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What Men Need to Know About Prostate Cancer Treatment Side Effects

There are several types of prostate cancer treatment, and each comes with its own risk of associated side effects.

When diagnosed with prostate cancer it is important for men to take the time to ask questions, talk to others, do the necessary research, and communicate with their loved ones. This will help ensure an informed decision on the best treatment for their specific situation.    

Men should know about common treatment side effects and speak with their doctors about them prior to undergoing treatment. This will create reasonable expectations about outcomes, and begin the discussion on ways to cope with or combat the potential side effects.

Erectile dysfunction (ED) and urinary incontinence are two of the most common side effects associated with prostate cancer surgery or radiation. ED and incontinence may be temporary or long-lasting, depending upon many factors, including the treatment, the skill and experience of the doctor performing the procedure, and the physical condition of the patient prior to treatment.

Men facing these side effects might find it hard to open up and talk about them. Many might suffer in silence, unable to admit they are struggling, which could cause depression and/or anxiety. It is important for men to discuss their feelings resulting from ED and incontinence with significant others, medical professionals, and with other men who are in the same situation. Loved ones need to know the struggles men are facing.

Keeping intimacy alive

“Erectile difficulties are one part of a bigger picture of sexual changes after treatment for prostate cancer,” said Dr. Anne Katz, a certified sexuality counselor from Winnipeg, Manitoba. “Men often experience a loss of masculine identity and this can affect their partner as well. The couple may start to distance themselves and this relationship stress sometimes causes the relationship to break down.

“Couples counseling can be helpful, but retreating into silence, as men often do, is not helpful. If erections go away as a result of treatment, it does not mean that intimacy and connectedness should also go away. There are ways of maintaining intimacy and being sexual that do not necessarily need to involve an erection. A counselor can help with this.”

Men who experience ED have several options available to help them regain some control of their sexual life, including pills, injections, vacuum pump therapy, and penile implant. Men should talk to their doctor about these options.        

“Prostate cancer is very treatable when caught early through screening with a PSA blood test and a digital rectal exam, but the most common ongoing long-term side effect after the various treatments for prostate cancer is sexual dysfunction,” said Dr. Jeffrey Albaugh, director of sexual health at NorthShore University HealthSystem in Skokie, Illinois. “ED affects 78 percent of men at two years after surgery, and 72 percent at five years after surgery; and from 78-87 percent at  two to 15 years after radiation.

“These ongoing sexual issues can be very frustrating for a man and greatly impact his relationship with his partner. Treatment for sexual problems will be centered around a man and his partner’s goals in terms of sex and intimacy. The good news is that men can continue to have a fulfilling intimate relationship with a partner, including sex, with the help of healthcare professionals.”

Dealing with Incontinence

Incontinence products like male pads and clamps can help address the immediate problem of urinary incontinence, which might be short- or long-term, depending on many factors going into treatment. To help address the source of the problem, men should consider consulting a physical therapist to assist with pelvic floor strengthening. This involves numerous exercises, such as Kegels.

It is important to consult with a medical professional to learn the proper techniques to do these exercises to avoid injury. In many cases, pelvic floor strengthening before and after treatment can help to reduce the severity of ED and incontinence after treatment.   

“Post-prostatectomy urinary incontinence and erectile dysfunction have huge impacts on quality of life,” said Dr. Heather Moky-Cordova, physical therapist at University of Illinois Hospital and Health Sciences System in Chicago. “A pelvic floor physical therapist can offer a supported, individualized plan that includes behavioral training, tailored exercises to the individual, biofeedback, muscle retraining, and assistance with return to work and play, and the different aspects that need to be considered to be successful. Pelvic floor therapists are here to help men in their journey back to health.”

Results from a recent survey of Us TOO support group leaders identified sexual health, ED, and urinary incontinence as topics that warrant additional educational content to address management of side effects to maximize quality of life. Educational videos were created to help meet this need at the Us TOO Prostate Cancer Pathways webcast and event series. To view videos from the series, visit the links below:

Dr. Anne Katz on Sex, Intimacy, ED, Penile Shrinkage, Incontinence After Treatment: https://www.youtube.com/watch?v=A2ZdDHw2WGY&t=8542s#

Dr. Jeffrey Albaugh on Sexuality and Intimacy at https://www.youtube.com/watch?v=Hiq0dDEb1l0&t=4483s  

Dr. Heather Moky-Cordova on Pelvic Floor Health at https://www.youtube.com/watch?v=Hiq0dDEb1l0&t=9109s
For more information about prostate cancer treatment side effects, or for support, visit www.ustoo.org, email [email protected], or call (800) 808-7866.   

Us TOO International Prostate Cancer Education and Support Network, [email protected]

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