Men With Prostate Cancer Worry Less About Recurrence Than Their Spouses Do

Researchers at The Mount Sinai Medical Center in New York have found that, when it comes to worrying about the recurrence of prostate cancer, male patients worry less than their female spouses or partners. The study was presented at the 30th annual meeting of the Society of Behavioral Medicine in Montreal.

In a study of 96 men and their spouses or partners, Michael Diefenbach, Ph.D., Associate Professor of Urology and Oncological Sciences at Mount Sinai School of Medicine, found that, at the time of prostate cancer diagnosis, the male patients described themselves as "moderately worried" about the chance of their disease recurring, while their female spouses and partners described themselves as "very much" worried.

"We know that illness perception and worries about cancer recurrence influence the emotional well-being of patients. But our studies show that this worry is actually a greater stress on spouses and partners. This research can help us develop programs to address the emotional health of the entire family unit," said Dr. Diefenbach.

For both groups, the concern about recurrence decreased over the next 12 months, though it decreased more for the male patients than it did for their spouses and partners.

This led to an even greater disparity after one year than what was observed at the time of diagnosis, with the men describing themselves as "a little bit" worried and their spouses and partners saying they were "moderately worried."

The study also showed that men were less likely to worry about their cancer recurring if they believed that treatment options for their cancer would be effective, while their spouses' and partners' worries were generally unaffected by outside factors.

"For the male patients, the main driver of worry about cancer recurrence was whether they believed that effective treatment was available for their disease," said Dr. Diefenbach.

"But for their spouses and partners it was not possible to determine the main driver of worry, as their response was mainly an emotional one. The one factor we could really measure that affects the level of spouse and partner worry is age in general, the older the spouse or partner, the more concerned they were about cancer recurrence."

Dr. Diefenbach leads a federally funded research program that aims to improve treatment decision making, patient-physician communication and quality of life through innovative patient and family focused programs. He is also the developer of the Prostate Interactive Education System (PIES), a Web tool that helps prostate cancer patients weigh their treatment options.

Source: Mount Sinai Medical Center

My Sentiments Exactly

With a Buzz Cut, I Can Take on Anything

GOT a buzz cut last July, four days before radical open surgery to remove my cancerous prostate. I told family and friends that I did it for reasons of ease and style: I wanted to avoid the heartbreak of hospital hair, that lank and greasy thatch that repels visitors.

But I was lying.

In a time of utter vulnerability — having already weathered three months of post-diagnosis ups-and-downs — I needed the primal ferocity that a buzz cut proclaims. I needed to look like a soccer thug or an extra from “Prison Break” to help get me through surgery, the physical indignities of post-op life, and my subsequent radiation and hormone therapy. I still do. My prostate cancer and its treatment have transformed me — in body and spirit — and the buzz cut has helped me cope with those changes.

I agree with the late Anatole Broyard, who wrote in his memoir “Intoxicated by My Illness,” “It seems to me that every seriously ill person needs to develop a style for his illness.” And the buzz is what I want to wear, what I need to wear, in this wicked waltz with cancer.

I’m an optimist, but not a day goes by in which I don’t wonder whether I’m going to die before I ever imagined. The buzz cut helps me scowl, glower and say “No!” to that thought.

Broyard, a New York Times literary critic who died of prostate cancer, also wrote, “Only by insisting on your style can you keep from falling out of love with yourself as the illness attempts to diminish or disfigure you.”

In some ways, I’ve already fallen out of love with my old self.

There’s a book-jacket photo taken of me early last year, before I learned that I had cancer, and I can’t stand to look at it. Can’t bear to look at my floppy mop of Glen Campbell hair, the innocent grin. I want to smack that cheery and naïve face and bellow: “Boy, you don’t know nothin’!”

That poor guy, at age 50, doesn’t yet know that he has cancer, that it will prove to be shockingly aggressive and that, among other indignities, his libido will take a sabbatical (on Ibiza, I hope).

For me, the buzz cut is a visible bulwark against the tide of emasculating side effects caused by the treatment for prostate cancer.

Wearing my buzz, hiking boots and a rugby shirt, I don’t feel like prey to the cancer. I can still fix my wife with my blue eyes, drop my voice into a Barry White register, and say, “Hey, baby.”

It was only after the fact that I learned that my hair-shearing reaction to having cancer wasn’t so unusual. I understood that the buzz cut spoke of a new me. It still reminds me that I’ve been tempered in the crucible of cancer, that I have changed.

