Urology Center Of Idaho

Urology Center of Idaho
208.233.3355
500 S 11th Ave # 301

Pocatello, ID 83201

         
 

A good many cancers occur in urology. Tumors may occur in the kidneys, adrenal glands, bladder, or prostate. At the Urology Center of Idaho we specialize in finding these.

Most of the time, there are no noticeable symptoms when a tumor first forms. They may be found when a simple blood or urine test turns up abnormal, and many are found ‘by accident’, when a test or X-ray was done for a totally unrelated reason.

We at the Urology Center of Idaho step in and do everything to figure out what is going on, and put together a treatment plan if a mass should be found.

Blood In The Urine: Bladder Cancer

There are two systems of the body which rids us of toxic substances: The liver and the kidneys. Over the ages, the kidneys and their filtering system have learned to deal with the challenges posed to them.

However, modern ages have put new challenges on the urinary tract: Chemistry has put new and so-far unknown substances into the mix of things our body has to deal with. Smoking tobacco, which in ancient times was limited to a small group of shamans has been taken on by a large part of the population during much of the last century.

If the lining of the urogenital tract is not prepared for these challenges it may develop tumors, most often in the bladder.

The only symptom of early bladder cancer seems very harmless. There is no pain or sickness, and there may not be any symptom at all. Sometimes, though, there may be a trace of blood in the urine. Typically, this occurs without any other symptoms.

This is why any blood in the urine, or “hematuria” in the absence of other symptoms needs to be worked up. Bladder cancer is a possible cause, and this needs to be ruled out.

Bladder cancer is very curable if caught early. A simple, minimally invasive procedure removing the cancer using the normal urethral opening is usually enough to cure this disease. When not caught early, however, the cancer may move into the deeper tissues of the bladder or even beyond. In that case no cure may be possible. If it is, it involves the surgical removal of the entire bladder which is mayor surgery carrying significant risk.

Therefore anybody who has seen even a trace of blood in the urine should seek medical attention immediately.

Prostate Cancer

Prostate cancer is most frequent solid organ cancer found in the male population today. Actually this top spot was once held by lung cancer, but since we stopped smoking this questionable honor since has transferred to prostate cancer. About every one in six male Americans will be diagnosed with this disease!

At the same time, however, the disease is also one of the most 'benign' cancers we know of. While this is really a contradiction in terms, I will explain what I mean.

If you take all cancers and look at how they act, you will come up with things like pancreatic cancer and melanoma at the very top. These will give you only months after being diagnosed. In the middle field there are things like colon or breast cancer. At the very end of the spectrum is the slowest-growing, least aggressive: prostate cancer. It takes this disease an average of 14 years to kill a man! Compare this to pancreas cancer, which gives you only a few months. So we find that in the early stages prostate cancer is quite harmless, really.

This is why in all men who have prostate cancer, it is the cause of death for only 1/6th, or about 16%. The reason for this is simply because we do not live forever; most of the time something else gets us first.

Obviously, this varies with age: A 50 year-old with this diagnosis runs a very high risk of getting into trouble with this disease, but a 90 year-old will very likely never run into a problem with it.

This also means that any benefit from treatment will not show up for one and a half decade. Also., it is important to mention that any treatment for prostate cancer has side effects and risks. So many of those who are diagnosed opt against treatment altogether. This very much becomes a question of ‘buy now, pay later’ versus ‘pay now, get the benefits later’.

Screening

Following this line of thinking, we have become careful about who should get tested (screened) for prostate cancer. Recommendations vary from ‘no screening at all’ to ‘discuss screening with your physician’ starting at various ages.

The discrepancy is easily explained. Any recommendations depend on studies done of prostate cancer. Now, when trying to study a disease which has a time course over 1.5 decades, the investigation better run at least this long. After all, no serious researcher would make any recommendations on pancreas cancer with data collected over only a two month period! Most of the better designed studies are still running and data are being gathered still. Therefore, the jury is still out on whether screening works, but indications are that the data will show it. Until the final word is in, these guidelines may serve us:

Screen, and talk to your physician about screening:

  • If you think you’ll live for 10 - 15 years
  • If you have a direct family member with the disease or are African American descent
  • If you are older than 55 years of age Don’t Screen (again, discuss with your physician):
  • If you have other medical problems which are chronic and more severe than prostate cancer
  • If you would not treat prostate cancer (if found) anyway. After all, it is much better not to know than trying to ignore an existing diagnosis! Regardless, feel free to discuss any of the above with a physician at the Urology Center of Idaho!

