What Is Carcinoid Cancer?
Warning Signs Of Prostate Cancer
Early detection saves lives, but these subtle symptoms frequently go unrecognized
Prostate cancer affects one in eight men during their lifetime, making it the second most common cancer among American males. Despite its prevalence, this disease often develops without obvious symptoms until it reaches advanced stages.
The walnut-sized prostate gland sits below the bladder, surrounding part of the urethra, which explains why urinary changes often become the first noticeable signs. However, many men dismiss these early warning signs as normal aging or minor health issues, potentially delaying life-saving early detection.
Understanding the subtle ways prostate cancer announces its presence could mean the difference between straightforward treatment and more complicated interventions. While some symptoms mirror those of benign conditions, recognizing the warning signs prompts timely medical evaluation.
Changes in bathroom habitsFrequent urination, especially overnight, often emerges as the first noticeable symptom. When prostate cancer develops, the growing tumor may press against the urethra, creating an urgent sensation of needing to urinate despite having recently emptied the bladder.
Difficulty starting urination can frustrate men who suddenly find themselves standing at the toilet waiting for flow to begin. This hesitancy stems from the narrowed urethra as cancer enlarges the prostate gland, requiring more bladder pressure to initiate urine flow.
Interrupted streams present another subtle warning sign, as men notice their urination starts and stops unpredictably. This intermittent flow pattern occurs when the enlarged prostate partially blocks the urethra, causing bladder muscles to work harder against the obstruction.
Sensation of incomplete emptying leaves many men feeling like they need to return to the bathroom shortly after urinating. This persistent fullness happens when prostate enlargement prevents the bladder from completely emptying, leaving residual urine behind.
Dribbling after finishing urination becomes increasingly common as the disease progresses. The compromised sphincter control resulting from prostate changes makes it difficult to stop urination completely, leading to embarrassing leakage after leaving the bathroom.
Unexplained pain patternsDeep pelvic discomfort that comes and goes without obvious cause may signal prostate changes. This pain typically feels like a dull ache deep within the pelvis that persists for days before temporarily subsiding, creating a cyclical pattern that differs from typical muscle strains.
Lower back pain concentrated just above the buttocks occasionally indicates prostate cancer that has spread to nearby tissues or bones. Unlike mechanical back pain that improves with rest or position changes, this discomfort tends to persist regardless of activity level or rest.
Hip or upper thigh discomfort, particularly on one side, sometimes indicates bone metastasis from advancing prostate cancer. This pain typically feels deep within the bone rather than in surrounding muscles and may worsen at night when lying down.
Rectal pressure or discomfort affects some men as their prostate enlarges posteriorly toward the rectum. This sensation creates a feeling of fullness or pressure that remains constant regardless of bowel movements, differentiating it from common hemorrhoids or constipation.
Unexplained testicular pain occasionally develops despite no injury or infection. While less common than other symptoms, this referred pain sometimes occurs when prostate cancer irritates nerves shared between these anatomically connected areas.
Sexual function changesErectile dysfunction sometimes serves as an early warning sign when prostate cancer affects nerves controlling blood flow to the penis. While occasional difficulties affect most men, sudden onset or rapidly worsening erectile function warrants medical evaluation, especially when accompanied by other prostate symptoms.
Painful ejaculation represents another potential indicator that something may be wrong. When cancer inflames the prostate or nearby tissues, the forceful contractions during ejaculation can cause discomfort ranging from mild to significant pain.
Reduced ejaculate volume sometimes occurs as prostate cancer advances, since this gland produces approximately 30% of semen fluid. Men might notice dramatically decreased ejaculate without other obvious causes such as recent medications or surgical procedures.
Blood in semen, while alarming, often goes unreported due to embarrassment. This symptom, called hematospermia, happens when tumors disrupt small blood vessels within the prostate gland. Even one occurrence justifies prompt medical evaluation.
Decreased libido beyond normal aging patterns sometimes indicates hormonal changes associated with advancing prostate cancer. While interest naturally fluctuates throughout life, a dramatic and persistent drop in sexual desire can sometimes reflect the body's response to an underlying condition.
