LONG-TERM CARE & RECOVERY
Embracing your “new normal”
With advances in prostate cancer management, patients are living longer after treatment. In my expert practice as a board-certified urologist, I routinely ask patients: how well are you coping with life after treatment?
Psychological Support
Depending on the selected treatment for prostate cancer, patients may experience a variety of emotions: hope, anxiety, fear, and sadness to name a few. Treatment regret is common in patients who may not have anticipated living with side effects of cancer treatment. Fortunately, through a collaborative approach, negative feelings following cancer treatment can be alleviated. I also encourage patients to engage family and friends who may have personal experience with treatment and offer valuable insight, as well as reach out to prostate cancer support groups. Education regarding the patient’s “new normal” is important to the success of any cancer survivorship treatment plan.
Diet and Nutrition
After treatment, it is important to maintain a healthy lifestyle. Optimal management of any underlying health condition—such as high blood pressure, diabetes, and heart disease—is crucial to overall health. Although there is no specific diet for prostate cancer survivors, healthier habits can improve overall health and minimize the toll cancer has taken on the body.
Urinary Leakage
Urinary leakage after treatment can range from mild to severe. Severe leakage is an uncommon side effect (less than 5% of surgical patients). Some men may complain of leakage of urine during ejaculation, also known as climacturia. Urinary frequency and urgency can lead to multiple trips to the restroom.
We typically offer men urinary pads and encourage pelvic floor exercises to strengthen their pelvic floor after treatment. Symptoms typically improve with conservative management; if not, procedures such as an artificial urinary sphincter or sling can be performed to help men stay dry. Changes to the bladder from radiation therapy may require studies to investigate how well the bladder is storing and eliminating urine. Patients treated with radiation therapy may experience urgency, frequency, or difficulty emptying their bladder over time, raising concerns for scar tissue in the urinary tube (urethral stricture or bladder neck contracture), which may require a corrective procedure.
Intimacy and Sexual Health
Some men have trouble with sexual performance prior to their treatment of prostate cancer, while for others, trouble started after treatment. As an expert urologic surgeon, I recommend men try to have erections as often as they can tolerate, as regular sexual activity preserves erectile function and length. Men treated with surgery or radiation may experience erectile dysfunction or trouble getting a firm enough erection for penetration. Depending on severity, treatment may include oral medications, injections, vacuum erectile devices, and penile prosthesis implantation for advanced cases.
Loss of sexual drive can be addressed by looking at the underlying cause, including depression or decreased testosterone levels. Depression can be treated through collaboration with a therapist, and intimacy issues via a sex therapist. Testosterone replacement therapy in prostate cancer survivors is controversial and constantly evolving within the field of urologic oncology.
Surveillance
Lastly, it is important for cancer survivors to stay in touch with their doctors and report any new symptoms for potential signs of recurrence. Monitoring for recurrence is a routine part of any cancer treatment plan. While the risk is low, exposure to radiation therapy may increase the risk for secondary cancers such as bladder cancer, which can present as blood in the urine. Patients should always ask questions and seek expert clarification regarding anything that is not clearly explained.
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