But it’s also part of a muted tradition that’s consistent with the transformation, transition and trauma that I’ve gone through.

Nuns and monks cut their hair, as do saints and rape victims. Soldiers, prisoners and mental patients have their hair cut for them. And issues of hair and appearance are often uppermost in the minds of cancer patients.

“The challenge with cancer is to find a new sense of self,” said Dr. Robert Klitzman, an associate professor of clinical psychiatry at Columbia University Medical Center, “because the narrative of yourself has been disrupted.”

Dr. Klitzman, who has explored issues of serious illness and appearance in several books, most recently “When Doctors Become Patients,” added, “Often, when a woman wears a scarf instead of a wig, she’s owning her cancer, not resisting it.”

That idea of ownership is crucial. My treatment hasn’t made my hair fall out, but partly I wear the buzz to show solidarity with my sisters-and-brothers-in-disease who have no choice.

And the buzz lets me set the social terms of how I face the disease. I’m not interested in the wan and weepy Romanticism of the 19th century in which the patient stoutly wastes away in a soft bed of pity-whispers.

I’m not interested, either, in keeping stoic secrets, in which cancer becomes the fetus of shame buried in the root cellar, or the insane uncle shut in the attic of fear.

Secrets were an epidemic in my rural New Hampshire family — silences about cancer and alcoholism, about bastards and near-bastards — and those secrets and silences killed people.

The buzz grants me the power to look people in the eye and matter-of-factly say: “I have cancer.” Most people who know me will tell you that my current feral style — looking like some vintage N.F.L. middle linebacker — doesn’t reflect my personality.

I am basically a cream puff. But I like the contradiction, the tension, that the buzz cut seems to represent between my inner and outer lives.

The buzz cut is a kind of veil or, perhaps, a mask hiding my secret identities: one of which is being a cancer patient.

But to be honest, I don’t think I’m hiding anyone. We are, all of us, a bundle of apparent contradictions. Even though I’m a dreamy pragmatist, I need the guy with the glare, the shaved skull and the brutishly broad forehead to help me through the day.

I walk into Balonze Barber Shop in Upper Montclair, N.J., every three weeks and tell the owner, Dennis, that I want the “one-zero” buzz, which is even shorter and tighter than the traditional No.1.

As I settle into the familiar chair, Dennis clicks the blade into place, then flicks on the shears. In a way, that chair and the soothing hum of the clippers are just as important a part of my cancer treatment as the TomoTherapy machine in which I received my seven weeks of radiation.

I revel in the smell of alcohol and shaving cream, shiver at the scritch-scratch-scritch of the straight-edge razor on my neck and sideburns. Dennis is preparing me for the next three weeks, the way James Bond gets prepped for a mission.

Besides the faux surface ferocity, the buzz cut also energizes me, puts an extra bounce in my step. And that metamorphosis also carries me back to childhood, when I’d get my summer “whiffle” cut.

So, too, it’s oddly redolent of the Monkees, neighborhood stickaburr fights and going to the stock car races at Star Speedway in Epping, N.H.

In the Bible, Jacob was renamed Israel after wrestling with an angel of the Lord. And, after wrestling with the dark angel of prostate cancer, I, too, have a new name: Cancer Patient and eventually, I hope, Cancer Survivor.

A new name demands a new look, a new style. In my case, it demands the “one-zero” buzz.

What Will Happen After Treatment for Prostate Cancer?

Completing treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer.

It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. You can learn more about what to look for and how to learn to live with the possibility of cancer coming back in the American Cancer Society document, Living with Uncertainty: The Fear of Cancer Recurrence, available at: (1-800-227-2345).


Follow-up care

After treatment for prostate cancer, your doctor will want to watch you carefully, checking to see if your cancer recurs or spreads further. Your doctor should also outline a follow-up plan. This plan usually includes regular doctor visits, PSA blood tests, and digital rectal exams, which will likely begin within a few months of finishing treatment. Most doctors recommend PSA tests about every 6 months for the first 5 years after treatment, and at least yearly after that. Bone scans or other imaging tests may also be done, depending on your medical situation. This is the time for you to ask your health care team any questions you need answered and to discuss any concerns you might have.

Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can be permanent. Don't hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.

It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment. Should your cancer come back the American Cancer Society document, When Your Cancer Comes Back: Cancer Recurrence gives you information on how to manage and cope with this phase of your treatment. You can get this document by calling: (1-800-227-2345).

