- Talk to a continence nurse who can offer suggestions about the best continence products for your needs. The Continence Aids Payment Scheme (CAPS) may provide financial assistance for continence products (see www.bladderbowel.gov.au/caps/capsfaq.htm).
- Talk with a continence nurse or physiotherapist for information on pelvic floor muscles training. Pelvic floor muscles are important for continence control (see www.bladderbowel.gov.au/adults/pelvicmen.htm), and are best learned and started before surgery, and continued afterwards.
You can obtain more information about surgery from the Understanding surgery for prostate cancer resource available from PCFA (www.pcfa.org.au).
OTHER SURGERY: TURP (TRANSURETHRAL RESECTION OF THE PROSTATE)
TURP surgery involves cutting away some of the tissue from inside the prostate while leaving the outside of the gland in place. This type of surgery is sometimes used to control urinary symptoms in men with advanced prostate cancer. A side effect is ‘retrograde ejaculation’, when semen is forced back into the bladder during ejaculation due to damage to the internal sphincter muscle (valve) located near the prostate. The valve cannot close shut, so semen flows back into the bladder. It is then passed out with urine the next time you go to the toilet; potentially giving your urine a cloudy appearance. This is a harmless effect which occurs in most men having this type of surgery.
RADIATION THERAPY (EXTERNAL BEAM RADIATION TREATMENT OR EBRT)
EBRT uses high energy x-ray beams that are directed at the prostate from the outside. Generally people are having this treatment in a hospital setting daily, Monday to Friday, for 7-8 weeks. During your EBRT treatment, you can continue to do what you would normally if you’re able; however, the multiple hospital visits and side effects associated with treatment may interfere with some day-to-day activities.
What to expect:
- Inflammation to the surrounding areas can cause pain. A small leakage of urine on ejaculation can occur. This is generally a short term side effect and improves as inflammation settles.
- Due to damage to the prostate cells that produce ejaculation fluid, you can notice a decreased amount of fluid or dry ejaculation.
- Unlike surgery, radiation therapy doesn’t usually have immediate effects on erectile function. Erectile problems typically occur in the longer term, commencing six months after treatment and progressing over the following years. Ageing and progressive damage to the blood vessels and nerves to the penis contribute to this.
- Radiotherapy will not affect your libido directly but the whole process may mean that you do not feel like having sex during the weeks of, or after, the treatment. There is no reason to avoid sex if you feel ready.
- If you wish to have children in the future, you will need to discuss alternatives such as having some of your sperm stored before treatment starts (this is called sperm banking). You can ask to speak with a fertility counsellor or be referred to a service that specialises in fertility issues.
- Hormone therapy is often used in conjunction with radiation therapy treatment, which can increase the impact on erectile function as well as libido.
Low dose rate (LDR): is given by implanting permanent radioactive seeds directly into the prostate. The seeds give off a focused amount of radiation to the prostate with the aim of destroying the cancer cells. LDR brachytherapy is generally a treatment for men with localised prostate cancer.
Note: There is a very small chance of passing a radioactive seed during sexual activity. A condom is recommended for use for the first two months after implantation. If your partner is pregnant, use condoms for the whole pregnancy as a precaution.
What to expect:
- Placement requires surgery that may take a few hours. You may have the treatment as a ‘day-only patient’ or have an overnight stay.
- Your semen may be discoloured or blood-stained for the first few weeks after placement, due to the bruising or bleeding from the prostate caused ￼12 by treatment. This usually resolves with time.
- You may have pain on ejaculation as the prostate contracts with orgasm. This is a short term side effect.
High dose rate (HDR): is given by inserting radioactive material directly into the prostate but, unlike LDR seeds, the placement of the material is temporary and for shorter periods – usually for a day or two at a time. The procedure takes place at a hospital but may require a longer stay than LDR brachytherapy. HDR brachytherapy is generally a treatment option for men with intermediate risk or locally advanced prostate cancer, and is often given in conjunction with EBRT.
What to expect:
- The side effects of high dose rate brachytherapy are similar to those of low dose rate brachytherapy.
- Often men have hormone (androgen deprivation) therapy or external beam radiation therapy in conjunction with high dose rate brachytherapy. Side effects from these treatments on sexual function may also be experienced.
You can obtain more information about brachytherapy from the Understanding brachytherapy for prostate cancer resource available from PCFA (www.pcfa.org.au).
‘I’d been used to waking up every morning virtually all of my life with an erection and basically as soon as I started the hormone treatment that ceased. I’m not saying I had intercourse or anything every day of my life, but it was just something that was part of me and I found that difficult.’
Prostate cancer is driven by hormones. By reducing these hormones, it is possible to slow the growth of the cancer. This is known as hormone therapy, also known as androgen deprivation therapy (ADT), and is the standard first treatment when prostate cancer has spread (metastatic prostate cancer).
There is also a surgical hormone treatment called orchidectomy, in which the testicles are surgically removed. The testicles are responsible for a high percentage of testosterone production, so removing them starves the prostate cancer cells of testosterone.
Testosterone is a male sex hormone (or androgen), which is produced by the testicles. It is vital in reproductive and sexual function. Hormone therapy reduces testosterone levels, and can often keep the cancer under control for several years by shrinking it, delaying its growth and reducing symptoms. How well hormone therapy controls the cancer is different from one man to another. It depends on how aggressive the cancer is, and how far the cancer has spread when you start hormone therapy.
What to expect:
Hormone therapy side effects can be difficult to predict. It is important that you tell your healthcare team about the side effects you’re having as they may be able to offer you ways to manage them (e.g. medications, techniques).
- Lowering testosterone levels may cause a reduction in sex drive and erectile difficulties.
- Work with a health professional (e.g. psychologist, sex therapist) who specialises in sexuality matters.
- Explore ways of being intimate with your partner that are not related to sex.
- Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for penetration. ED can be variable, with some men still able to achieve erections but not for long periods or with the ability to reach orgasm.
- Medications: Some medications in tablet and injectable forms can be prescribed to manage erectile difficulties. Because these medications can have side effects, discuss with your healthcare team if they are suitable for you.
- Implants/devices: If you don’t want to use medications, devices that draw blood into the penis (e.g. vacuum erection device) or the use of penile implants (e.g. flexible rods or inflatable tubes) could be ways of getting an erection. Members of your healthcare team (e.g. urologist, nurse, sex therapist) can provide you with information about these.
- Other physical side effects of hormone therapy, such as loss of muscle, weight gain, hot flushes and growth in breast tissue can impact how you feel about yourself sexually. You can obtain more information about hormone treatment from the Understanding hormone therapy for prostate cancer resource available from PCFA.
Prostate cancer is driven by hormones. By reducing these hormones, it is possible to slow the growth of the cancer.