By Dr. Ryan P. Dorin
Urologic Oncology
Hartford Healthcare Medical Group
Prostate cancer is the most common non-skin cancer diagnosed in American men today. It is estimated that 1 in 6 men will be diagnosed with prostate cancer in their lifetime.
Fortunately, prostate cancer is also characterized by a long period of survival after treatment, largely related to early detection of the disease while it is still localized and effectively treated with surgery and/or radiation therapy. Many patients are therefore cured of the cancer and live long lives thereafter.
There are still many patients in whom prostate cancer has spread prior to treatment or after treatment. Although the majority of these cases are not curable, hormonal manipulation therapies and new treatments for metastatic prostate cancer developed in the past few years have enabled many of these patients to also live for many years after their diagnosis.
Whether a man has been treated with surgery, radiation, hormone manipulation, immune therapy or chemotherapy for his prostate cancer, long-term side effects from treatment invariably need to be addressed.
Let’s summarize some common quality-of-life issues survivors face after the different prostate cancer treatments and available therapies.
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Prostate Surgery
Patients who have undergone radical prostatectomy usually do not require further treatment for their cancer, but commonly have to live with some degree of loss of urinary continence (control) and loss of sexual function. This is because the prostate is very close to structures that play a large role in achieving erections and maintaining urinary continence.
Most men do achieve urinary continence after robotic prostatectomy and do not require the use of a pad or diaper in the long term, although a small minority may have long-term issues. This may lead men to urinate more frequently to keep the bladder empty or to require the use of a daily sanitary pad. Fear of leakage may result in avoidance of certain social situations as well.
You can improve urinary control after surgery. The simplest way is the regular performance of Kegel exercises to contract the pelvic floor sphincter muscles and strengthen them. These are similar to the exercises women commonly do to improve continence after childbirth.
There are also smartphone apps that can help motivate improved performance of these exercises. For patients requiring more intensive therapy, specialized pelvic-floor physiotherapists available at Hartford Healthcare will perform weekly sessions designed to strengthen the muscles which control continence and improve a man’s ability to activate these muscles.
If urinary incontinence is severe and not responding to physical therapy, men can undergo a short outpatient surgery to improve continence. There are two types of procedures. In one, a small segment of mesh is placed under the man’s urethra. In the other, an artificial silicone sphincter is implanted around the urethra with a pump hidden within the man’s scrotum. Both procedures are very effective in achieving dryness.
When safe from a cancer control standpoint, a nerve sparing technique is utilized during radical prostatectomy to preserve a man’s ability to achieve erections after surgery. However even with nerve sparing, most men will notice a decline in their ability to obtain and maintain a firm erection. For many this may lead to the need for medications such as Sildenafil (Viagra) to engage in satisfactory sex. A subset of men may require other treatments such as penile injection therapy, the use of a vacuum erection device, or in the more severe cases the implantation of a penile prosthetic. After radical prostatectomy, most men still experience orgasm during sex, but there is no significant ejaculation due to the absence of the prostate and seminal vesicles.
Radiation Therapy
Many men are treated for their prostate cancer with radiation, either using external beam therapy (IMRT, Cyberknife, proton beam) or using brachytherapy, which is the implantation of radioactive metal pellets into the prostate under anesthesia. These treatments are usually not associated with development of significant urinary incontinence soon after treatment but men may experience some degree of incontinence later in life.
Long term side effects of radiation treatment can include irritation of the bladder or rectum. This can result in more frequent bathroom visits for urination and bowel movements, diarrhea, difficulty holding the urine, or blood in the urine or stools. In most cases these side effects can be managed by avoiding bladder irritants in the diet, supplementing fiber, and by taking medications that relax the bladder muscle.
After radiation treatment men may also experience loss of sexual function, including decreased erections or loss of libido, especially if they are receiving hormonal manipulation therapy as part of their treatment regimen. Erectile dysfunction therapies are often used in these patients.
Advanced Prostate Cancer
Over the past 10 years, numerous new medications have been approved for treating prostate cancer that has spread outside of the prostate. These have resulted in many more years of life after diagnosis and improved quality of life for patients living with metastatic prostate cancer.
The majority of these treatments can cause health side effects such as increased body fat, increased risk of diabetes, elevated cholesterol and increased risk of heart attacks. Patients may also feel more tired and lose muscle mass and bone mass.
To counter these side effects, it is important to work closely with a medical professional to control blood pressure and normalize cholesterol levels through diet, exercise, stress reduction and sometimes medications and certain vitamins. Maintaining a healthy weight and regular exercise can significantly decrease a man’s risk of complications from treatment.
Prostate cancer remains a common diagnosis for men around the world. Advances in treatments have significantly increased survival and also increased the number of men living with prostate cancer, making survivorship programs increasingly important in the care of prostate cancer patients.
Receiving care from a comprehensive center such as the Hartford Healthcare Cancer Institute and Tallwood Men’s Health, with a specialized team of cancer specialists, urologists, cardiologists, nutritionists, physical therapists, and primary care providers, can ensure the best possible outcomes for patients with prostate cancer.
For more information about prostate cancer treatment at the Hartford HealthCare Cancer Institute, click here.
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