Prostate cancer can recur many years after initial treatment, which is why it is important to keep regular doctor visits and report any new symptoms (such as bone pain or problems with urination). Should your prostate cancer come back, your treatment options will depend on where it is thought to be located and what types of treatment you've already had. For more information, see the section, "How is prostate cancer treated?"


Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself in the office of a new doctor. Your original doctor may have moved or retired, or you may have moved or changed doctors for some reason. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy:

*A copy of your pathology report from any biopsy or surgery

* If you had surgery, a copy of your operative report

* If you had radiation therapy, a copy of your treatment summary

* If you were hospitalized, a copy of the discharge summary that every doctor must prepare when patients are sent home from the hospital

* Finally, since some drugs can have long-term side effects, a list of your drugs, drug doses, and when you took them

Lifestyle changes to consider during and after treatment

Having cancer and dealing with treatment can be time-consuming and emotionally draining, but it can also be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even begin this process during cancer treatment.


Make healthier choices

Think about your life before you learned you had cancer. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol, or ate more than you needed, or smoked, or didn't exercise very often. Emotionally, maybe you kept your feelings bottled up, or maybe you let stressful situations go on too long.

Now is not the time to feel guilty or to blame yourself. However, you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier. What better time than now to take advantage of the motivation you have as a result of going through a life-changing experience like having cancer?

You can start by working on those things that you feel most concerned about. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call the American Cancer Society's Quitline® tobacco cessation program at: (1-800-227-2345).


Diet and nutrition

Eating right can be a challenge for anyone, but it can get even tougher during and after cancer treatment. For instance, treatment often may change your sense of taste. Nausea can be a problem. You may lose your appetite for a while and lose weight when you don't want to. On the other hand, some people gain weight even without eating more. This can be frustrating, too.

If you are losing weight or have taste problems during treatment, do the best you can with eating and remember that these problems usually improve over time. You may want to ask your cancer team for a referral to a dietitian, an expert in nutrition who can give you ideas on how to fight some of the side effects of your treatment. You may also find it helps to eat small portions every 2 to 3 hours until you feel better and can go back to a more normal schedule.

One of the best things you can do after treatment is to put healthy eating habits into place. You will be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Try to eat 5 or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit meats that are high in fat. Cut back on processed meats like hot dogs, bologna, and bacon. Get rid of them altogether if you can. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the most. And don't forget to get some type of regular exercise. The combination of a good diet and regular exercise will help you maintain a healthy weight and keep you feeling more energetic.


Rest, fatigue, work, and exercise

Fatigue is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment, and can discourage them from physical activity.

However, exercise can actually help you reduce fatigue. Studies have shown that patients who follow an exercise program tailored to their personal needs feel physically and emotionally improved and can cope better.

If you are ill and need to be on bed rest during treatment, it is normal to expect your fitness, endurance, and muscle strength to decline some. Physical therapy can help you maintain strength and range of motion in your muscles, which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired.

Any program of physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis 3 times a week. If you haven't exercised in a few years but can still get around, you may want to think about taking short walks.

Talk with your health care team before starting, and get their opinion about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.

If you are very tired, though, you will need to balance activity with rest. It is okay to rest when you need to. It is really hard for some people to allow themselves to do that when they are used to working all day or taking care of a household. (For more information about fatigue, please see the document, Cancer-Related Fatigue and Anemia.)


Exercise can improve your physical and emotional health.

* It improves your cardiovascular (heart and circulation) fitness.

* It strengthens your muscles.

* It reduces fatigue.

* It lowers anxiety and depression.

* It makes you feel generally happier.

* It helps you feel better about yourself.

And long term, we know that exercise plays a role in preventing some cancers. The American Cancer Society, in its guidelines on physical activity for cancer prevention, recommends that adults take part in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity are preferable.


How about your emotional health?

Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of people. You may have been going through so much during treatment that you could only focus on getting through your treatment.

Now you may find that you think about the potential of your own death, or the effect of your cancer on your family, friends, and career. You may also begin to re-evaluate your relationship with your spouse or partner. Unexpected issues may also cause concern -- for instance, as you become healthier and have fewer doctor visits, you will see your health care team less often. That can be a source of anxiety for some.

This is an ideal time to seek out emotional and social support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or individual counselors.

