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Diagnosis: Prostate Cancer

Let’s Talk about the Side Effects

by Mark A. Moyad, MD, MPH

Author of Article photo

Dr. Mark Moyad
(Photo by University of Michigan Photo Services)

If you’ve been diagnosed with prostate cancer and have ques­tions about treatment-related side effects, you’ve come to the right place. Here, we’ll review common side effects from some of the conventional prostate cancer treatments, as well as what can be done to alleviate them or reduce their impact.

Depression and Mood Changes
Simply being diagnosed with cancer and going through any treatment can be a challenge, physically and mentally. Therefore, it is important to discuss mental health before, during, and espe­cially after prostate cancer treatment of any kind. Whether you are waiting for your next PSA test result, trying to get into a clinical trial, or experiencing a new side effect, cancer can be stressful.

Prescription medications are avail­able and effective for treating depression. The most common medication classes for depression are known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). More­over, research shows that exer­cise may play a role in preventing depression, and in individuals on antidepressant med- ication, exercise may improve the efficacy of the medication. Talk to your doctor about your options.

Erectile Dysfunction and Loss of Libido
Erectile dysfunction is the inability to achieve or maintain an erection adequate for sexual activity or intercourse, while a loss of libido simply means feeling uninterested in sexual activity. Most prostate cancer treatments have the ability to cause some degree of erectile dysfunction or libido problems. In general, localized prostate cancer treatment (surgery, radiation, cryotherapy) has traditionally been associated with erectile dysfunc­tion, and androgen deprivation therapy (ADT) or hormone manipulation has been associated with a loss of libido.

Simply being diagnosed with cancer and going through any treatment can be a challenge, physically and mentally.

Erectile dysfunction can occur days, weeks, or months after prostate cancer treatment. Some doctors encourage men to use a variety of erectile dysfunction treatments (pills, pumps, etc.) soon after prostate cancer treatment to help reduce the risk of future erectile prob­lems. This is called penile rehabilitation. Making some lifestyle changes can also be beneficial. Exercising, maintaining low blood pressure and cholesterol, and losing weight can all help to improve blood flow to the penis.

This is a partial or complete loss of urinary control, also known as leakage and dribbling. Pros­tate cancer treatments such as surgery, radiation, and cryosurgery are the more common causes of incontinence, but the prevalence of this side effect has decreased dramatically over the years. Today, only a small percentage of men experience incontinence that requires a pad after treatment.

There are many options available for preventing and treating incontinence, including Kegel exercises, which you can do before and after treatment. These exercises involve strengthening the pelvic muscles by tightening the muscles of the pelvis or buttocks as if you were stopping and starting the urine flow. Regular practice of Kegel exer­cises may reduce leakage or correct it permanently, but the results may vary from individual to individual. On aver­age, these exercises should be repeated at least several times a day for several weeks or months.

The opinions of doctors on the importance and frequency of Kegel exercises and on other incontinence treatments after prostate cancer treat­ment can vary significantly. Keep in mind that special undergarments, briefs, pads, pills, inserts (catheters), injections, biofeedback, and even surgery are all viable options for managing and treat­ing mild to severe incontinence.

Penis and Scrotum Shrinkage
If the nerve bundles that run along the prostate and help to control erections become injured or less active, a small change in length or width of the penis can occur. Additionally, male hormone helps main­tain the size of the genital area, so a reduction in testosterone can potentially reduce penis and scrotum size.

Any treatment that may affect male hormone levels or the nerves near the prostate could potentially affect penis size. Therefore, most prostate cancer treatments, from surgery to radiation to ADT, could have this impact.

The “use it or lose it” phenomenon of the human body can help prevent this problem. Talk to your doctor about regularly using erectile dysfunction treatment methods in order to maintain nerve stimulation and penis size. Pills, injections, pumps, and other methods of improving erectile function can also help prevent size reduction of the genital area. Talk to your doctor about your options.

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Dr. Mark Moyad works in the Department of Urology at the University of Michigan Health System in Ann Arbor, MI, and is the Jenkins/Pokempner Director of Preventive & Alternative Medicine. Adapted with permission from Promoting Wellness for Prostate Cancer Patients: A Guide for Men and Their Families, fourth edition, by Mark A. Moyad, MD, MPH, copyright © 2013 by Spry Publishing.

This article was published in Coping® with Cancer magazine, March/April 2014.