You’ve made it through prostate cancer treatment successfully, and your doctor has pronounced you cancer-free. You are probably feeling an overwhelming sense of relief! The last thing you ever want to think about is that the cancer may come back. It is up to you now to make sure it doesn’t by visiting your doctor regularly and committing to a healthy lifestyle.
Awareness of your personal health has probably never been this high – you have had to endure uncomfortable tests, even more uncomfortable treatments, and maybe even some undesirable side effects. Because you have successfully navigated through all of these experiences, you can now help other men and their families to understand the disease, how it is treated, and what they can expect physically and emotionally, as well as provide them with a source of support and inspiration. Becoming an advocate for prostate cancer patients and their families can not only help other men and their families, but can improve your own emotional recovery from the disease.
This section gives a brief summary of what you need to do for the long-term to keep the chance of cancer recurrence low. It also describes ways in which you can become an advocate for prostate cancer awareness.
A prostate cancer diagnosis can be devastating for the patient and his spouse or companion. The often-resulting erectile dysfunction and/or incontinence due to surgery or other treatment can bring additional grief, confusion and trauma to couples during an already stressful time. After treatment, many couples feel utterly unprepared to deal with the physical and emotional impact on their intimate relationship. One spouse confessed, “I though ED was the guy down the street, not a medical condition that could devastate my marriage.”
Couples facing prostate cancer often feel the need to be more connected than ever. Instead, confusion, embarrassment and fear caused by ED can cause both parties to feel alone and disconnected.
In the midst of this difficult news, it is important to know that there is HOPE. Perhaps more importantly, there are options that make mutually satisfactory sexual relationships possible in the presence of ED and impotence. In this instance, information truly is power. Paired with open and frank discussion and a willingness to explore options, couples facing ED can find satisfying solutions.
So what exactly is ED and why is it so closely linked with prostate cancer?
Normal male sexual function is a constellation of processes, including desire, emotional and psychological considerations, and physical function. Erectile dysfunction -- commonly known as impotence -- is defined as the inability to achieve or maintain an erection that is sufficient for satisfactory sexual intercourse. However, almost all men who have ED/impotence can overcome it.
The reason ED can occur in men undergoing radical prostatectomy is due to damage to the pelvic nerves that control erections. These nerves lie within millimeters of the prostate. During surgery, the nerves may be cut or stretched. This may cause temporary or permanent impotence, although sexual desire and the ability to achieve orgasm should remain. The causes of impotence following radiation and cryosurgery are less clear but may be a combination of fibrosis, damage to blood vessels or damage to the tissues inside the penis. Hormone therapy can also cause a reduction in libido and possible difficulties with erections. This is generally reversible when the therapy is discontinued.
Many couples who have successfully faced ED and prostate cancer stress the many facets of their journey:
Erectile dysfunction and sexual intimacy can be challenging to discuss under the best of circumstances. Add the stress of a prostate cancer diagnosis, and the challenge to remain open can be multiplied. When sexual challenges arise, many couples suffer far too long because the lines of communication shut down and fear takes over. Those who are successful at finding solutions are those who are willing to keep the lines of communication open, even when it is uncomfortable or difficult.
Most couples do not realize is that there are many possible solutions to restoring sexual intimacy, even after prostate cancer treatment. From pills, to external devises, injections and surgical procedures, there are solutions for nearly everyone. With persistence, a little humor, open discussion, and medical support, couples can reclaim sexual intimacy once again.
Fortunately there are many medical professionals, generally urologists, who specialize in treating ED. An excellent urologist is one who is:
Diane, whose husband, was diagnosed with prostate cancer in 1999, says this about their journey, “After treatment we were just so glad that he was alive. As the months passed, we resumed our lives, except an important part was now mysteriously gone. After one failed attempt in the bedroom, we both shut down and pretended to focus on other things. I didn’t want to pressure him and he was too embarrassed to discuss it. One year later, we were both deeply sad and disconnected. On a weekend vacation, we both started crying and acknowledged our fears. After a tearful discussion, we recommitted to our intimacy and began our quest for solutions with a wonderful urologist. It was not always smooth sailing, some options didn’t work for us and others worked only for a while. Persistence won the day though. Five years later, we have a wonderful relationship again and far better communication than ever before.”
Don’t let ED become a silent, unwelcome, over-bearing house guest. If you and your spouse are facing ED, whether is it the result of prostate cancer treatment or not, do not let fear, embarrassment, or discomfort destroy your love life. Become knowledgeable about ED. Seek help from medical professionals who specialize in sexual function and keep the lines of communication open.
Read more about the following impotence solutions in Managing Impotence: A Patient Guide
Read article “Outer-course vs. Inter-course” by Dr. Jo-an Baldwin Peters, on sexual intimacy suggestions and tips
Erectile Dysfunction - information from The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), part of the National Institutes of Health of the U.S. Department of Health and Human Services
Prostate cancer is now the most common internal malignancy in men. The lifetime prevalence of prostate cancer is 1 in 6 men. With the more widespread use of the Prostate Specific Antigen (PSA) blood test for prostate cancer screening, 60% of all prostate cancers are discovered while still localized. Many urologists recommend radical prostatectomy (removal of the prostate gland and lymph nodes) as the treatment of choice for their patients who are younger and in good health and have localized cancer. One of the major side effects of this surgery is urine leakage (incontinence).