Almost everyone who has been through cancer can benefit from getting some type of support. What's best for you depends on your situation and personality. Some people feel safe in peer-support groups or education groups. Others would rather talk in an informal setting, such as church. Others may feel more at ease talking one-on-one with a trusted friend or counselor. Whatever your source of strength or comfort, make sure you have a place to go with your concerns.

The cancer journey can feel very lonely. It is not necessary or realistic to go it all by yourself. And your friends and family may feel shut out if you decide not include them. Let them in -- and let in anyone else who you feel may help. If you aren’t sure who can help, call your American Cancer Society at: (1800-227-2345) and we can put you in touch with an appropriate group or resource.

You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making healthy choices and feeling as well as possible, physically and emotionally.


What happens if treatment is no longer working?

If cancer continues to grow after one kind of treatment, or if it returns, it is often possible to try another treatment plan that might still cure the cancer, or at least shrink the tumors enough to help you live longer and feel better. On the other hand, when a person has received several different medical treatments and the cancer has not been cured, over time the cancer tends to become resistant to all treatment. At this time it's important to weigh the possible limited benefit of a new treatment against the possible downsides, including continued doctor visits and treatment side effects.

Everyone has his or her own way of looking at this. Some people may want to focus on remaining comfortable during their limited time left.

This is likely to be the most difficult time in your battle with cancer -- when you have tried everything medically within reason and it's just not working anymore. Although your doctor may offer you new treatment, you need to consider that at some point, continuing treatment is not likely to improve your health or change your prognosis or survival.

If you want to continue treatment to fight your cancer as long as you can, you still need to consider the odds of more treatment having any benefit. In many cases, your doctor can estimate the response rate for the treatment you are considering. Some people are tempted to try more chemotherapy or radiation, for example, even when their doctors say that the odds of benefit are less than 1%. In this situation, you need to think about and understand your reasons for choosing this plan.

No matter what you decide to do, it is important that you be as comfortable as possible. Make sure you are asking for and getting treatment for any symptoms you might have, such as pain. This type of treatment is called palliative treatment.

Palliative treatment helps relieve symptoms, but is not expected to cure the disease; its main purpose is to improve your quality of life. Sometimes, the treatments you get to control your symptoms are similar to the treatments used to treat cancer. For example, radiation therapy might be given to help relieve bone pain from bone metastasis. Or chemotherapy might be given to help shrink a tumor and keep it from causing a bowel obstruction. But this is not the same as receiving treatment to try to cure the cancer.

At some point, you may benefit from hospice care. Most of the time, this is given at home. Your cancer may be causing symptoms or problems that need attention, and hospice focuses on your comfort. You should know that receiving hospice care doesn't mean you can't have treatment for the problems caused by your cancer or other health conditions. It just means that the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult stage of your cancer.

Remember also that maintaining hope is important. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends -- times that are filled with happiness and meaning. In a way, pausing at this time in your cancer treatment is an opportunity to refocus on the most important things in your life. This is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do.

Last Revised: 08/25/2008

Sexual Function After Treatment

Introduction

Treatment for prostate cancer can affect your sexual function. This information sheet describes what may happen and why, and what is available to assist you. Not all aspects of male sexual problems are covered here - just the ones you may encounter with treatment.

When a man has trouble gaining an erection, doctors call this "erectile dysfunction" or ED. Many factors can influence normal sexual function and one of the most important is simply growing older! But others are diabetes, smoking or a history of smoking, high alcohol intake and some medications. Emotional or psychological stress can also cause a decline in sexual activity. Many men will have a combination of these influential factors, and so there is a wide variability in sexual function as men grow older.

There is a wide variability in sexual function as men grow older; however a gradual decline is normal.

Prostate cancer therapy is an additional negative influence on whatever your normal level of function is. Thus men who had frequent sexual activity before their treatment are more likely to continue this after treatment, than men who were only occasionally sexually active. Similarly those who have weak erections before treatment are likely to have weaker or no erections afterwards. The prostate cancer itself rarely has a direct effect on reducing erectile function.

But let us now look more closely at what sexual activity involves.


Normal Sexual Function

There are four parts to normal sexual function in men - sex drive (also called libido), erection, ejaculation (emission of fluid), and orgasm.


What causes sex drive?

At puberty, the brain increases production of hormones that stimulate greater production of testosterone by the testicles. Testosterone is the main hormone responsible for the development of male sex organs and sexual behaviour. When testosterone levels drop, sex drive diminishes. This occurs naturally with aging, but may also occur with illness, some commonly used medications and with hormone treatment for prostate cancer.


