Senin, 28 Desember 2015


Berikut merupakan kutipan ilmiah kedokteran yang bermanfaat sehingga disusun dan digunakan sebagai referensi pribadi.

When you’re diagnosed with prostate cancer, you might wind up with one looming thought: What do I do now? Here's a roadmap to guide you through the first part of your new journey.
Educate yourself. Prostate cancer is the most common cancer in men, so there's a lot of good information out there. The downside? There's a lot of good information out there. Take a breath. You don't need to read and digest everything right now. Most men with the disease have time to figure things out. Many prostate tumors grow slowly, so you might not need to make decisions right away. Get help from your doctor to figure out what you need to know now and what can wait. You'll feel calmer, and you'll make better choices.
Decide if you want treatment. Yes, "if." Because prostate tumors often grow slowly or not at all, they might not be harmful enough to need treatment. Some men decide -- with their doctors -- that "watchful waiting" or "active surveillance" are better options than surgery, chemo, or radiation. This approach means you’ll keep close track of the cancer with tests, biopsies, and regular doctor's visits to see if it gets worse.  Research has shown that these can be safe options for many men. If the tumor starts to grow or if you're not comfortable with "doing nothing," talk with your doctor about moving forward with treatment.
Start thinking about side effects. As prostate cancer treatments fight your disease, they can also cause other problems, like losing control of your bladder or trouble getting erections. Not all men will have these side effects, but you should talk about them with your doctor before you decide if and how you’ll treat your disease. The risks may steer you toward one treatment over another.
Pick the right doctor. Prostate cancer treatment is complicated. You need to have a health care team you trust and with whom you can build a long relationship. You will need to see a doctor who specializes in cancer or in urology or both. Here are some tips on how to choose the right one:
  • Find a doc who has a lot of experience with prostate cancer. Usually, it will be a urologist.
  • Try to talk with any doctors you are considering, either in person or on the phone. You'll get a better idea if they're the right fit for you.
  • Work with your primary care doctor to find the right prostate cancer doctor.
Talk about it. Whether or not it’s true, men are known to keep their feelings inside. But if you've just learned you have prostate cancer, you may find it helps to talk about it. Some people find it easier to be open with someone they don't know well. If that sounds like you, try volunteer or professional counselors and other cancer survivors. When you feel ready to talk to your partner or family members, either now or later, keep these things in mind:
  • Don't expect things to stay the same. There will probably be changes in your close relationships as you adjust to living with cancer.
  • Make sure you give the other person a chance to express feelings.
  • Be direct about what kind of support you need and ask what they might need. This also might change over time.
  • Talk about things other than your disease. The interests you share and things you both enjoy can give you a break from stress and bring you closer together.

Prostate cancer is the second most common cancer among men in the United States. Men with prostate cancer face challenges that go beyond fighting the disease. They worry about how the disease and its treatments will impact their lifestyle and relationships.
Some potential side effects of prostate cancer and its treatment include:
  • Urinary incontinence (inability to control urination)
  • Erectile dysfunction (impotence)
  • Bowel problems
  • Emotional issues (e.g., anxiety, depression)
  • Loss of libido (sex drive)
  • Fatigue
  • Infertility

What causes UI and ED?

Some men with prostate cancer experience urinary incontinence (UI) and/or erectile dysfunction (ED) during or after treatment. A prostatectomy (removal of the prostate) can damage the valves of the bladder and disrupt the way it holds urine. It can also damage certain nerves and blood vessels that control a man's ability to get or keep an erection, ejaculate or reach orgasm.
Radiation therapy to the pelvis can affect bladder function by changing the nerves and muscles used to control urine flow. It can also damage the arteries that bring blood to the penis and cause problems with getting or keeping an erection. Some hormonal therapies, chemotherapies and medications can also cause UI and/or ED.
Depending on the type of treatment received, extent of the damage, and other individual factors, UI and ED may be temporary or permanent. It often takes a longer period of time to regain erectile function (e.g., 6 -12 months) than it does to overcome incontinence.

Getting back to normal after prostate cancer

Getting back to "normal" after prostate cancer is a real concern for many men. Fear or embarrassment over urine leakage may keep you from participating in activities you enjoy. Anxiety about sexual performance can put a strain on intimate relationships. Other side effects, like fatigue, nausea or constipation, can decrease sexual feelings.
Fortunately, even if urinary incontinence and/or erectile dysfunction do not completely resolve, you can learn how to manage these conditions so you can continue to live an active life after treatment.

Managing UI and ED

Treatment for UI and ED depends on the type, severity and cause of the problem, and may include a combination of approaches. Fortunately, new and innovative techniques in prostate cancer treatment can help lessen damage to the bladder valves and to the nerves and blood vessels that control erections.
Your doctor may recommend nerve-sparing methods during surgery to preserve erectile function. Also, advanced radiation technologies target cancerous cells and protect healthy tissues, helping to minimize sexual and urinary side effects.
If ED occurs, treatment methods may include: medications, injections, vacuum devices, implants, or testosterone replacement. Your doctor may also recommend counseling, as sexual dysfunction can cause emotional distress.
Treatment for UI may include surgical interventions and/or certain medications that help to reduce bladder muscle contractions and block the nerve signals that cause urine urgency and frequency. Your doctor may also recommend biofeedback methods to help you learn how to control the muscles you use to urinate. Additionally, products like absorbent pads can help hide urine leakage.