Unusual physical changesUnexplained weight loss without dietary changes or increased exercise sometimes signals how cancer increases metabolic demands. Losing more than 5% of body weight within six months without trying warrants medical investigation, particularly for men at prostate cancer risk due to age or family history.
Swelling in the legs or pelvic area occasionally develops when enlarged lymph nodes block proper fluid drainage. This swelling typically affects both legs symmetrically and worsens throughout the day, improving somewhat after elevating the legs overnight.
Unusual fatigue that persists despite adequate rest can indicate advanced prostate cancer's systemic effects. This exhaustion typically feels different from normal tiredness—it doesn't improve with sleep and often prevents engaging in previously enjoyable activities.
Anemia sometimes develops with advanced disease, causing pallor, shortness of breath, and weakness. This condition occurs when cancer affects bone marrow function or causes small amounts of ongoing bleeding that gradually depletes iron stores.
Unexplained bone fractures from minimal trauma occasionally indicate metastatic disease that has weakened the skeletal structure. These fractures typically occur in the spine, hips, or ribs—areas where prostate cancer commonly spreads when it moves beyond the pelvis.
Changes in urinary appearanceBlood in urine, even just once, requires immediate medical attention. This symptom, called hematuria, ranges from visibly red urine to microscopic amounts detectable only through testing. When prostate cancer erodes into urinary tract tissues, bleeding can result.
Darker urine color that persists despite adequate hydration sometimes reflects microscopic blood or other substances released when prostate cells break down. This change typically appears consistent rather than varying throughout the day.
Cloudy or foul-smelling urine occasionally develops when partially obstructed urine flow allows bacteria to multiply. While most often indicating infection, persistent cloudiness despite antibiotics might suggest an underlying obstruction caused by prostate enlargement.
Foamy urine that continues for several days might indicate protein leakage associated with kidney changes. In rare cases, advanced prostate cancer affecting nearby structures can impact kidney function, resulting in protein appearing in urine.
Unusual particles in urine sometimes become visible when prostate inflammation causes shedding of cellular material. These particles typically appear as tiny threads or specks that persist across multiple urinations.
When to seek medical attentionUnderstanding these warning signs empowers men to take charge of their health, but knowing when to consult a doctor remains equally important. Any persistent changes in urinary patterns lasting more than two weeks warrant medical evaluation.
Men experiencing pain during urination or ejaculation should schedule appointments with healthcare providers rather than assuming symptoms will resolve independently. These sensations often indicate inflammation requiring treatment, whether cancerous or not.
Blood in urine or semen, even just once, justifies immediate medical consultation. While most cases stem from non-cancerous causes, this symptom always requires proper evaluation to determine its source.
Family history significantly impacts prostate cancer risk. Men with fathers, brothers, or sons diagnosed with prostate cancer should begin discussions about screening approximately five years before the age their relative was diagnosed.
Age-appropriate screening recommendations vary based on risk factors. Men should discuss prostate-specific antigen (PSA) testing with their doctors around age 45, or earlier with family history or African American heritage, which increases risk.
Proactive steps for prostate healthWhile some prostate cancer risk factors like age, race, and family history cannot be changed, certain lifestyle modifications may support prostate health and overall wellbeing.
Mediterranean diet patterns rich in fruits, vegetables, fish, olive oil, and whole grains correlate with lower prostate cancer rates in population studies. This eating approach provides anti-inflammatory compounds that may help protect prostate tissue.
Regular physical activity appears protective against aggressive prostate cancer forms. Aim for at least 150 minutes of moderate exercise weekly, which improves hormone balance and reduces inflammation throughout the body.
Maintaining healthy weight reduces risk, as obesity correlates with more aggressive prostate cancer variants. Fat tissue produces estrogen and inflammatory compounds that potentially influence prostate cell behavior.
Tobacco avoidance benefits overall health while potentially reducing prostate cancer risk. Smokers diagnosed with prostate cancer typically experience more aggressive disease progression than non-smokers.
Stress management techniques including meditation, deep breathing, or counseling help moderate stress hormone levels that might influence cancer development and progression when chronically elevated.