What happens when you have an erection?

The penis contains nerves, smooth muscle and blood vessels in three spongy chambers called sinusoids. When a man is sexually stimulated, the nerves release a substance which causes the smooth muscle to relax. This causes the spongy chambers to dilate and blood is pumped in. The penis elongates shutting off the veins so that blood doesn't leave the penis.

After ejaculation, the nerves stop releasing the smooth muscle relaxing substance, blood flow to the penis is reduced, blood flow out of it increases and the erection subsides. It follows that both nerves and healthy blood vessels are important for erections. The nerves necessary for erections are separate from those involved in the skin sensation from the penis and those involved in orgasm.

Maintaining a healthy blood flow to the penis is essential for successful erections and lifestyle factors can improve it: quitting smoking, reducing alcohol intake, eating a healthy diet, and engaging in regular exercise and physical activity - all can help improve blood flow.


What happens during ejaculation?

Sperm mature and are stored in a structure close to each testis called the epididymis and structures close to the bladder called the seminal vesicles (Figure 1). During ejaculation, semen, which contains sperm and fluid from other sources (such as the prostate and seminal vesicles), is propelled by muscular contractions along tubes into the urethra (urine tube). During ejaculation, a muscular valve at the bladder outlet closes, blocking the outflow of urine and forcing semen out of the penis.

What happens during orgasm?

Orgasm mainly happens in the brain and has little to do with the prostate. As long as normal skin sensation is intact, orgasm can occur even in the absence of an erection and ejaculation. This is the key reason why satisfactory sexual function can be restored to most men after prostate cancer treatment involving surgery or radiotherapy. The common exception here is men receiving hormone therapy, because this frequently causes loss of libido (sexual desire) as well as function.


Why are erections affected by treatment to the prostate gland?

The prostate is not particularly important for normal sexual function. It adds secretions to the ejaculate, which help the sperm to survive. However it does not control the ability to have an erection.

Nevertheless, structures which are important to erectile function lie in close proximity to the prostate and can be damaged when the prostate cancer is treated. A series of fine nerves which assist in the ability to have an erection lie in bundles against the prostatic capsule. During sexual arousal, blood fills the penis to create an erection, and small blood vessels expand in order to deliver enough blood. Prostate cancer treatment such as radiotherapy and surgery can damage both the nerves and the blood vessels.


Trans-urethral resection of the prostate gland

A trans-urethral resection of the prostate (TURP) is an operation to remove prostate tissue through the urine outflow tube (the urethra). It can improve urine flow when the tube is blocked by benign enlargement of the prostate, or by prostate cancer. Only a part of the prostate is removed and so some men call this a "re-bore".

During this operation, the constricting "valve" at the urinary bladder outlet is often opened - so that during ejaculation (because there's no barrier to keep semen from going back into the bladder), semen is propelled into the bladder rather than along the penis to the outside. This results in a "dry ejaculation". It is neither painful nor dangerous and the semen is passed out when the bladder is next emptied.


Radical prostatectomy

During this operation for cancer, the entire prostate and the seminal vesicles are removed. After a radical prostatectomy, initially the focus of attention is on the return of urinary control (continence), as the nerves and muscles controlling urination also lie close to the prostate area.

A man will normally lose the capacity to have erections immediately after the operation, however with time, there is usually some return of erections. In part, the return of erections depends on the extent to which the nerves which lie close to the prostate have been spared during surgery. This in turn depends on how far the cancer extends into this area and so is a choice that the surgeon can make only at the time of surgery. To spare the nerves and also leave cancer behind would defeat the purpose of the operation.

However if it is considered safe to do so, techniques are available to preserve these nerves. More recently some surgeons have been reconstructing the pathway by grafting nerves taken from another part of the body, into the area. Nevertheless, although the nerves are important they are not essential. After a radical prostatectomy, approximately 10% of men who did not have nerves spared have some return of erections.

You may be advised by your doctor to "give it time". After surgery your body needs time to heal. Erections may return gradually. The erection you may have 4 months after surgery is not necessarily as good as the one you will have 2 years later. Many men experience improved natural erections over time with continued improvement reported for up to 4 years postoperatively! Aids to assist with an erection after surgery may improve your long-term function and so you may want to consider these quite early - only a few weeks after your operation.

