Life After Prostate Cancer
by Drogo K. Montague, MD
Prostate cancer is the second most common type of cancer found in American men, so it’s no surprise that detection of the disease has become well refined. The advent of PSA screening allows today’s physicians to detect microscopic prostate cancer years earlier than when just a digital rectal exam was performed.
The positive news also extends to the period after diagnosis. There are several treatment options for prostate cancer, including external beam radiation therapy and implantation of radioactive seeds, in addition to radical prostatectomy (removal of the prostate). Moreover, options for the treatment of common post-prostatectomy conditions like erectile dysfunction and urinary incontinence are greater than ever before, and their effectiveness shows real promise in restoring a lifestyle with which men and their partners can be content and comfortable.
In the past, almost all men undergoing a radical prostatectomy experienced subsequent erectile dysfunction, or the inability to get or keep an erection that’s firm enough, or lasts long enough, to have successful sexual intercourse. While ED can be frustrating, embarrassing, and disheartening, the development of nerve-sparing techniques during surgery has lessened the percentage of men who experience permanent post-operative ED. And for those who do experience the condition on a permanent basis, a number of treatment options are available:
◊ Oral medications , such as Viagra®, Levitra®, and Cialis®, are often the first option to try. These drugs are, in general, less effective for men who have undergone a radical prostatectomy than for other men with ED; however, some success is possible, so initial trial is usually preferable.
◊ Vacuum pump therapy is a noninvasive treatment that requires the use of a small pump to enhance blood flow to create and maintain an erection. While no surgery is required for the use of the vacuum pump, it can be somewhat inconvenient to use.
◊ Transurethral suppositories are small pellets of medication that are placed, using an applicator, into the urethra opening at the end of the penis. The medication is absorbed into surrounding erectile tissue, causing blood vessels to relax so the penis fills with blood and becomes erect. This treatment is minimally invasive; however, it can be somewhat uncomfortable.
◊ Injection therapy involves the man or his partner using a very fine needle to inject medication directly into the base of the penis. The relaxation of muscle tissue allows blood to flow into the penis, creating an erection. Again, this is a minimally invasive treatment; however, some men are uncomfortable with it.
◊ A penile implant (also called a penile prosthesis) is a surgical solution that is concealed entirely within the body. The surgery can be done on an outpatient basis. The implant requires some degree of manipulation before and after intercourse to make the penis erect or flaccid. Penile implants are surgical solutions and, therefore, have the usual risks associated with surgery, including anesthesia reactions, infections, pain, and other complications.
Another result of radical prostatectomy can be urinary incontinence, or the inability to control the flow of urine from the body. This occurs when the bladder sphincter is damaged or scarred and cannot squeeze or close off the urethra, meaning urine can leak or flow freely from the bladder. While this is undoubtedly an embarrassing and troubling condition, there are effective solutions:
◊ Absorbency products like pads, diapers, and garments can help individuals deal with bladder control problems; however, they are best used on a shortterm basis.
◊ Biofeedback/electrical stimulation can be used to train a person to gain awareness and control of the urinary tract muscles so that weak muscles can be activated on demand and overly tense muscles can be relaxed.
◊ “Male sling” implantation can be an effective and minimally invasive procedure to correct mild to moderate stress urinary incontinence. The device supports the muscles around the urethra, reducing urine leakage and providing discreet urinary control.
◊ Artificial urinary sphincter implantation is a surgical solution that is effective for moderate to severe urinary stress incontinence. The device, which can be implanted on an outpatient basis, mimics the function of a normal, healthy urinary sphincter.
Hope for a Healthy Lifestyle
Advances in therapies for common side effects of prostate cancer treatment have given men a range of options from which to choose, leading to a happy, healthy lifestyle for them and their partners. The first step is a frank and informative talk with a qualified and trusted physician.
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Dr. Drogo Montague is director of the Center for Genitourinary Reconstruction and professor of Surgery at the Cleveland Clinic in Cleveland, OH.
This article was originally published in Coping® with Cancer magazine, March/April 2010.