10 tips for managing prostate cancer side effects

  • Understand your options. Advanced technologies for treating prostate cancer can help to minimize side effects like UI and ED. Learn about all the options available to you before, during and after treatment. Understanding your options can help you make the right treatment choices for you.
  • Communicate with your care team. Ask your doctors what side effects you can anticipate from prostate cancer treatment, and how your care team will help you manage these side effects. Be open about any sexual dysfunction, incontinence, or other symptoms you may experience during treatment.
  • Give yourself time. It takes time to adjust to the physical and emotional changes prostate cancer brings to your life. Try to be patient if certain side effects, such as depression, pain or fatigue, lower your desire for sexual activity. Also, remember that it may take time to resolve symptoms of incontinence.
  • Plan ahead. It's important to plan ahead if you're dealing with UI or ED. Empty your bladder (even if you don't think you need to) before leaving the house and going to bed. Since levels of sexual desire vary during prostate cancer treatment, try to plan sexual activity for when you have the most energy.
  • Try other forms of intimacy. Even if you can't have sexual intercourse, you can still maintain intimacy through loving affection and touch. Start out slowly by cuddling, kissing and touching. Give your partner a massage. Even going for a walk or watching a movie together can create intimacy.
  • Try bladder retraining techniques. Bladder retraining can help increase your bladder capacity so it can hold more urine for longer periods of time. Set routine times to urinate. Instead of urinating whenever you feel the urge, try to wait a few minutes and gradually lengthen the time between bathroom trips.
  • Enhance your self-image. Prostate cancer can affect your feelings of attractiveness, desirability and masculinity. Simple boosts like a new haircut or clothing may help you feel better about yourself. Your doctor may also recommend medical options (e.g., devices to improve erectile function, etc.).
  • Get healthy in other areas. Maintaining a healthy lifestyle, including regular exercise and good nutrition, can help increase energy and improve mood, which can stimulate sexual desire. Also, avoid foods that can aggravate UI, including dairy products, acidic or spicy foods, vinegars, sugar, alcohol and caffeine.
  • Talk openly with your partner. You may feel embarrassed about urine leakage or anxious about resuming sexual activity after prostate cancer treatment. It's important to share your feelings and concerns with your partner so you understand each other's needs and preferences.
  • Seek emotional support. Prostate cancer side effects can cause emotional distress, including depression and anxiety. It may help to meet with a professional counselor, social worker, or chaplain. Also, support groups allow you to share your concerns and trade advice with others in similar situations.
  • There's no single treatment that’s right for every man with prostate cancer. Some tumors grow very slowly or not at all, so you may never need treatment. But others grow faster and spread to other places in your body. In either case, you and your doctor will work together to decide what's best for you.
    The treatment you need will depend on a few things:
    • Your age, health, and lifestyle
    • How serious your prostate cancer is (how large the tumor is and if it has spread in your body)
    • Your thoughts (and your doctor’s opinion) about if you need to treat the cancer right away
    • Possible side effects
    • The chance that a treatment will help or cure your cancer
    The most common prostate cancer treatments are:
    Watchful waiting. Because some men may never need treatment for slow-growing tumors, you and your doctor may decide to just keep a close eye on your disease. This is sometimes called active surveillance or observation. You may have regular PSA (prostate-specific antigen) blood tests, rectal exams, ultrasounds, and biopsies to see if the cancer is getting worse. If your cancer starts to grow or spread, then you would think about other treatments.
    Surgery. Surgery is an option if you're healthy and your cancer hasn't spread. There are several types. Your doctor may decide to remove just your prostate gland or also the tissue around it. The most common side effects from an operation are problems controlling your urine and trouble getting and keeping an erection. Sometimes these problems go away on their own after surgery, especially issues with bladder control. Talk to your surgeon beforehand to see if he thinks he'll be able toprotect the nerves around your prostate so you won’t have these side effects. 
    Radiation therapy. This treatment uses high-energy beams (similar to X-rays) to kill the cancer.  It's often a choice for older men and for those with other health problems. You also might have it after surgery to get rid of any cancer cells left behind. There are two types of radiation: external and internal (brachytherapy). With external radiation, a machine outside the body directs rays at the cancer. With internal radiation, a doctor does surgery to place small radioactive "seeds" into or near the cancer. Sometimes, a mix of both types is best.
  • Hormone therapy. Prostate cancer cells need male sex hormones, like testosterone, to keep growing. This treatment blocks the cancer cells from getting them. This is called androgen deprivation therapy. Some hormone treatments lower the levels of testosterone and other male hormones. Other types block the way those hormones work.
    Cryotherapy. Sometimes a doctor will kill cancer cells by freezing them. Your doctor will put small needles or probes into the prostate that deliver very cold gasses to destroy the cells. Scientists haven’t done much long-term research that focuses on cryotherapy for prostate cancer, so it’s hard to say for sure how well it works. It's usually not the first treatment option a doctor recommends.
    Chemotherapy. This treatment uses drugs to shrink or kill prostate cancer cells. You can take the drugs by mouth or have them injected into your bloodstream. Most men with early prostate cancer don’t get chemo. It’s usually only for advanced cases or when cancer has spread to other parts of the body.
    Cancer vaccine. Most vaccines work by boosting your body's defenses so it can fight an infection. The prostate cancer vaccine sipuleucel-T (Provenge) gets your immune system to attack cancer cells. The vaccine is best for men who’ve tried hormone therapy that isn't working anymore. The vaccine is custom-made for each man. Scientists don’t know if it stops or slows down the cancer’s growth, but it does seem to make men live longer with prostate cancer.
    Bone-directed treatment. If the cancer reaches your bones, drugs called bisphosphonates can help ease pain and prevent breaks.
    You may start with one treatment and change it or have a mix of different treatments. Work with your doctor to find the best plan for you.
  • What you eat is really important when you have cancer. Your body needs enough calories and nutrients to stay strong. Good nutrition can help treatments work better, too. But the disease can make it hard to get what you need, which can be different before, during, and after treatment. And sometimes, you just won’t feel like eating.
    You don’t need a drastic diet makeover. Just a few simple tricks to make good-for-you foods easy and appetizing.

