ࡱ>   ,(im `/ 0DArialngsؖ0pp, 0DWingdingsؖ0pp, 0@ .  @n?" dd@  @@`` xpb.  !#" 0123456789:;<=>?@ABCDE  HG 0AA@8  w+iV ʚ;w8ʚ;g4KdKd_ 0ppp@ <4dddd<&) 0p,<4!d!d<&) 0p, 80___PPT10 pp?  %$+BSide effects following radical treatments for prostate cancer A Mary Symons Helen Worth Worcestershire Acute Hospitals NHS Trust2BP(,Radical Prostatectomy \The most common side effects are:- Impotence Urinary incontinence Urinary tract infections $9]-Radical Prostatectomy (OLong term side effects are most likely to be:-- Impotence Urinary Incontinence. &Radical prostatectomy Urinary problems''(Urinary incontinence could be just the occasional leakage or severe leakage There is a definite reduction if the patient is taught pelvic floor exercises to do before surgery as well as post-operatively Not advised to do while the catheter is in situ/!&Radical prostatectomy Urinary problems''(Advise reduction in alcohol and caffeine and encourage extra fluids in the form of water, squash or milk Medication may be required Less than 5% may have long term urinary problems which may require further surgery0"#Radiotherapy Long term side effects$$(CBowel problems Bladder problems Erectile dysfunction Infertility1#% Radiotherapy Long term side effects &&(Bowel problems:- Rectal bleeding my occur and require referral to a colo-rectal surgeon Bowel motions may be more frequent and the stools may be loose2$#Radiotherapy Long term side effects$$(Bladder problems Radiation cystitis, same advice on fluids Haematuria (blood in urine) will require further investigation Frequency & urgency  medication 1% may have urinary leakage  greater risk if patient has had previous turp3%Hormones Side effects(Hormones are given for a short term with radiotherapy and most side effects abate over time Erectile Dysfunction Hot flushes Gynaecomastia (breast swelling) Tiredness4&Hormones Side effects(.Hot flushes affect 50-80% of men Stop smoking Advice on fluids Reduce spicy food Keep room cool  use a fan Light cotton bedding Wear cotton clothing Z5' Hormones Side effects (Hot flushes:- Drug treatments progestogens e.g. megestrol acetate Anti androgen e.g. cyproterone Alternative therapies Eat soy Sage Tea Evening primrose oilZV =6(Hormones Side effects(Gynaecomastia, this is very rare for short term users Tamoxifen  cannot be used with oestrogens One treatment of radiotherapy Surgery 7)$Brachytherapy Long term side effects%%((Erectile dysfunction Uretheral narrowing  patient may need a catheter for a while or to do self catheterisation Less than 1% suffer urinary leakage8*9+:,;-<.=/>0?1  Leaflets and booklets expanding on this information are available Any questions? 27th April 2010 Worcester Sixways Rugby club&ZV) Radical Prostatectomy \The most common side effects are:- Impotence Urinary incontinence Urinary tract infections $9] Radical Prostatectomy (OLong term side effects are most likely to be:-- Impotence Urinary Incontinence &Radical prostatectomy Urinary problems''(Urinary incontinence could be just the occasional leakage or severe leakage There is a definite reduction if the patient is taught pelvic floor exercises to do before surgery as well as post-operatively Not advised to do while the catheter is in situ &Radical prostatectomy Urinary problems''(Advise reduction in alcohol and caffeine and encourage extra fluids in the form of water, squash or milk Medication may be required Less than 5% may have long term urinary problems which may require further surgery #Radiotherapy Long term side effects$$(CBowel problems Bladder problems Erectile dysfunction Infertility% Radiotherapy Long term side effects &&(Bowel problems:- Rectal bleeding my occur and require referral to a colo-rectal surgeon Bowel motions may be more frequent and the stools may be loose#Radiotherapy Long term side effects$$(Bladder problems Radiation cystitis, same advice on fluids Haematuria (blood in urine) will require further investigation Frequency & urgency  medication 1% may have urinary leakage  greater risk if patient has had previous turpHormones Side effects(Hormones are given for a short term with radiotherapy and most side effects abate over time Erectile Dysfunction Hot flushes Gynaecomastia (breast swelling) TirednessHormones Side effects(.Hot flushes affect 50-80% of men Stop smoking Advice on fluids Reduce spicy food Keep room cool  use a fan Light cotton bedding Wear cotton clothing Z Hormones Side effects (Hot flushes:- Drug treatments progestogens e.g. megestrol acetate Anti androgen e.g. cyproterone Alternative therapies Eat soy Sage Tea Evening primrose oilZV =Hormones Side effects(Gynaecomastia, this is very rare for short term users Tamoxifen  cannot be used with oestrogens One treatment of radiotherapy Surgery $Brachytherapy Long term side effects%%((Erectile dysfunction Uretheral narrowing  patient may need a catheter for a while or to do self catheterisation Less than 1% suffer urinary leakage   Leaflets and booklets expanding on this information are available Any questions? 