Screening

As mentioned above, prostate cancer is a very slow mover. Initially, there are few symptoms of prostate cancer.

This early phase usually last years, sometimes a decade. No symptoms are noticeable. When it has not spread to other organs, the disease may be treated with local therapies with a chance to cure.

The first symptoms of prostate cancer are caused by the prostate’s enlargement. Since urine has to pass through the glad during voiding, problems with emptying the bladder usually show up. Once prostate cancer moves to other parts of the body, pain these areas may occur, especially bone.

In late stages of prostate cancer it causes problems like any other advanced malignancy including appetite and weight loss, along with loss of energy.

Therapy Options For Prostate Cancer

There are several ways to deal with prostate cancer. This, again, is because it is such a slowly progressing disease gives several options. Just consider what would happen to a patient just diagnosed with a more aggressive type of disease, pancreas cancer for example. There would not be a lengthy discussion about options; the patient would be scheduled for the operating room first chance. Not so with prostate cancer here the accepted treatment options span everything from surgery to ‘simply watch it’.

In the following, a list of options is presented. These are accepted, not experimental and FDA approved ways to address prostate cancer. It does not replace any direct doctor-patient discussion. For every treatment option, risks and benefits are listed. You will find that any option aimed at curing prostate cancer will have as risks erectile dysfunction and urinary incontinence. Any other option will have as a drawback of not curing prostate cancer.

Prostate Surgery

A prostatectomy, as removal of the prostate is called, will remove the cancer from the body, if it truly confined to the gland. It may be done in several ways: Removal through laparoscopic surgery, or with open surgery. These approaches are equivalent in effectiveness, but the former has the advantage of causing less blood loss or pain.

Risks

  1. Erectile dysfunction: The nerves triggering an erection run right alongside the prostate. These nerves follow blood vessels at the bottom of the prostate. If the cancer is small and likely organ confined, surgery aims to preserve these vessels and the nerves. In other cases like when there is high grade or high volume cancer, this is not indicated. Even when preservation of the neurovascular bundle is tried, this frequently does not succeed, and the nerves are compromised. This means that sexual function is often less than it was before.
  2. Urinary incontinence: As with any prostate cancer treatment, there is a risk of urinary incontinence. Immediately after prostatectomy, most everyone will experience this, but in the months after the procedure full urinary control is regained by 95% of patients. Only 5% of patients will have lasting problems. However, these patients may be helped with further procedures in order to regain continence.  

Radiation

Ionizing radiation can be used to control prostate cancer. With this treatment option, the prostate is left in place, and radiation is applied in order to kill the cancer cells. There are 2 ways to achieve this:

  1. External beam: The prostate is imaged using computer tomography. A treatment plan is then generated, shaping the radiation beam from a linear accelerator. This is non-invasive, but requires about 40 trips to the radiation center. For this reason, most out-of-town patients opt to stay at hotel close the center for the duration of treatment.
  2. Insertion of radioactive “seeds”. This is formally known as transperineal interstitial brachytherapy, and requires an operative procedure at a hospital to provide radiation safety and general anesthesia. During the about 1 hour procedure between 70 and 100 radioactive pellets are placed into the prostate. After this is done, the pellets are doing their work to kill prostate cancer cells in the prostate.  

Risks

  1. Erectile dysfunction: It is difficult to deliver an adequate radiation dose to the prostate and at the same time to avoid the nerves triggering an erection. This is why many patients will have problems achieving and maintaining an erection following radiation therapy.
  2. Irritative voiding problems and urinary incontinence: The bladder neck is the location of the urinary bladder where the sensation of bladder fullness is generated. During radiation, this area is often irritated and may subsequently ‘falsely’ trigger this sensation, even trigger voiding. This frequently resolves over the course of several months after radiation.
  3. Bowel problems: A rare problem is a consequence of the radiation effect on the rectum. Symptoms of diarrhea (in some cases bloody diarrhea) may occur in about 5% of patients.  