    Before Treatment

    Start focusing on healthy foods even before you begin your treatment. You don't know how it will affect you or what kind of side effects you might have. That's why it's a good idea to get good nutrition now. It will help your body stay strong and lower your risk of infections.
    It’s also a good time to plan for the days when you won’t feel like making anything to eat. Fill your fridge and pantry with healthy foods, especially those that need very little (or no) cooking. Nuts, applesauce, yogurt, pre-chopped veggies, and microwaveable brown rice or other whole grains are easy options. Make batches of some of your favorite entrees and freeze them, too.
    You may also want to line up some friends and family who can bring you meals for the first days or weeks of your therapy.

    During Treatment

    You may have days when you feel hungry, and others when food is the last thing you want.
    On good days, eat lots of protein and healthy calories. That will keep your body strong and help repair any damage from your treatment.
    High-protein foods include:
    • Lean meat, chicken, and fish
    • Eggs
    • Beans, nuts, and seeds
    • Cheese, milk, and yogurt
    Try to eat at least 2 1/2 cups of fruits and vegetables a day. Include dark green and deep yellow veggies, and citrus fruits like oranges and grapefruits. Colorful foods like these have many healthy nutrients. Just be sure to wash them thoroughly.
    Drink plenty of liquids all day. Water is a great choice. Try fresh-squeezed juice, too. It gives you some extra vitamins along with the liquid your body needs to stay hydrated.
  • It's also key that you don't eat raw or undercooked meat, fish, and poultry. Don't eat foods and beverages that are unpasteurized.
    Eat when you're hungry. If that's in the morning, make breakfast your biggest meal. Drink meal replacements later if your appetite fades as the day goes on. If meals are a struggle, eat five or six small ones instead of two or three big ones during the day.
    Have small, healthy snacks on hand, too. Yogurt, cereal, cheese and crackers, and soup are all good choices. If you’re having chemotherapy, a snack or small meal right before a session might keep nausea away.

    Side Effects and Your Diet

    Many side effects of cancer treatments can make it hard to get enough to eat. Try these ideas to get past some of the most common issues:
    • Nausea/Vomiting: Avoid high-fat, greasy, or spicy foods, or those with strong smells. Eat dry foods like crackers or toast every few hours. Sip clear liquids like broths, sports drinks, and water.
    • Mouth or Throat Problems: For sores, pain, or trouble swallowing, stick with soft foods. Avoid anything rough or scratchy, and spicy or acidic foods. Eat meals lukewarm (not hot or cold). And use a straw for soups or drinks.
    • Diarrhea and Constipation: For diarrhea, it’s really important to stay hydrated. Drink lots of liquids, and cut back on high-fiber foods like whole grains and vegetables. If you’re constipated, slowly add more high-fiber foods to your diet. Plenty of liquids is key for this problem, too.
    • Change in Taste: Treatment can have a funny effect on your taste buds. Things you didn't like before might taste good now. So be open to new foods. See if you like sour or tart flavors like ginger or pomegranates. Spices such as rosemary, mint, and oregano might help you enjoy other foods, too.

    'Cancer Diets'

    Plenty of people tout "special" diets that they say will help treat cancer or keep it from coming back. Maybe you’ve heard that you should go vegan, vegetarian, or start a raw diet. Before you make any major changes, talk to your doctor.
    There’s no diet that can cure cancer. There's also no good research that shows that any eating plan, like a vegetarian diet, for example, can lower the chance of cancer coming back.
    Your best bet is to stick with a balanced diet with lean proteins, fruits, vegetables, whole grains, and low-fat dairy. Limit your sugar, caffeine, salt, and alcohol.

Sumber : MD

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