Life Begins At...

The Retiree Magazine Summer 2011-12

Life Begins At.....

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MEN'S HEALTH How is prostate cancer treated? How prostate cancer is treated depends on many factors, including the patient's age and general health, the characteristics of the cancer, such as its aggressiveness and how far it has spread, and what the patient and the doctor decide is best for that individual patient. The common treatments include: • Watchful waiting or active surveillance • Surgery – radical prostatectomy – open / laparoscopic / robotic • Radiotherapy – external beam • Brachytherapy – radioactive seed implants • Hormonal therapies Prostate cancer found early, and treated appropriately, should be able to be cured. Prostate cancer – the bad news All treatments for prostate cancer are likely to cause side effects. This is largely because of the location of the prostate, deep down in the male pelvis, behind the pubic bone and directly underneath the bladder. Any physical treatment, such as surgery, radiotherapy, or brachytherapy, is likely to cause damage to the structures surrounding the prostate. The areas that might suffer from this 'collateral' damage include the bladder control muscles, the nerves to the penis that control erections, the lower bowel, or the bladder or urethra itself. One of the most common treatments is radical prostatectomy (surgery to remove the prostate completely) and it is this treatment most people think of these days when dealing with prostate cancer. It can cause the following problems: • 1 to 5% of men – severe incontinence. • 5 to 15% of men – mild incontinence during physical exertion. • Impotence or erectile dysfunction occurs in up to 75% of men after a radical prostatectomy. • Some men report penile shortening or curvature. • Ejaculation is not possible after prostate removal, as the ejaculatory glands have been removed. • Some men have reported no orgasms, or painful orgasms. It doesn't matter whether the prostate cancer surgery is done in the traditional open way, or with keyhole or robot-assisted techniques, unfortunately there is still the same chance of these complications occurring. Now for the good news All the complications of the treatments for prostate cancer can be treated in their own right. The two most common complications of radical surgical removal of the prostate, and the ones particularly distressing to men with prostate cancer, are the loss of urinary control, and the loss of erections. It is these two issues we will now concentrate on. These happen in a variable number of men, and it is reassuring to know that the numbers have improved over the years. This has particularly come about because of a better understanding of the important anatomy of the nerves and muscles around the prostate, better surgical techniques, and earlier efforts at rehabilitating these functions. Urinary incontinence after prostate cancer "Although not life-threatening, the embarrassment, humiliation and inconvenience that urinary incontinence causes make it a 'social cancer'". This statement was made by British urologist Roger Hadley and published in Campbell's Urology, a number of years ago, but holds just as true now as it did then. The loss of bladder control, apart from being distressing and inconvenient, is associated with significant loss of quality of life. Studies have shown that men with incontinence become depressed, socially isolated, lose their self- esteem, suffer loss of dignity and embarrassment, and make changes to their lifestyle – less travel, less recreational pursuits etc. It can totally change someone's life. Normal bladder control requires normal function of the nervous system, a normal bladder, normal closing muscles of the urethra (water- tube), and a normal pelvic floor (the sheets of muscles that support and surround the pelvic organs). During surgical removal of the prostate, the closing muscles in the urethra may be damaged or shortened, the pelvic floor may be THE RETIREE SUMMER 91

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