Cryotherapy of the Prostate

As with radiation therapy this method leaves the prostate in place. Under general anesthesia, 4 to 6 needles are placed into the gland, which are then used to cool it to -40 degrees. This technique is minimally invasive, and is generally very well tolerated.  

Risks

  1. Erectile dysfunction: Although in some patient there is some recovery, erectile ability is generally lost after this procedure.
  2. Urinary problems: Since the prostate gland swells after the freeze, some patients experience urinary retention. This is usually only a short term problem and resolves in the weeks after the procedure.  

Hormone Therapy

The prostate gland is a male organ, and therefore dependent on the hormone testosterone. In fact, if testosterone is removed from the bloodstream, the gland shrinks. This sensitivity to the presence of the hormone is preserved in prostate cancer which means that it also will shrink. What is more, even if the disease has already spread to other organs do these metastases respond to the absence of testosterone. However, this effect does not last. Cancer is bodily tissue which has lost the ability to repair its own DNA. With its blueprints more and more compromised, basic control mechanisms stop working. This means that eventually the cancer will start growing again, even in the absence of testosterone. However, this may take years which makes hormone manipulation a therapy which gives a patient meaningful lifetime gain.

There are two ways to effect hormone therapy. It may be done with a shot or a small implant which suppresses the testosterone production in the gonads. While effective, this has to be repeated on a regular basis in order to prolong suppression. Another way is the removal of the testes. Most men have a problem with the idea of having the gonads removed. However, this method is very effective and obviously needs to be done once.

Risks/Side Effects: 

Men have testosterone for a reason. Removal of the hormone will cause a slew of side effects: 

  1. Just like a woman going through the change of life, a man on hormone therapy may develop hot flashes. They may be very annoying, and may be treated with medication.
  2. Without testosterone, bone and muscle mass will be reduced. Men may experience a loss of strength and endurance, and after years of therapy a loss of bone density men are at higher risk of fractures.
  3. Loss of libido, or sex drive, is a typical effect of hormone deprivation. This effect usually occurs before erectile dysfunction, which is another side effect of therapy.

Watchful Waiting

This way of managing prostate cancer can be explained with ‘we will only treat symptoms’. If there are painful growths in a bone, this is treated with radiation. Any problems with urination may be addressed with a limited resection of the obstructing tissue. The aim is not to cure or eradicate the disease, but to let it run its course.

The obvious advantage that the patient may spend years without symptoms or treatment side – effects. In a disease which only kills 15 % of the diagnosed, we know we are over – treating many patients. In turn, this means we are under – using watchful waiting as a treatment option.

Expectant Management 

Initially very similar to the above watchful waiting method, this does not forgo the idea of cure, but simply aims at waiting until there are any signs the prostate cancer starts to become more aggressive. It may be viewed as ‘setting a trigger’ for treatment. For example, if the PSA was 6ng/ml at diagnosis, the trigger for treatment may be set at 10ng/ml. Or, as another example, if a second biopsy is done and the cancer has become larger or more aggressive as seen under the microscope, treatment is pursued.

Again, as in watchful waiting the idea is to benefit the time of life without symptoms or treatment side – effects as long as possible. And, as we know, for many prostate cancers the time to treat it may never come at all.

I hope I have been able to give a brief but informative overview of prostate cancer treatment and management options. It should be viewed as a rough guide and help to form any questions. If you were diagnosed with prostate cancer at the Urology Center of Idaho, these will be discussed between you and your physician individually. Generally, it is very helpful to bring your spouse or a friend to the visit: The more eyes and ears, the better!  

 

 
 

Urology Center of Idaho
500 S 11th Ave # 301
Pocatello, ID 83201
208.233.3355

 
 
         

Urology Center of Idaho
500 S 11th Ave Ste. 301,
Pocatello, ID 83201
208.233.3355

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98 Poplar St.
Blackfoot, ID 838221
208.785-3800

 

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