Although urine leakage is temporary for many men after removal of the prostate gland for prostate cancer, persistent leakage is not uncommon. Patient surveys have shown a 39-63% prevalence 1 year after surgery, with 24-56% of patients wearing incontinence pads. The incidence depends in part on the expertise of the surgeon; more experienced surgeons have much lower rates. This persistent leakage can have significant medical, psychological, social, and economic consequences. Many men have said that incontinence was the most burdensome part of their experience with prostate cancer treatment.
There are non-surgical treatments available that have proven effective for many men with leakage after prostate surgery:
Talk with your doctor about your level of leakage, and to learn more about the non-surgical treatment options listed above.
Urinary Incontinence in Men - information from The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), part of the National Institutes of Health of the U.S. Department of Health and Human Services
As prostate cancer advances, your bones can be impacted. Bone health may be affected by prostate cancer and its treatment.
Another situation in which bone is affected by prostate cancer is when the cancer metastasizes, or breaks away and travels—usually via the bloodstream—to other parts of the body, primarily in the advanced stages of the disease. When this happens in prostate cancer, the most common place for the cancer to go is to the bone. The bones most commonly affected are the spine, hips, and ribs. Normal bone is constantly being remodeled, or broken down and rebuilt. Cancer cells that have spread to the bone disrupt the balance between the activity of osteoclasts (cells that break down bone) and osteoblasts (cells that build bone), disrupting their normal remodeling and causing excessive bone breakdown or abnormal build-up. Bone metastases cause damage that may make the bone more susceptible to complications such as pain and fractures.
Prostate cancer behaves differently in each individual. In many men, prostate cancer never spreads to any other site. In the men in whom it does spread, bone metastases occur in 65% to 75% of all patients, and the bone is often the only site of metastases.
Prostate cancer that spreads to the bones is still prostate cancer, not bone cancer. Bone metastases result in areas of weak, unstable bone that could cause debilitating pain and fractures.
Although the majority of spinal fractures (also called vertebral compression fractures or VCFs) are caused by osteoporosis, cancer and medical treatments such as hormone therapy and chemotherapy can also weaken bone and increase the likelihood of fracture.
About 1 million American men are now receiving androgen deprivation therapy (ADT), also known as hormone therapy, annually -- 19% are at an elevated risk of developing vertebral compression fractures (VCFs). Men on androgen deprivation therapy should have their bone density measured and treatment should be administered when it is low. FDA approved medications are available.
When prostate cancer has spread to other tissues in the body, particularly the bones, it can cause pain. Radium-223 (Xofigo) has recently been approved, which treats this pain and prolongs survival. External beam radiation or systemic radiation therapy such as samarian-153 (Quadramet®) and strontium-89 (Metastron®) can reduce bone pain caused by metastases. Bisphosphonate medications, usually pamidronate (Aredia®) and zoledronic acid (Zometa®), can reduce skeletal related events that include pain, fracture and the need for radiation or surgery.
Xgeva™ (denosumab) is indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors. Xgeva is a fully human monoclonal antibody that binds to RANK Ligand, a protein essential for the formation, function and survival of osteoclasts (the cells that break down bone). Xgeva prevents RANK Ligand from activating its receptor, RANK on the surface of osteoclasts, thereby decreasing bone destruction.
An independent, successful, satisfying life is possible with prostate cancer. Because prostate cancer has an affinity for your bones, knowing about your bones is important. You can make a difference in managing your bone health:
If you’ve been treated for prostate cancer and have been declared cancer-free by your doctor, chances are you’re biggest worry is that the cancer may come back. Sticking to your follow-up appointment schedule and living healthy can keep your risk of recurrence low.
Your doctor will schedule routine follow-up examinations, usually every 6 months for 5 years, and then yearly. He will test your serum PSA level at regular intervals, usually every 3 to 6 months for 1 to 2 years and then annually. Your doctor may also perform yearly DRE's. A repeat prostate biopsy may be performed in men on active surveillance or those treated with radiation therapy, cryosurgery, or HIFU if the PSA increases.
It’s important for you to realize that PSA levels normally fluctuate, and that if your PSA levels begin to rise a few years after radiation treatment, it may not mean that the cancer has returned. Make sure that you commit to taking a PSA test as recommended by your doctor and talk candidly with your doctor about any concerns you may have.
Although the causes of prostate cancer aren’t fully understood, eating well, getting plenty of rest, and exercising regularly may reduce your risk of cancer recurrence.
Testosterone stimulates prostate cell growth, and what you eat can change your testosterone levels.
Many foods contain antioxidants, substances that can prevent cell damage and may enhance the immune system and reduce the risk of cancer and infection. A low-fat diet of fish, fruits, vegetables, and grains contain antioxidants and may decrease the risk of cancer.
|Vitamin A and Carotenoids||Vitamin C||Vitamin E||Selenium||Lycopenes|
|Carrots||Citrus fruits||Nuts and seeds||Whole grains||Tomatoes|
|Squash||Green peppers||Whole grains||Garlic||Tomato products|
|Sweet potatoes||Green leafy vegetables|
Regular exercise has been shown to strengthen the immune system and improve digestion, circulation, and the removal of waste products from the body. In men with prostate cancer, exercise can help reduce osteoporosis and the weight gain associated with androgen deprivation therapy. Exercise also prevents obesity, which is a risk factor for many diseases, including cancer. Regular exercise may also reduce the risk of benign prostatic hyperplasia (BPH), or prostate gland enlargement.