Life after Prostate Cancer Treatment
by Steven Lamm, MD, Herbert Lepor, MD, and Dan Sperling, MD
The transition from prostate cancer patient to prostate cancer survivor can be difficult for some men. Even if all detected cancer was removed or eradicated through treatment, there is always the fear that it may return or spread. It’s natural to experience some level of anxiety around this, and it’s not unfounded. Statistically, biochemical recurrence, a rise in PSA levels that may indicate the presence of active prostate cancer, is not uncommon. This is why regular follow-up with your doctor after treatment is complete is so important.
Your doctor should review your follow-up plan with you at your first post-treatment appointment. For most men with non-metastatic cancer who have had their cancer removed or destroyed through surgical, radiation, or ablative treatment, follow-up will be every six months for at least five years. You will have regular PSA tests to catch any recurrence early. Your doctor may also recommend periodic imaging tests such as MRI following focal ablation.
If you have metastatic prostate cancer, your treatment will be ongoing and focused on containing further spread of the cancer and managing any unpleasant symptoms you are experiencing. You should remain an active participant in your treatment plan. When your doctor recommends changes, ask why, and make sure you are fully informed on what side effects you may experience. Keep a written record of symptom changes that you can share with your doctor at each visit. Stay involved and encourage your significant other to do so as well.
For many men, going through cancer treatment offers a good opportunity to reassess life priorities.
If you haven’t already, now is a good time to get all of your medical records in order. If at any point in the future you need to see a new doctor, having a full set of records of your
cancer-related treatment history is
important. These should include:
♦ Pathology Reports Request a copy of all biopsy and surgical pathology reports.
♦ Imaging Reports Request a digital copy of all scans from the imaging facility or radiologist’s office.
♦ Operative Reports If you have had a radical prostatectomy, request a copy of the surgical report from your surgeon or hospital.
♦ Radiation Reports If you have had radiation therapy, request a treatment summary from your radiation oncologist.
♦ Hormone or Other Drug Treatment Keep a list of all cancer-related medications you have taken and are currently taking, including dosage and special instructions. Note the dates you started and discontinued a medication.
♦ Hospital Discharge Summary If you had inpatient prostate cancer treatment, keep a copy of the summary you received at discharge.
If you do need to pass these records along to a new physician at any point, make sure you keep a copy for your own files.
Dr. Herbert Lepor
Cancer is a life-threatening and, subsequently, a life-changing condition. For many men, going through cancer treatment offers a good opportunity to reassess life priorities, a time to reflect on where they’ve been and rethink where they are headed. If we must find a silver lining in cancer, it is this unique opportunity to really look at your value system and see what really matters to you – family, career, lifestyle, etc. You may find that things that used to aggravate or upset you really don’t bother you much anymore with your new post-cancer perspective on life.
Urinary, sexual, and bowel-related side effects of treatment are troublesome to many men; however, these will often improve with time, patience, and, in some cases, additional treatment. Being well informed about what is normal following treatment, and being prepared to cope with it, is the best way to get through this sometimes-difficult post-treatment period. You may need to make temporary changes in your schedule and activities to deal with some issues. For example, if your work or recreational activities involve a lot of travel or outdoor time, you may need to change your routine to have closer access to bathroom facilities.
Being well informed about what is normal following treatment, and being prepared to cope with it, is the best way to get through this sometimes-difficult post-treatment period .
Remember, prostate cancer treatment and recovery affect other people in your life too. Make sure your significant other is also aware of the side effects you are dealing with. Having their emotional support can be extremely helpful during your recovery.
Dr. Dan Sperling
Most men experience some level of anxiety at prostate cancer diagnosis and throughout treatment. There is fear of the unknown and a constant parade of doctor’s appointments, laboratory tests, and hospital visits that can disrupt life for weeks or even months. Once you’ve passed the milestone of your last treatment session, it can be tough to return to your regular pre-cancer life of work, home, and family and let go of all of the worry and fear. You may also be anxious about the cancer coming back or spreading and your vulnerability to other health problems.
In some cases, this persistent anxiety is linked to depression and poor sexual performance. Anxiety may be inhibiting the return of sexual function, or erectile problems may be feeding your anxiety. Either way, support groups, therapy, or both may be helpful if you find that anxiety and depression are getting in the way of your daily functioning and enjoyment of life. If depression is ongoing and persistent, there are medications that may help.
Intimacy and Sex
It’s important to have realistic expectations about sex following prostate cancer treatment. The goal should be to try to return erectile function to the level it was before treatment. Depending on your age and health, this may have been limited to begin with, and you should not expect your erections to be better than they were before diagnosis. All men should have a healthy dose of patience. It is not uncommon for men to continue to recover erectile function up to several years following treatment. Give yourself time.
One issue men may experience that often doesn’t come up in discussion with their doctor before treatment is incontinence during sex. Men may leak urine during foreplay or sexual activity. While this can be awkward for you and your partner, just knowing it is a possibility ahead of time can alleviate any anxiety. This problem may be easily remedied by urinating before any sexual contact.
After radiation, radical prostatectomy, or whole gland ablation of the prostate, the discharge of semen is eliminated. In some men, a small discharge of sticky fluid will appear just prior to orgasm. This fluid is from the urethral glands and contains no sperm.
Even if you aren’t able to maintain an erection hard enough for penetration and intercourse, there are still plenty of other ways to achieve intimacy and pleasure with your partner. Erection is not necessary for orgasm, and with a loving partner whom you trust, you may find that your sex life is more adventuresome than ever.
Maintaining a healthy lifestyle, with plenty of exercise, nutritious food, and other healthy habits, grows in importance as you age. Men with other health conditions, such as high blood pressure, diabetes, or heart disease, should focus on staying on top of their treatments for those conditions. If you smoke, quitting is the single best thing you can do to improve your health, reduce your risk of cancer recurrence, and prevent osteoporosis if you are on androgen deprivation therapy.
If you have brothers or an adult son, make sure they are aware of their increased risk for developing prostate cancer. They should talk to their own doctor or urologist about their specific risk profile and the screening schedule that’s right for them.
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Dr. Steven Lamm is the director of the Men’s Health Center at New York University’s Langone Medical Center in New York, NY, and a practicing internist. Dr. Herbert Lepor is the Martin Spatz Chairman of the department of Urology and the director of the Smilow Comprehensive Prostate Cancer Center at NYU Langone Medical Center. Dr. Dan Sperling is the medical director at the Sperling Prostate Center in New York, NY.
Excerpted with permission from Redefining Prostate Cancer: An Innovative Guide to Diagnosis and Treatment by Steven Lamm, MD, Herbert Lepor, MD, and Dan Sperling, MD, © 2013 by Spry Publishing.
This article was originally published in Coping® with Cancer magazine, November/December 2013.