It is not necessary to achieve erection or penetration in order to achieve orgasm!

After a radical prostatectomy, the stimuli that cause an erection may need to be altered. Visual stimulation may not be as important as direct stimulation of the penis. No damage can be done through experimenting with your sexual activity. If you have a partial erection, go ahead and attempt intercourse - vaginal stimulation will encourage further and better quality erections. Continue with sexual relations even though erections may not occur. Don't wait for the time when they "just happen".

Natural erections can improve for up to 4 years after a radical prostatectomy.

Soon after surgery traditional vaginal penetration may not be easy. Some men have found that if they attempt sexual activity standing up, they can achieve a much firmer erection. Sexual activity can continue either while a man remains standing, or while he's kneeling. Lubrications, such as K-Y jelly, may also help.


Radiotherapy

After radiotherapy to the prostate, sexual function is not usually affected in the short to medium term. Several years after radiotherapy erectile function typically declines gradually. This is thought to be due to the progressive damage to the nerves and small blood vessels near the prostate that are important for erections. It is reported that brachytherapy (interstitial radiotherapy) to control prostate cancer carries a lower risk of erectile dysfunction in comparison to conformal radiotherapy delivered by external beam (see Mr PHIP no 3) or surgery.

Further research is needed on this issue. Intensity modulated radiotherapy is a newer delivery technique that may reduce damage to healthy tissues adjacent to the prostate. Remember also that aging itself has an effect on sexual function!


Hormone Treatment

Control of prostate cancer using hormone therapy usually results in the reduction of testosterone, and sex drive will be diminished for most men. However, continuation of simple physical expressions of love and concern between you and your partner can be very important in the ensuing years.


What you can do

Medications

A group of drugs available in Australia called PDE5 inhibitors (Table 1) can help men achieve an erection or better quality erection. If the medication doesn't work at the first attempt, it may be worthwhile retrying a month or so later. These are not aphrodisiacs (ie do not increase sex drive) and typically direct penile stimulation is required to stimulate an erection when using these drugs. Men on hormone therapy may be helped, but their sexual desire is usually low. These drugs are not subsidized by the Government Pharmaceutical Benefits Scheme (PBS).

Men taking nitrate medication (eg. anginine) for a heart condition must not use these medications as the risk of low blood pressure and sudden death is increased. Your doctor will advise you on your risk or may recommend you seek advice from a heart specialist. Sexual activity is indeed a form of exercise and heart attacks are more likely to occur during exercise than otherwise.




Side effects

Headaches, facial flushing, indigestion and visual disturbances (not reported with Cialis) may be experienced by a few men. There are a small number of medications that if taken at the same time may increase the risk of these side effects, eg. the antibiotic erythromycin and antifungals such as ketoconazole.


Other products and ways of taking them will be made available in the future.

Injection therapy

Direct penile injections are the most effective form of therapy to achieve erections after a radical prostatectomy. A drug is injected each time an erection is required - this occurs without any direct sexual stimulation - it is a chemical response. Caverject ImpulseTM (alprostadil) is the most freely available but, as with PDE5 inhibitors, it is not supported by the PBS scheme.

It is important to start by injecting small doses (eg 2.5 - 5 micrograms) and then gradually increase the dose until a satisfactory result is achieved. This reduces the risk of one of the uncommon side effects - a painful prolonged erection, called priapism. Any erection lasting more than 4 hours with this type of medication requires urgent medical intervention. Typically blood is drained from the penis and an "antidote" injected into the penis. Some doctors prescribe a tablet to help deflate the erection, should it last for 3 hours or more, eg. pseudoephidrine 60 - 120 mg orally.

Most doctors recommend a maximum of 3 injections per week because more frequent use may lead to scarring within the penis. The correct technique of injection therapy can be learned by most men, provided their eyesight and dexterity are reasonable.

There are injectable medications other than Caverject ImpulseTM that have been used, some in combination. As all rely on a relatively normal blood supply to the penis, injection therapy can fail if this is inadequate. Caverject ImpulseTM is in a powder form that can be stored or transported at room temperature. When required it is mixed to a solution in the syringe. Other agents usually require refrigeration to store.





