Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.
Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.
Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.
"It's important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them," says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.
Side Effects From Prostate Surgery
A common surgery for prostate cancer is a radical prostatectomy. This is when the surgeon removes the entire prostate gland, seminal vesicles, and often, pelvic lymph nodes. The most common side effects of prostate cancer surgery are urinary incontinence (the inability to control your bladder) and erectile dysfunction, or ED (the inability to achieve a full erection).
The most common type of urinary incontinence after surgery is called stress incontinence. This is when a man may leak urine when he laughs, coughs, sneezes or exercises. This occurs because the sphincter that controls the flow of urine may not work properly in the short-term after surgery.
"Following the surgery, we recommend that men wear an undergarment pad," Calvaresi said. "The incontinence improves slowly over a period of months. The majority of men show vast improvement by approximately six months after surgery. Many men may continue to wear a very thin pad, for security."
An initial treatment for urinary incontinence is Kegel exercises to strengthen pelvic floor muscles, which are vital for bladder control. If you're going to have prostate cancer surgery, your doctor may suggest that you start doing these exercises before your surgery.
Another option is biofeedback along with Kegel exercises. This will help you judge how well the pelvic floor muscles are working and whether you're doing the exercises the right way. Pelvic floor physical therapy may also be helpful in training muscles to prevent incontinence.
Surgery is a last option if other treatments have failed. Your urologist can implant a device called an artificial urinary sphincter. This compresses the urethra to keep it closed except when you need to urinate.
Many men have trouble with erections after prostate cancer surgery. This is because nerves can be damaged during surgery. All men who are treated for prostate cancer will experience ED for at least a short time after surgery.
The chance of ED after treatment depends on a number of factors. These include your age, overall health, whether you had ED before treatment, and/or if your nerves near the prostate were impacted during surgery.
The first treatment for ED after prostate cancer surgery is oral medications such as sildenafil (Viagra), that improve blood flow to the penis. If medication is not enough a penile pump may be suggested. This device uses vacuum pressure to draw blood from the body into the penis. It comes with a ring that is placed at the base of the penis to keep blood there for sexual activity.
A third option is a penile injection. This is when medicine is injected into the penis to boost blood flow for an erection. Finally, there is a penile implant. This is a device that is surgically placed in the penis. It can be inflated to create an erection and deflated after sexual activity. This is only used for permanent ED, or when other treatments don't help.
Side Effects From Radiation
Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. "It's more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate," Calvaresi said. These problems often go away once treatment is complete.
Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.
Men undergoing radiation are likely to have ED, but not immediately. "It slowly sets in after radiation treatment," Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.
Side Effects From Hormone Therapy
Hormone therapy for prostate cancer, known as androgen deprivation therapy (ADT), suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.
The severity and length of side effects depend on how long treatment lasts. "If a man has only six months of treatment, their level of testosterone rises again, and they'll go back to feeling like themselves," Calvaresi said.
Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. "If we can manage those other side effects, then often that improves mood," she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.
If you have been diagnosed with early stage prostate cancer, your doctor may recommend that you undergo "active surveillance."
Active surveillance is a type of close follow-up. It usually involves regular PSA tests and digital rectal exams to determine how the cancer may be growing. It also includes prostate biopsies (tissue samples), which help predict if the tumor is likely to grow and spread. If these tests show your cancer is growing quickly, your doctor may discuss other forms of treatment with you.
Weighing Your Options
When you're considering your options for prostate cancer treatment, it's important to discuss potential side effects of each one with your urologist.
"We tell our patients what the associated side effects of each treatment would be," Calvaresi said. "In patients who would be a candidate for either surgery or radiation, we ask them to consider possible outcomes and impact on quality of life when deciding which treatment to undergo."
Some men are more concerned about urine leakage, while others primarily want to avoid ED. "The good news is there are many options to treat these side effects ," she said. "For urinary incontinence, the leakage may start off persistent, but eventually we'll get it to stop. For maintaining an erection, there are many options-it just depends on how aggressive you want to be in treating it."