Whether you undergo surgery or radiation to treat your prostate cancer, chances are you’ll contend with urinary and sexual side effects afterward.
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Both radical prostatectomy and radiation treatments can damage the delicate structures surrounding the prostate that control urination and erections, leading to urinary incontinence and erectile dysfunction (ED). Radiation also can cause irritative urinary symptoms and, in some cases, rectal side effects.
How severe these side effects are (and how long they’ll last) vary significantly. So before you undergo prostate cancer treatment, ask your physician about side effects and what can be done to manage them.
“Patients should be aware of what the side effect profile of each of these treatments is,” says Andrew Stephenson, MD, Director of the Center of Urologic Oncology. “Just be well-informed and do your homework to understand what impact each of these treatments can have on your quality of life.”
Dealing with ED
Nearly all men undergoing radical prostatectomy experience ED immediately afterward, but most start to regain sexual function within six months, Dr. Stephenson says. Men treated with radiation typically develop no immediate ED, but problems tend to manifest months to years later.
Medications such as avanafil (Stendra®), sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®) can help men with post-treatment ED achieve erections sufficient enough for sexual intercourse. But it’s important to note: You must recover or maintain enough nerve function after treatment for the drugs to work.
If the medications fail to help, you might try a vacuum constriction device, which includes a pump that draws blood into the shaft of the penis to create an erection. Another option is an injection of medication directly into the penis to produce an erection.
To promote a return of natural erections, some experts recommend penile rehabilitation, which entails engaging in sexual stimulation in the immediate post-operative period and, in many cases, administering a prophylactic, or preventive, ED medication. However, evidence supporting this practice is mixed, Dr. Stephenson notes.
“For men who have partial recovery with or without an oral medication, it’s advisable to be patient and allow the recovery process to complete itself before thinking about something more definitive for treatment, because the recovery can be quite protracted,” he adds.
A more definitive option for post-treatment ED that isn’t improved by more conservative therapies is a surgically implanted penile implant. Compared with other treatments, penile prostheses allow for more spontaneity and provide more predictable results, explains urologist Drogo K. Montague, MD.
“The medications don’t work as well after prostatectomy or radiation as they do in other circumstances. If they don’t work, men can try vacuum devices or injections, but most men who are serious about regaining potency will need a penile prosthesis,” Dr. Montague says.
Managing urinary side effects
Most men undergoing radical prostatectomy develop some degree of urinary incontinence and need to wear protective pads to absorb urine leaks as they recover. Usually, men regain continence within six months after surgery, Dr. Stephenson says, although some may need more time.
To help with incontinence, limit fluid consumption (especially in the evening), avoid caffeine and alcohol, and schedule regular bathroom trips so you’re not rushing to urinate. Furthermore, your doctor may recommend pelvic floor exercises — better known as Kegels — to help you strengthen the muscles you use to stop urination. Questions remain about their effectiveness, but the exercises have no risks, and they might help, Dr. Stephenson adds.
Radiation treatments are less likely than surgery to cause urinary incontinence, but they can irritate the urethra and cause painful urination, difficulty emptying the bladder, or an increased urge to urinate. In these instances, and for some men with urinary incontinence, physicians may prescribe medications that relax the bladder, such as mirabegron (Myrbetriq®) and anticholinergic drugs — oxybutynin (Ditropan®), solifenacin (Vesicare®) and tolterodine (Detrol®) are examples.
External-beam radiation also can cause bowel problems, such as diarrhea, rectal bleeding and painful or difficult bowel movements, that require symptomatic treatment, such as anti-diarrheal medication. An injectable hydrogel — SpaceOAR®, which is injected prior to radiation therapy and pushes the rectum away from the prostate — can reduce these side effects.
If you’re among the minority of men with severe, bothersome urinary incontinence that persists a year after radical prostatectomy, ask your physician about surgery to implant an artificial urethral sphincter or a urethral sling. While raising the subject of urinary incontinence can be embarrassing, it’s important to tell your doctor about any lingering problems you’re experiencing, Dr. Montague advises.
“Probably the most underserved people after prostate cancer surgery are the many men who are incontinent and don’t get treatment,” he adds. “There’s a large number of men out there who are just living with their incontinence. It’s a significant quality-of-life issue, and many of those men could be helped.”
More and more men with low-risk prostate cancer are being managed with active surveillance, allowing them to postpone and potentially avoid the urinary and sexual side effects that accompany surgery and radiation. So, review all your treatment options, and ask your doctor if you’re a candidate for active surveillance.
“We need to restrict treatment to patients who have clinically important prostate cancer as a way to reduce the side effects of treatment,” Dr. Stephenson cautions. “So, we should increasingly surveil patients, especially older men who don’t have aggressive prostate cancer.”
This article originally appeared in Cleveland Clinic Men’s Health Advisor.