The journey toward prostate health begins with awareness and continues with appropriate medical consultation. By recognizing these warning signs and taking proactive steps, men can ensure early detection when treatment options remain most effective and least invasive.
Remember that many prostate symptoms stem from benign conditions rather than cancer, but professional evaluation remains the only way to determine their true cause. With prostate cancer, knowledge truly becomes power—the power to protect your health through timely intervention and appropriate care.
Reducing Bowel Complications Following Radiation In Prostate Cancer
SpaceOAR Hydrogel reduced the risk of bowel disorders, the need for colonoscopy and rectal resection following radiation therapy in prostate cancer.
SpaceOAR Hydrogel reduces the risk of bowel complications and need for procedures like colonoscopy in prostate cancer patients receiving radiation therapy, study shows.
The utility of SpaceOAR Hydrogel, a polyethylene glycol-based hydrogel spacer placed between the prostate and rectum, led to a reduction in hazard of developing bowel disorders as well as a reduction in requirement of procedures such as colonoscopy in patients undergoing radiation therapy for prostate cancer, according to a study published in JAMA Network Open.
Because of the rectum's close proximity to the prostate, radiation exposure due to prostate cancer treatment can lead to complications such as diarrhea, rectal bleeding and discomfort during bowel movements. In some cases, these side effects can be severe enough to require medical intervention, impacting a patient's quality of life after treatment ends.
In order to address these needs, investigators launched a retrospective cohort study of SpaceOAR to better understand the incidence of radiation-related bowel toxicity, including bowel disorders and related medical procedures, among patients who received radiation therapy for prostate cancer.
Dr. Ron Morton, the chief medical officer and vice president of medical affairs of Urology at Boston Scientific, sat down for an interview with CURE to discuss what these findings mean for patients considering radiation therapy, the broader implications for long-term bowel health and questions patients should ask their oncologists when evaluating their treatment options.
CURE: How does radiation therapy for prostate cancer impact bowel health, and why is minimizing bowel toxicity a critical concern for patients?
Morton: Radiation therapy aims to kill cancer cells while avoiding damage to surrounding healthy tissue. But radiation to treat prostate cancer can cause damage to the rectum due to its proximity to the prostate, which can lead to issues with bowel function, including diarrhea, painful bowel movements and rectal bleeding.
These side effects can negatively impact patients' quality of life. And in rare cases, these complications can be serious and require hospitalization or surgical intervention to manage.
Can you explain how SpaceOAR Hydrogel works and why it is an option for patients undergoing radiation therapy for prostate cancer?
SpaceOAR Hydrogel is an absorbable polyethylene glycol (PEG)-based hydrogel that temporarily creates space between the prostate and rectum. It's designed to reduce the radiation dose delivered to the rectum during radiation therapy to help lessen damage to the rectum and minimize side effects.
The procedure to place SpaceOAR is minimally invasive and typically happens in an outpatient setting – a doctor's office, hospital or clinic. It's composed of biodegradable material and is naturally absorbed by the body after approximately six months. SpaceOAR is an option for patients because it may help maintain a patient's quality of life and reduce the often frustrating and embarrassing side effects of radiation therapy.
The recent study published in JAMA Network Open found that patients receiving SpaceOAR had a 25% lower hazard of developing bowel disorders. What does this mean for patients considering radiation therapy?
In this large retrospective database review of patients with prostate cancer, those who received SpaceOAR as part of their treatment had a significantly lower chance of developing bowel complications due to radiation therapy as compared to patients that did not receive SpaceOAR as part of their treatment.
The findings of this study are consistent with other clinical trial results, further supporting SpaceOAR as a safe and effective treatment option that can potentially protect quality of life for prostate cancer patients. This is good news for patients who are considering radiation therapy for prostate cancer and want to minimize bowel-related side effects.
Many patients worry about long-term side effects of treatment. How does the use of SpaceOAR Hydrogel compare to not using it in terms of bowel-related quality of life years after treatment?
