their own mental health following their partner's diagnosis of prostate cancer. The aim of this review is to summarise and critically evaluate the current literature reporting psychosocial intervention studies for partners of prostate cancer patients. An extensive literature search of electronic databases was conducted (OvidMEDLINE 1946, 26th September 2013, and psychINFO 1967, 26th September 2013) using the keywords prostate cancer AND intervention* OR therapy* OR psychosocial intervention* OR support* AND couple* or Spouse* or Partner* or Intimate partner* matched to the title as well as secondary scanning of reference lists. Studies were included if they described interventions for partners of prostate cancer patients, either solely for the partners or as a couple, intended to alleviate distress and enhance the partner's or couple's quality of life, and reported a measurable outcome for partners. A total of 11 prostate cancer-specific intervention studies that included partners and reported separate results for the partners were found. Only one of these interventions was partner specific, the other eight involved the patient-partner dyad. The studies identified primarily focussed on two areas: emotional distress and sexual intimacy, and mixed findings were reported for efficacy of interventions. Despite strong evidence that partners of men with prostate cancer experience difficulties associated with the impact of prostate cancer, there is limited research that has investigated the efficacy of psychosocial interventions for partners. Of the reviewed studies, it is evident that interventions targeting the reduction of emotional distress, improved communication and sexual intimacy between the couple and utilisation of strategies that enable partners to express their distress, learn new strategies and implement behavioural change show the most promising results in enhancing partner well-being. Significant progress is required in developing and evaluating appropriate and effective psychosocial support interventions for partners of prostate cancer survivors as partners appear to have significant unmet needs in this area.

Patient-reported outcomes after prostate cancer treatment

Objective: Our aim was to understand patient-reported toxicities resulting from treatment of prostate cancer using various different modalities that have similar oncological endpoints. Methods and materials: An Internet-based survivorship care plan tool was used to collect patient-reported toxicity data for men who had undergone prostate cancer treatment. Results: A total of 127 users of the survivorship care plan tool reported to have been treated for prostate cancer. The median age of the patients at diagnosis in this group was 60 years (range = 25–74 years) and median time since diagnosis was 4 years (range 1–15 years); 61 (48%) received radiation as primary treatment, 44 (35%) received surgery as primary treatment and 22 (17%) received both surgery and radiation (adjuvant or salvage). Hormonal treatment was given to 50 (39%) patients. Some 15% (7/48) in the radiation group versus 50% (21/42) in the surgery group ( p &lt; 0.001) developed urinary incontinence; 61% (33/54) in the radiation group and 86% (37/43) in the surgery group ( p = 0.02) reported having erectile dysfunction since treatment. Most users (84%) had not been offered a survivorship care plan previously. Conclusion: Men with prostate cancer experience significant urinary and sexual sequelae from treatment regardless of the modality used. Patients treated with surgery reported more urinary and sexual side effects than those treated with radiation. The majority of these men are not offered a survivorship care plan to deal with these long-term effects. Survivorship planning tools to assess such side effects and design long-term individualized plans are essential for all prostate cancer patients.

Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depression Scale in 329 prostate cancer patients before surgery as well as 3, 6 and 12 months after surgery. These results were compared with those of a male German general population reference group. Adjustment to disease was assessed using the Perceived Adjustment to Chronic Illness Scale. Patients reported low levels of PD at all points of assessment similar to population norms of age-matched German men. Persistent PD was seen in about 8% of the patients and 20% had PD at least two of the measurement points. Relevant predictors for PD after surgery were urinary symptoms and baseline PD. Adjustment to disease was highest before surgery and had significantly reduced at 3 and 6 months after surgery. In general, men are resilient to the experience of localised prostate cancer and adjust well psychologically after surgery. However, between 8% and 20% of patients could possibly benefit from mental health support.

The first clinical experience in prostate cancer salvage cryotherapy

Introduction. Prostate cancer is the most common malignant neoplasia among men in Lithuania, though it presents a low mortality rate. In 2007 more than 3 500 Lithuanians were diagnosed with prostate cancer. Many patients were treated with radiotherapy. Unfortunately, after several years the number of cases of prostate cancer recurrence after radiotherapy started to grow. This new problem requires the following difficult decision to make: which treatment method to choose? Radical prostatectomy, high-dose radiotherapy, cryotherapy, high-intensityfocused ultrasound, active surveillance or hormone therapy – all are viable salvage methods. In 2012 we performed the first cryotherapy procedures. Now we want to present our first clinical experience in prostate cancer salvage cryotherapy. Materials and methods. Five patients diagnosed with prostate cancer were selected for prostate cryotherapy. Four patients were treated only with radiotherapy, one patient was treated with radiotherapy plus neoadjuvant hormonal treatment. Prostate cancer recurrences were diagnosed by multiparametric MRI and ultrasound guided transrectal or transperineal biopsies. MRI findings were validated with the Magnetic Resonance Prostate Imaging Reporting and Data System (PI-RADS). CT, MRI, ultrasound scanning, and bone scintigraphy were performed for patients before treatment. No pathological bone changes were detected. All patients received 2-cycle cryotherapy with real-time ultrasound guidance and temperature change tracking. Results. The described treatment scheme for these patients enables to deliver two freezing-thawing cycles with 10–12 probes and a urethra-warming catheter. All procedures were completed succesfully without any intraoperative complications. Urinal obstruction was observed after 1 week for 1 of 5 patients. He had to stay with epicystostomy and overwent prostate transurethral resection. After these procedures the patient could urinate normally. One patient had biochemical progression due to metastasis in parailiacal lymph nodes, and he got external beam therapy to lymph-node projection. After 6 months there was no cancer progresion signs on MRI and PSA was 1.77 ng/ml. No patients suffered from urinary incontinence. Conclusions. Our initial experience shows that cryotherapy can be a viable alternative for patients with disease progression after radiotherapy. Currently the biggest advantages of cryotherapy are as follows: possibility to treat patients not suitable for salvage prostatectomy, short hospitalization, low complication risk and lower overall cost than other methods. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

African and Afro-Caribbean men's experiences of prostate cancer

It is well documented that prostate cancer presents a significant health problem for middle-aged and elderly men in the UK, with further evidence suggesting that the disease is more prevalent in men of African and Afro-Caribbean (AAC) ethnicity. There is also evidence that these men are diagnosed much later and that the disease is more aggressive than in Caucasian men. To explore AAC men's experiences of prostate cancer and their understanding of its associated risks. The purpose was to gain an insight from these men's perspectives and ascertain whether a more focused health promotion strategy, and specific UK-based research, was needed in this area. A purposive sample of seven AAC men was recruited from a hospital trust's patient list after gaining approval from a research ethics committee. In-depth face-to-face interviews were carried out and the transcripts analysed thematically. The four main themes that emerged were: disease-prompted awareness, checking up as a necessary evil, defining and constructing factors influencing prostate cancer screening uptake, and appraising perceived myths about prostate cancer through personal beliefs. Among this group of AAC men, socioeconomic status, such as education and professional background, were factors that influenced their level of awareness of prostate cancer and prompted their decisions to seek help. However, it is evident from these men's perspectives that a more specific health education strategy that promotes early detection and management, targeting AAC men, would help in demystifying prostate cancer and encourage them to seek help earlier. Further research studies and health education in prominent social outlets are recommended in increasing AAC men's awareness of prostate cancer and its associated risks.