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Prostatectomy Following Radical Radiotherapy and hormone therapyV  0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +  0N0 / '  (      ^4 x?Title 1"3-PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``    (Erectile Dysfunctionh     x?,Content Placeholder 2 `   <TREATMENT OPTIONS PDE5 inhibitors Viagra Cialis Levetra ==,-V  0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +;  0N0 J B  (      ^P x?Title 1"3-PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``    (Erectile Dysfunction   d x?,Content Placeholder 2 `   WTREATMENT OPTIONS Vacuum pump devices Intracavernosal Injections Urethral Pelletts 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9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``    (Erectile Dysfunction6     x?,Content Placeholder 2 `   n0 Is there a place for testosterone replacement?"/1V  0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +  0 &P(  ~  s *,3 x,'g<  3  H  0޽h ? 3F433___PPT10i.-+D=' 4 = @B +  0 D<(  D~ D s *( 3 x ``  3  ~ D s *3 x ` 3  H D 0޽h ? 3F433___PPT10i.^c̆+D=' 4 = @B +  0  H<(  H~ H s *3 x ``  3  ~ H s *3 x ` 3  H H 0޽h ? 3F433___PPT10i.b+D=' 4 = @B +  0 0L<(  L~ L s * 3 x ``  3  ~ L s *!3 x ` 3  H L 0޽h ? 3F433___PPT10i.+D=' 4 = @B +  0 @P<(  P~ P s **3 x ``  3  ~ P s *+3 x ` 3  H P 0޽h ? 3F433___PPT10i. v+D=' 4 = @B +  0 PT<(  T~ T s *73 x ``  3  ~ T s *83 x ` 3  H T 0޽h ? 3F433___PPT10i.<+D=' 4 = @B +  0 `X<(  X~ X s *@3 x ``  3  ~ X s *PC3 x ` 3  H X 0޽h ? 3F433___PPT10i.v+D=' 4 = @B +  0 p\<(  \~ \ s *K3 x ``  3  ~ \ s *N3 x ` 3  H \ 0޽h ? 3F433___PPT10i.0_+D=' 4 = @B +  0 `<(  `~ ` s *,V3 x ``  3  ~ ` s *W3 x ` 3  H ` 0޽h ? 3F433___PPT10i.p+D=' 4 = @B +  0 d<(  d~ d s *0a3 x ``  3  ~ d s *b3 x ` 3  H d 0޽h ? 3F433___PPT10i.b+D=' 4 = @B +  0 h<(  h~ h s *Xt3 x ``  3  ~ h s *0u3 x ` 3  H h 0޽h ? 3F433___PPT10i.1x+D=' 4 = @B +  0 l<(  l~ l s *3 x ``  3  ~ l s *3 x ` 3  H l 0޽h ? 3F433___PPT10i.` ?+D=' 4 = @B +  0 p<(  p~ p s *(3 x ``  3  ~ p s *3 x ` 3  H p 0޽h ? 3F433___PPT10i.pÒ+D=' 4 = @B +v 0N0 }@(     vܛ3 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&2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``  3  (Erectile Dysfunctionh   3 x?,Content Placeholder 2 ` 3  <TREATMENT OPTIONS PDE5 inhibitors Viagra Cialis Levetra ==,-V  0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +;  0N0 J B p (      ^3 x?Title 1"3-PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``  3  (Erectile Dysfunction   3 x?,Content Placeholder 2 ` 3  WTREATMENT OPTIONS Vacuum pump devices Intracavernosal Injections Urethral Pelletts XX,(V  0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +  0    e (       ^<3 x?Title 1"3-PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ 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_rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``  3  (Erectile Dysfunction  $  3 x?,Content Placeholder 2 ` 3  X(TREATMENT OPTIONS Penile Rehabilitation))V $ 0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +  0N0   ( (  (  (  ^ 3 x?Title 1"3-PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!űKdrs/shapexml.xmlT=o0 ?\ Wᦵ9$ݹ8S"rm>RRf*ҥzWJ4:㣏CΤ&/6׷/9O:'eI:~5{N]]Zg|}&;Yhj+hImړGJ%"|P6H3>LS+F<)!ˆ@П-DegY$AFKHZ?ՀxnjOx) ck>CU?M~]R̽4ZQgH @.)(}@ ʟ@_F\J޿DTdAx:-u"-SqbM9d2}#+х@g S;5\ve"kJj0Z,gB0<\m{3?k y|ai7͍cuӬO-x:c…R 6‡q(ż^MUVl)Ezp7:=P"6-d\#Ev[1ڬ^p7`e9U k8¢EWY~6*uuKkL弴%W% q6R )3x׋[-87e: 1{J'Y&86q (C8P>^)$ ^)] ~~CŘ,x#CEm=#ƻNKgPK!todrs/downrev.xmlDj1CBw5@EFQvVp;S'7!I ]9|oM/CgYl Qy~{^Yco(zBہt=F$1BPd0L#N]mo8$eesiТ]Kc|{֋A.qdܼ4_*D~>b$d,APK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!űK*drs/shapexml.xmlPK-!to!drs/downrev.xmlPK" ``  3  (Erectile Dysfunction6 (  3 x?,Content Placeholder 2 ` 3  n0 Is there a place for testosterone replacement?"/1V ( 0޽h ?"` N[o;z_wy___PPT10Y+D=' 4 = @B +  0 &(  ~  s *3 x,'g<  3  H  0޽h ? 3F433___PPT10i.-+D=' 4 = @B +L 0 \(  d  c $<P   4   s *$4 <   4  FMARY SYMONS MARY SYMONS  H  0e ? 3380___PPT10.@~m*rpZJ r"y-Y8 0sj ,OMW.h? upOC+Ptw7z|qHYtdϻsiCfE GY1Oh+'0| hp   Slide 1gilesm dave.test8Microsoft Office 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