The study findings show that the use of SpaceOAR was associated with a significant reduction in the incidence of bowel disorders and related procedures in the four years after radiation treatment. A cancer diagnosis can be scary and overwhelming, and patients are often faced with having to make challenging decisions about their treatment plans. Knowing that SpaceOAR can help minimize long-term side effects of radiation therapy and maintain quality of life post-treatment can hopefully ease some of the concern's patients may have as they make those important decisions.
This study also found that patients who received SpaceOAR had a 46% lower hazard of requiring procedures such as colonoscopies and rectal resections. How significant is this reduction for a patient's long-term health and overall quality of life?
The significant reduction of bowel-related procedures in the SpaceOAR group compared to the non-SpaceOAR group is indicative of the ability of SpaceOAR to preserve normal bowel function and help protect quality of life for patients undergoing radiation therapy for prostate cancer. Anecdotally, what I've heard from fellow physicians is that because of the higher risk of bowel complications with stereotactic body radiation therapy (SBRT), many of them won't perform SBRT without placing a perirectal spacer.
What should patients ask their oncologists about SpaceOAR to determine whether it is the right option for their specific case?
SpaceOAR Hydrogel is widely available in the United States and covered by many insurance plans. It's also available globally in many countries where contemporary radiation therapy techniques are practiced.
I encourage patients to engage in shared decision-making with their care team about their prostate cancer treatment. Available options, including surgery, radiation therapy and watchful waiting should be considered. Patients who decide to undergo radiation therapy should discuss with their physician the risks and benefits of including a perirectal spacer such as SpaceOAR in their treatment plan.
Reference:
"Bowel Disorder Incidence and Rectal Spacer Use in Patients With Prostate Cancer Undergoing Radiotherapy" by Dr. Michael R. Folkert, et al., JAMA Network Open.
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Rectal Spacer Use During Prostate Cancer Radiation Reduces Bowel Toxicity
Use of a hydrogel rectal spacer reduces the incidence of bowel disorders and related procedures over 4 years in patients with localized prostate cancer undergoing radiation therapy, real-world data show.
The biocompatible polyethylene glycol-based hydrogel spacer acts as a barrier between the prostate and rectum to reduce the radiation dose delivered to the anterior rectum.
Investigators pooled data from 261,906 patients with prostate cancer from 4 datasets from Medicare and 2 commercial insurance databases. Of the cohort, a rectal spacer was placed before radiation therapy in 9.6%.
Over 4 years, patients who received the rectal spacer had a significant 25% lower risk of bowel disorders and a significant 46% lower risk of procedures such as colonoscopy, sigmoidoscopy, and rectal resection, compared with patients who did not receive the spacer in adjusted analyses, Ryoko Sato, PhD, of Boston Scientific in Marlborough, Massachusetts, and colleagues reported in JAMA Network Open. The spacer significantly reduced the risks for hemorrhage, ulcer, and diseases of the anus and rectum, as well as gastrointestinal hemorrhage and fecal incontinence.
At baseline, the rectal spacer group had a lower mean Charlson Comorbidity Index score: 2.48 vs 3.14.
Rates of bowel disorders (12.4% vs 10.3%) and bowel procedures (1.1% vs 0.7%) were comparable between the spacer group and an age-matched general population. The group not receiving the rectal spacer had a significant 1.4- and 1.9-fold higher risk for both bowel disorders (17.1% vs 10.3%) and bowel procedures (2.0% vs 0.7%) compared with the general population.
Rectal spacer use significantly lowered the risk for bowel disorders following all radiation modalities, the investigators pointed out. Spacer use also reduced risks for bowel procedures following intensity-modulated radiation therapy (IMRT), proton beam therapy, brachytherapy, and combination radiation therapy.
Stereotactic radiation therapy was employed more frequently in the group with vs without rectal spacer placement (10.9% vs 3.7%), whereas IMRT was less common (50.7% vs 60.2%).
"These findings corroborate the potential benefits of [polyethylene glycol-based hydrogel spacer] in improving patient outcomes and reducing GI toxic effects seen in prior prospective studies, supporting its value as an effective intervention in the treatment of patients with PCa undergoing RT," Dr Sato's team concluded.
Disclosure: This research was supported by Boston Scientific. Please see the original reference for a full list of disclosures.
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