Prostate cancer is the second most common type of cancer diagnosed in men in the U.S. According to statistics gathered by the American Cancer Society, approximately 191,930 new cases of prostate cancer will be diagnosed in this country in 2020, with one in nine men at risk of being diagnosed with this cancer during his lifetime. While advanced or aggressive disease can lead to death from prostate cancer, most men diagnosed with the disease do not die from it. In fact, many physicians describe prostate cancer as a disease that men die with, not from, meaning that the cause of death is frequently another health condition, such as heart disease, stroke, or dementia.
There are currently more than three million men living with prostate cancer in the U.S. Many of them are also living with side effects caused by their treatment. Side effects vary depending on the type of treatment, which can include hormone therapy, radiation, surgery, immunotherapy, cryotherapy, and chemotherapy. The most common side effects from prostate cancer treatment include incontinence, erectile dysfunction, and infertility. The good news is that there are approaches that can help manage and mitigate these side effects in most cases.
Post-treatment incontinence can be temporary or ongoing, and there are several types of incontinence men may face, including:
- Stress incontinence: The most common type of incontinence experienced after treatment, it can occur when a man coughs, sneezes, laughs, or lifts heavy objects.
- Overflow incontinence: This occurs when scar tissue narrows or blocks the urethra, which prevents the bladder from completely emptying or holding all the urine that is produced.
- Urge incontinence: Men with this type of incontinence, which is also called overactive bladder, experience more frequent urges to urinate because the bladder contracts too often.
A number of approaches can help manage post-treatment incontinence, ranging from exercises to strengthen the muscles of the pelvic floor to surgery. Those approaches include:
- Kegel exercises to strengthen the muscles used to stop the flow of urine
- Lifestyle changes such as drinking less fluid and avoiding caffeine, alcoholic beverages, and spicy food
- Urinating regularly rather than waiting until the urge is strong
- Losing weight
- Medications called anticholinergics that stop the bladder from contracting or spasming and medications that reduce the amount of urine produced. For some men, tricyclic antidepressants decrease incontinence.
- Catheters that drain urine from the bladder, including a non-invasive type of catheter known as a condom catheter
- Surgical treatment, including minimally invasive, endoscopic urethral bulking procedures to decrease the size of the urinary passageway; a bulbourethral sling that supports and compresses the urethra; and an artificial urinary sphincter to control the release of urine
Treatments for erectile dysfunction
If cancer treatment affects erectile function, several treatment options may help. Oral medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), relax the muscles in the penis and allow blood to flow to the organ more freely and quickly.
For men for whom these medications are not effective or who have other health conditions that make taking these medications risky or who take other medications that may interact with these medications, there are other options, including:
- Alprostadil (MUSE), a tiny medicated pellet inserted into the urethra to stimulate blood flow to the penis and Alprostadil (CaverJect), an injectable form of this medication
- Vacuum pumps that mechanically create an erection
- Surgical penile implants made up of a narrow flexible plastic tube, a small fluid-filled balloon attached to the abdominal wall, and a release button inserted into the testicle
Strategies to preserve fertility
In most cases, the treatment of prostate cancer causes infertility. Men who undergo surgical removal of the prostate are no longer able to produce semen, which makes ejaculation impossible. Radiation can affect the prostate cells and seminal vesicles, which in turn results in semen that does not transport sperm effectively. In some cases, radiation can also damage sperm.
Men who plan to father children after treatment should talk with their physician about sperm banking and artificial insemination. One other option is directly extracting sperm from the testicles and injecting them into an egg. If the egg is fertilized, it can then be implanted in the uterine wall to create a pregnancy, though this approach has a relatively low successful conception rate of less than 50 percent.
Miles J. Varn is chief executive officer, PinnacleCare, and can be reached on LinkedIn.
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