Men are talking. Whether it be to find out how the kids are doing, recap that game last night, or just make sure they know that the Stones are back on tour. Now more than ever, men across the country are opening lines of communication with each other. Now is the time to talk about prostate cancer. After all, chances are you know someone who has had it; one in every nine men will be diagnosed with prostate cancer in his lifetime.
Prostate Cancer Survivorship is Strong
The American Cancer Society estimates that in 2018 164,690 men will find out that they have prostate cancer and the lives of nearly 30,000 men will be claimed by the disease.
The good news is that an estimated 2.8 million men count themselves prostate cancer survivors.1 With advances in prostate cancer treatment and early detection, more than 90% of men are expected to live 15 years after their diagnosis.2 As you can see, prostate cancer survivorship extends well beyond any treatment of the disease. So, what should someone expect after they are treated for prostate cancer?
Prostate Cancer Treatment Side Effects
As you may appreciate, the prostate rests in close proximity to some valuable real estate, and the urethra (i.e., the tube draining the bladder) runs through the core of the prostate. When the prostate is treated with either surgery or radiation, the mechanics of urination change. In essence, the system must recalibrate – during which time urinary incontinence is common. Thankfully, the majority of men will regain urinary control by 6 to 12 months following treatment.
Both surgery and radiation for prostate cancer also may affect sexual function. Older men and those with previous erectile dysfunction (ED) are particularly susceptible to long-term ED. For all men treated for prostate cancer, 10% to 46% will have some degree of ED following treatment.3
The “Trifecta” of Prostate Cancer Survivorship
In talking about prostate cancer survivorship, imagine three pillars that we like to call the “Trifecta”. The Trifecta of prostate cancer survivorship consists of: #1 Living Cancer-Free, #2 Restoring Urinary Continence, and #3 Resuming Sexual Activity. Let’s look at each of these pillars individually.
#1 Living Cancer-Free
While treatment for prostate cancer is effective, it is important to follow up with your doctor to ensure no signs of it come back. There are many opinions on the best way to watch for any signs of recurrence, but all recommended protocols include close monitoring of a simple blood test called a PSA. You might ask, “Why would I check my PSA if you took my prostate out?” A good question, indeed. In the case of surgery to remove the prostate, the PSA is expected to become zero (<0.05 on most lab testing). However, if radiation was used to treat the disease, the PSA will decrease but may not reach zero. The most important aspect of monitoring your PSA after treatment is to ensure that the value is not increasing, which may suggest that the disease has returned.
One of the commonly utilized guidelines for prostate cancer surveillance after treatment comes from the National Comprehensive Cancer Network (NCCN). NCCN recommends checking the PSA every 6-12 months for 5 years, then annually thereafter. Your urologist will work with you to set up an appropriate surveillance schedule.
#2 Restoring Urinary Continence
As we discussed earlier, most men will experience some degree of urinary dysfunction or “leakage” following prostate cancer treatment. For most men, urinary function and incontinence improve gradually, with most men regaining urinary control by one year.4 In an attempt to hasten the process, your doctor may instruct you to perform exercises to improve the strength of your pelvic muscles (aka Kegel exercises).
For some men, however, problems with urination may continue. In many of these cases, bladder symptoms (frequency, urgency, etc.) may be easily controlled with medication. In other cases, a doctor may want to do further testing, which may lead him/her to recommend a urethral sling (designed to add support to the urethra) or an artificial urethral sphincter, which uses an implanted device to hold the urethra closed until you deactivate it using an implanted pump. These medical devices can greatly improve urinary continence for those men who need a little help.
#3 Resuming Sexual Activity
While many men will regain the ability to obtain erections, this may take a significant amount of time (3 to 36 months), and up to 50% of men will require some form of treatment to return their potency.5 With that in mind, perhaps the most important first steps are to remain patient and start the rehabilitation process as soon as possible after prostate cancer treatment. The use of medications (such as Viagra, Cialis, etc.) may help some men, though many will require additional treatment.
Further treatment of erectile dysfunction comes in many forms. A vacuum erection device utilizes vacuum suction pressure to draw blood into the penis, then a constriction band is slid around the penis to trap it there, thus creating the erection. Alternatively, medication can be delivered directly to the penis in the form of a urethral suppository (Medicated Urethral System for Erection) or an injection into the penile erectile tissue (Intracavernosal Injection), both of which work similarly to oral medications to increase the blood flow to the penis. Finally, some men elect for the insertion of a penile prosthesis, which involves the implantation of an artificial device to allow for achievement of erection. As you can see, when it comes to erections, we have many options to help men resume sexual activity.
Talk to Your Doctor About Prostate Cancer
Now that the conversation has started, that conversation should continue with your doctor to understand prostate cancer risks, testing, and treatment and to achieve the Trifecta of prostate cancer survivorship.
- Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA:
Cancer J Clin. 2012;62:220-241. - Id.
- Ficarra V, Novora G, Alhering TE, Costello A, Eastham JA, Graefen M, et al. Systematic review and meta‐analysis of studies reporting potency rates after robot‐assisted radical prostatectomy. European Urology 2012;62:418‐30.
- Skolarus TA, Weizer AZ, Hedgepeth RC, He C, Wood DP Jr, Hollenbeck BK. Understanding early functional recovery after robotic prostatectomy. Surg Innov. 2012;19:5-10.
- Skolarus TA, Wolf A, Cowens-Alvarado RL, et al. American Cancer Society Prostate Cancer
Survivorship Care Guidelines. CA Cancer J Clin 2014;64:225-249.
