Prostate cancer treatment may lead to urinary continence and / or erectile function problems in some patients. Good post-operative care and rehabilitation can help patients to manage these conditions, and greatly improve their quality of life.
Prostate cancer treatments
Prostate treatment is likely to differ from one patient to the next, depending on the severity of the cancer as well as symptoms and the age of the patient. Treatments include active surveillance and regular testing (for lower-grade cancers and possibly for men of more advanced age), brachytherapy (radioactive pellet implantation), radiotherapy, and surgery.
Prostate cancer surgery – known as radical prostatectomy – is performed to remove any cancer in the prostate and the surrounding tissues, and involves complete removal of the prostate, the seminal vesicles, and the associated lymph nodes.
Fortunately, modern surgical techniques involve what is known as nerve sparing – which basically refers to preserving the nerves involved in erectile function. Nerve sparing helps to reduce the risk of erectile problems after surgery, and may also help to make erectile dysfunction treatments more effective.
Post-operative rehabilitation options
For men who undergo surgery and who do experience urinary incontinence and / or erectile function problems there are various treatment options available.
Urinary incontinence post prostatectomy
This may occur as a result of a weakness in the urinary sphincter valve which forms part of the pelvic floor group of muscles. It can be treated by:
- Pelvic floor training – when this is undertaken before and after surgery it helps to strengthen the pelvic floor and reduce incontinence problems. In most cases, patients recover full bladder control within three to six months after surgery. Pelvic floor exercises should not be done until after the post-operative catheter is removed (usually one to two weeks).
- Male sling surgery – this procedure involves implantation of a nylon ‘sling’ under the urethra to prevent leakage. It is minimally invasive, and can usually be done in a day clinic, although it may occasionally require an overnight stay. It has around an 80% success rate.
- Artificial inflatable urinary sphincter – this may be required for more severe cases of incontinence or where the sling procedure is inadequate. The artificial sphincter is made up of three parts – a balloon reservoir in the abdomen, an inflatable cuff and a pump – with activation of the pump opening up the cuff and allowing urination. The artificial sphincter has been shown to provide dramatic improvements for many sufferers of severe incontinence.
Some degree of erectile dysfunction occurs in a number of prostate surgery patients. Treatments include:
- Drug therapy – medications may be effective where a degree of nerve function is present. They include oral treatments such as Viagra and other PDE-5 inhibitor drugs, and penile injections. These treatments work by increasing the flow of blood to the penis.
- Vacuum constriction device or vacuum pump – a hand or battery-operated device designed to create a vacuum that increases blood flow to the penis.
- Penile implant surgery – this option may provide a very effective long-term treatment, especially for more severe cases.