Vacuum erection devices (VEDs)

An erection can be created by drawing blood into the penis by way of a vacuum pump placed over the penis. Once the erection is created, a constrictive band is placed onto the penile base close to the pubic bone to maintain the erection during sexual activity. The band should be released within 30 minutes to reduce the risk of damage to the penis itself. A VED is reusable. Education and personal experience with these devices is very helpful and most companies have video tapes which demonstrate their use. VEDs are not available on the PBS and cost between $500 and $800 each.





Penile prostheses

Devices can be placed within the penis to create a mechanical erection. Such an operation is normally not performed until 2 years after radical prostatectomy since recovery may occur naturally prior to this. During the operation, the normal spongy penile structure is destroyed to allow the device to be placed. Most of the cost of inserting these devices is covered by private health funds.





In conclusion

Most men are able to enjoy a sexual relationship following surgery and radiotherapy, since their sensation of arousal, excitement and orgasm is typically unchanged. What is often lacking is the spontaneous event of a rigid penis. A number of options for achieving an erection have been mentioned and one or more of these is often successful. You can experiment also with other forms of sexual intimacy - there may be new discoveries to be made!

Remember there is no potential for harm to your sexual partner from either the cancer or from any potential urinary leakage during a sexual encounter. Your partner, wherever possible should be included in discussions about your sexuality and treatment choices.

Check out these useful websites:
www.impotence.org www.prostatehealth.org.au www.prostatehealth.org.au

Keep in mind the larger picture. There is far more to a fulfilling relationship than an erect penis, even though the latter often becomes the focus of attention during consultations with doctors! There are many resources available to assist you to explore and develop your relationship (see below). The ultimate goal is to continue a fulfilling relationship and to be rid of a life threatening disease.

Radiation Therapy - Week FOUR

DAY TWO

Today things were 'back to normal' at the Oncology Department. With the Linear Accelerators in full swing; it was 'action stations' and 'full steam ahead'.

On a personal note, I find it amazing, the bond that grows between fellow patients while awaiting treatment day after day!

I guess I would describe it as a bond of 'camaraderie'. You feel as though you are fellow combatants who both understand the enemy and appreciate its resourcefulness and at the same time grow to appreciate and respect the courage in your 'fellow soldiers'!


Laughter is a GOOD Medicine

There’s not much laughter in the Oncology Department, at the best of times. However, having our daughter and her children visit every day for the last few weeks has certainly changed all that!

It has been wonderful to see the smiles on so many faces that previously have simply sat there rather stoically and avoided eye contact with each other!

Many of those receiving treatment in the Oncology Department, are there trying to ‘buy time’.

That is, they have been told that there is NO cure for their condition and are hoping against hope that Radiation treatment will allow them to secure some precious extra weeks … months … years!

Not exactly the setting; for striking up in depth conversations and forging new friendships!

My Treatment

Once again my treatment went off without a hitch! Once again, I am grateful for the incredibly dedicated team who look after us! Well done guys!

My medicine!

Radiation Therapy - Week THREE

DAY TWO

Today we were 'racing against the clock' a bit! Even though we allowed 90 minutes to make a 30 minute journey; BUT ... it rained ... and rained ... and rained! And the traffic slowed to a dead stop, so many times; that we thought for a while, we were not going to make it on time!

Well, we arrived at the hospital at 10:50am, for my 11:15am appointment; very much relieved ... at least I know that I was; only to find that the Radiation Department was well behind schedule anyway.

Treatment number 8, went off without a hitch; and we were back in the car and on the way home before we knew it!

Celebrities

The grandchildren have become quite the celebrities at the hospital. Partly because they represent hope for the future; in an environment which otherwise could represent death or at least many valiant efforts to defeat 'premature' death! And partly because they are just so darn cute!

Little Matti has become something of a star, as 'Nurse Judy' has taken a real shine to her! We no sooner arrive, and Nurse Judy has wisked Matti away from her mother and is off on her 'rounds' to show her off!!

Well today, Banjo decided that he wanted to (once again) accompany grandad to the change room after treatment. I always get a kick out of this! But today, unbeknown to Banjo or me, several of the staff were watching on! I heard the commotion and the: "Now that's really cute / adorable / so nice" etc, and thought that it was Matti once again stealing the show!!

It was only when Banjo and I emerged from the change room that I realised what had happened ... it felt pretty good I must say!

While on the subject of feeling good, I cannot stress (pardon the pun) the absolute importance of remaining as 'upbeat' as possible; even through all the setbacks and challenges! Having my daughter and her two children accompany me each day is like medicine to my soul!

Thanks Lauren!!!