Cancer that spreads outside the prostate gland is what makes prostate cancer dangerous. Metastatic prostate cancer cells cause malfunction by impeding normal function. Some organs, like lymph nodes for example, continue to function quite nicely, even if the degree of cancer spread is extensive. Lymph node spread, therefore, is the least dangerous form of prostate cancer metastases. At the other end of the spectrum is the liver, which is far less tolerant. The seriousness of bone metastases, the most common site of prostate cancer spread, lies about half way between that of node metastases and liver metastases.
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Although I don’t subscribe to the idea that we men are exclusively the products of our hormones, our sex life—or lack of it—following cancer treatment is a matter of serious concern to almost all of us.
The term "adjuvant" means treatment “added to” the primary or initial treatment. When the primary treatment is surgery, even when all detectable disease is removed, there remains a statistical risk that the cancer will return due to microscopic cancer cells left behind. Men with high-risk features such as extra-prostatic extension or high Gleason score face a higher risk of recurrence.
In May 2011, the New England Journal of Medicine reported on 695 men from Sweden, Finland, and Iceland, average age 65, who were randomly allocated to either immediate surgery or delayed hormone therapy (DHT) between 1989 and 1999. The median PSA for the 695 men was 13. Eighty percent of the men had palpable disease found during their digital rectal exam. In the men treated with DHT, hormone therapy was initiated if and when bone metastasis occurred. Bone scans were performed every other year.
Beware of indulging your initial gut reaction to “just cut it out.” Instead of saving your life from cancer, all you may be accomplishing is the eradication of your sex life.