Adjusting to Life After Prostate Cancer Surgery
- “Celebrity Big Brother” winner Paddy Doherty, 65, shared that before being diagnosed with prostate cancer, he would experience excruciating pain while urinating. After noticing blood, his doctor made the diagnosis.
- Part of Doherty’s treatment included a prostatectomy, which is an option for men with prostate cancer that hasn’t spread outside of the prostate gland.
- During this procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Side effects may include erectile dysfunction and urinary incontinence.
- The nerve-sparing surgery option can reduce the risk of side effects like sexual dysfunction, though it may not be suitable for everyone.
- Surgery is not needed for all men diagnosed with prostate cancer. In some cases, active surveillance is a preferred treatment option for older men or those with a low risk of the disease spreading.
“I would be screaming, and my grandchildren could hear me — that is so embarrassing and demeaning for me,” Doherty told U.K. news outlet “The Sun.”
While at the doctor, Doherty underwent several tests which helped his physician make a diagnosis.
“He [Doherty’s doctor] told me straight: ‘Paddy, you’ve got cancer in your prostate.’ I know people think I’ve got this tough image, but I just started stuttering. I couldn’t speak properly — it’s when you hear that word ‘cancer,’” Doherty explained.
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He underwent treatment, which included prostate cancer surgery, to recover.
Doherty chose to speak about his cancer journey openly because he says, “Men don’t talk about these things.” By breaking the norm, he hoped he could ease the stigma surrounding prostate cancer.
Helping Patients Cope with Treatment Side Effects
How is Prostate Cancer Diagnosed?
When you do get screened for prostate cancer, your doctor will run a few tests.
One of the tests is the PSA test, a simple blood test that screens for prostate cancer. It looks for larger amounts of protein-specific antigen (PSA) in the blood. An elevated PSA test does not always mean you have prostate cancer. It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.
Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.
Depending on the results of these tests, imaging scans and a biopsy may be ordered.
WATCH: How Gleason Grade Determines Treatment
After tests, your doctor analyzes the results to give you a Gleason Score. This score ranges from 6 to 10. The higher the score, the more aggressive the cancer.
This score, along with your other test results, helps doctors determine if your cancer is “low risk,” “intermediate risk,” or “high risk.”
When to Screen for Prostate Cancer
Prostate cancer is the most common cancer in men. It starts in the walnut-shaped prostate gland, located between the rectum and bladder, producing the fluid that nourishes sperm. Fortunately, most prostate cancer is caught with screening examinations.
Prostate cancer does not always behave the same in every man it impacts. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about how much screening is necessary.
The United States Preventive Services Taskforce recommends men at average risk between the ages of 55-69 years old should talk with their doctor about the pros and cons of prostate cancer screening. Most doctors agree that men over the age of 70 do not need screening.
SurvivorNet experts suggested that men consider factors like their family history, genes, and age when deciding whether and when to screen.
Symptoms of prostate cancer may include:
- Urinating more often
- Waking up in the middle of the night to urinate
- Blood in your urine
- Trouble getting an erection
- Pain or burning when you urinate
- Pain in your back, hips, thighs, or other bones
- Unexplained weight loss
- Fatigue
Treatment Options for Prostate Cancer
After testing and establishing your risk, your doctor will discuss possible treatment options. Treatment may include “active surveillance,” usually for men with low-risk prostate cancer, which again involves regular testing every six months to monitor the prostate and check for any progression of the disease.
More aggressive treatment options include surgery and radiation therapy.
Surgery is an option for men with any risk group of prostate cancer that hasn’t spread outside of the prostate gland. The type of surgery most often used is called a radical prostatectomy.
During the procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Your doctor can perform this through a traditional open procedure with one large or several small incisions called laparoscopic surgery.
Surgery side effects may include erectile dysfunction and urinary incontinence. Fortunately, the side effects are usually temporary, and there are ways to help you manage them.
Radiation therapy is often done when prostate cancer is caught early and confined to the prostate gland.
The Side Effects of Prostate Cancer Surgery
Prostate cancer warriors should ask their doctor questions about the side effects of surgery.
Some of the known side effects of prostate cancer surgery include erectile dysfunction (difficulty getting or keeping an erection) and urinary incontinence (leaking urine by accident).
Treatments for prostate cancer, especially surgery, can damage nerves and blood vessels essential for erectile function, leading to ED. The risk for these side effects depends on the type of surgical approach and factors specific to your cancer.
WATCH: Sexual Function Recovery After Prostate Cancer Surgery
“Erectile function is so sensitive when we’re dealing with prostate cancer because of the fact that the nerves that are critical for this function wrap around the prostate; they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, told SurvivorNet.
Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, explained to SurvivorNet that most people regain normal function in these areas over time.
Opting for nerve-sparing surgery can reduce this risk, though it may not suit everyone. Nerve-sparing surgery involves removing cancer without harming the nerves, but if the cancer is near the nerves, it may not be possible.
Within a year of nerve-sparing prostatectomy, 40% to 50% of men are back to their pre-cancer sexual function.
For men experiencing erectile dysfunction, there are many other solutions as well.
Oral medications — usually a pill — work for mild to moderate ED by enhancing blood flow to the penis to bring on an erection.
There are medications currently on the market that can aid in sustaining erections, such as Viagra, Cialis, and Levitra. There are also treatments such as penile injections and vacuum erection devices (VED), as well as the option of a penile prosthesis. Vacuum erection devices use vacuum pressure to draw blood into the penis, inducing an erection.
Dr. Freedland says there are two main prosthetic options: an inflatable prosthesis placed in the scrotum or a bendable plastic prosthesis.
According to Dr. Freedland, most men who choose this route report being pleased with the outcome.
Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function. This approach actively addresses the psychological, emotional, and relationship impacts on sexual health.
In counseling, individuals and couples can discuss concerns, explore sexual aids and techniques, and find ways to maintain intimacy.
Questions to Ask Your Doctor
If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:
- If I have elevated PSA levels, what could be causing that besides cancer?
- How long will it take to learn if my PSA levels warrant further testing?
- What are the treatment options that are best suited for me based on my risk level?
- What financial resources exist to help me with the costs associated with treatment?
- How long will my potential treatment prevent me from working or continuing normal activities?
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