With advances in prostate cancer management, patients are living longer after treatment. In my practice, I routinely ask patients how well they are 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 after 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. I encourage patients to reach out to prostate cancer support groups as well. 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 important 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 leakage to severe leakage. 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 to urinate. We typically offer men urinary pads, and encourage them to perform exercises to strengthen the pelvic floor after treatment of prostate cancer. Symptoms typically improve with conservative management; if, not a procedure may be performed such as artificial urinary sphincter or sling to help men stay dry. Some 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 not experience urinary leakage but they may experience urgency, frequency or take longer to empty their bladder over time, which should raise concerns for the development of scar tissue in the tube that drains the bladder, also known as a urethral stricture or bladder neck contracture. This may require a procedure to help alleviate symptoms.

Intimacy and Sexual Health

Some men have trouble with sexual performance before their treatment of prostate cancer, for others trouble started after treatment. As a urologic surgeon, I recommend men try to have erections as often as they can tolerate it, as regular sexual activity preserves erectile function and length. Men who are treated with surgery or radiation may experience erectile dysfunction. Men may have trouble getting an erection that is firm enough for penetration. Depending on the severity, treatment may include oral medications, injections, vacuum erectile devices and penile prosthesis implantation for patients with advanced erectile dysfunction not responding to oral or injectable medications.

Loss of sexual drive can be addressed by looking at the underlying cause, which can include depression or decreased levels of testosterone. Depression can be treated through collaboration with a therapist. Intimacy issues can be treated in collaboration with a sex therapist. Testosterone may be recommended for the appropriately selected patient. 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 sign of recurrence. Monitoring for recurrence of disease is a routine part of any cancer treatment plan. While the risk is low, exposure to radiation therapy may increase risk for development of secondary cancers such as bladder cancer which can present as blood in the urine. Patients should be encouraged to ask questions and seek clarification regarding anything that is not clearly explained.