Post-Treatment Issues  
 
Erectile Dysfunction/Impotence | Incontinence/Urine Leakage | Bone Health | Follow-up Appointments | Nutrition | Glossary
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.

 
Erectile Dysfunction/Impotence Top

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.

Prostate Cancer & ED

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 activity. However, almost all men who have ED/impotence can overcome it.

The link to prostate cancer: The prostate is a small gland located at the bottom of the bladder. Common treatments for prostate cancer include pelvic surgery to remove the prostate (called a radical prostatectomy) radiation and/or hormone therapy. 

ED following major pelvic surgery is not uncommon. The nerves which allow for an erection lie within millimeters of the prostate. These nerves may be injured by being cut or separated from the prostate during surgery. This may cause temporary or permanent impotence, although sexual desire and the ability to achieve orgasm should remain. Radiation can also impact this group of nerves. Hormone therapy can also cause a reduction in libido and possible difficulties with erections. This is generally reversible when the therapy is discontinued.

The Journey To Solutions

Many couples who have successfully faced ED and prostate cancer stress the many facets of their journey:

  • Acknowledging the grief of the loss of their intimate life as they knew it before
  • Recognizing the fear that the level of intimacy they previously enjoyed would not return
  • Making a choice to remain open and discuss their feelings and concerns
  • Remaining willing to examine their intimate life and possibly redefine intimacy
  • Staying committed to exploring options and finding solutions.

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:

  • Sensitive to the difficult nature of the topic
  • Able to engage in open and frank discussion with the patient and his spouse or companion
  • Exceptionally knowledgeable and skilled in a large variety of treatment options for restoring sexual function.

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

  • Oral Medication (Viagra, Levitra or Cialis) 
  • Intra-Urethral Suppository (MUSE)
  • Penile Injection
  • Vacuum Device
  • Penile Prosthesis

Read article “Outer-course vs. Inter-course” by Dr. Jo-an Baldwin Peters, on sexual intimacy suggestions and tips

Listen to presentation
or read transcript from “Intimacy & Prostate Cancer” Oct 30, 2007 teleconference featuring Lawrence S. Hakim, MD and a married couple

Listen to presentation or read transcript from “Intimacy & Prostate Cancer” Feb 13, 2007 teleconference featuring Arnold Bullock, MD and a married couple

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

Successful Self Penile Injection Hints, Questions and Answers

Incontinence/Urine Leakage Top

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. The major side effect 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. 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.

Treatments

There are non-surgical treatments available that have proven effective for many men with leakage after prostate surgery:

  • Pelvic Muscle Exercises – done properly, these strengthen the muscles that help prevent urine loss. How to perform Pelvic Muscle exercises (also known as Kegel exercises)
  • Bladder Control Techniques – training to use muscles to help prevent leakage during coughing, sneezing or physical activity. Training can also be done to learn to reduce urgency, so men can make it to the bathroom in time.
  • Biofeedback – training techniques in which muscle and bladder activity can be monitored and displayed on a screen so that men can learn to accurately control their pelvic muscles and reduce leakage.
  • Electrical Stimulation – home or office treatments in which low electrical current is used to help strengthen the pelvic muscles and make the bladder less irritable.
  • Medications – taken every day, these help reduce urgency and urge-related leakage, but are not helpful for leakage with coughing, sneezing, or physical activity.

Practical Tips

  • When planning to go home after surgery, bring a pair of Jockey-type underware (not boxers) and incontinence pads. After the catheter is removed post surgery, patients will pour urine. This is normal, and may occur for up to 1 to 2 months. 
  • After surgery, your abdominal muscles will be weak. Until you rebuild your strength, you will experience leakage when getting out of a car, or standing up from a chair. Again, this is normal.
  • Stay away from caffeine.

Talk with your doctor about your level of leakage, and to learn more about the non-surgical treatment options listed above. 

Read NEW FREE patient resource: Prostate Cancer & Incontinence: Coping Strategies & Treatment Options

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

Read more about the types and management of clinical incontinence here.

 
Prostate Cancer and Bone Health: What’s the Connection? Top

As prostate cancer advances, your bones can be impacted. Bone health may be affected by prostate cancer and its treatment. 

Two conditions that can arise and impact bone health are:

  • Treatment-induced bone loss – could be caused by the side effects of medications taken for prostate cancer
  • Bone metastases – A result of advancing prostate cancer, when the disease spreads to the bones

Some treatments for prostate cancer can increase bone loss risk:

  • Men with decreased testosterone levels resulting from treatment for prostate cancer are at an increased risk for developing bone loss. Examples of medications that decrease testosterone include Lupron® (leuprolide acetate) and Zoladex® (goserelin acetate implant).
  • Radiation therapy to the bone and some kinds of chemotherapy also might decrease bone density and increase the risk for bone loss

Bone Metastases and Advancing Prostate Cancer

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.

Spinal or Vertebral Compression 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).

Learn more about spinal fractures and treatment options here.


Treating Pain Associated With Advanced Prostate Cancer

When prostate cancer has spread to other tissues in the body, particularly the bones, it can cause pain. 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 slow the growth of bone metastases and reduce pain.

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.


Prostate Cancer and Bone Health: The Bottom Line

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:
  • Don’t let symptoms scare you. See them as a signal to get more information and take action.
  • Not all symptoms represent recurrence of prostate cancer.
  • Maintaining your bone health will help maintain your quality of life.
  • If you have symptoms that concern you, quickly tell your health care provider.
  • The sooner your symptoms are diagnosed, the more that can be done to help.
  • You are the expert on you. Know yourself...and trust yourself.

Bone Health in Focus: A 2010 Report on Prostate Cancer’s Impact on Bones

Bone Health Take Action Tips 

What You Need to Know for Better Bone Health

Taking Care of Yourself While Living With Cancer: Dental Health and Osteonecrosis of the Jaw
 

Long-Term Care Issues Top

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.

Visit Your Doctor

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 DREs and may take a repeat prostate biopsy 1 year after treatment.

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 your treatment, it may not mean that the cancer has returned. Make sure that you commit to taking a PSA test each year and that you talk candidly with your doctor about any concerns you may have.

Live Healthy

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.

  • Limit intake of high-fat foods, which can stimulate testosterone
  • Increase intake of soy products that contain isoflavones, which may reduce testosterone

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
Broccoli Broccoli Vegetable oil Seafood Grapefruit
Sweet potatoes Green leafy vegetables      
Tomatoes Tomatoes      
Peaches Strawberries      
Apricots        

For cancer-healthy recipes, visit The Cancer Project

Regular exercise has been shown to strengthen the immune system and improve digestion, circulation, and the removal of waste products from the body. 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.

 

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