Dr. Ira Hantman (Courtesy of Kevin Parks/Mercy…)
Because of advanced treatments, curing prostate cancer has become more common. There now are more than 2.5 million survivors in the United States. Still, many men suffer from side effects after treatment, which may be a deterrent to obtaining care or even discussing the matter with a doctor. But early diagnosis and appropriate treatment will provide the best outcomes, according to Dr. Ira E. Hantman, a urologist with Urology Specialists of Maryland at Mercy Medical Center in Baltimore. He said men should discuss the pros and cons of screening with their doctors as they approach 50.
What long-term effects do men typically suffer after prostate cancer treatment?
The treatment options for prostate cancer have improved significantly over the years. There are three basic choices available to treat localized prostate cancer. These include surgical approaches, most importantly robotic prostatectomy (i.e., robot-assisted laparoscopic surgery); various types of radiation treatments including brachytherapy (placing radioactive seeds in the prostate gland); and active surveillance. Most common long-term side effects of any treatment for prostate cancer are related to urinary issues, including incontinence (difficulty controlling urination), urgency and frequency, as well as sexual problems (erectile dysfunction).
Can they be harmful, or are they more quality-of-life issues?
Although these side effects are not necessarily harmful in terms of longevity, obviously if these problems occur they will have a significant effect on one's quality of life. Fortunately, with the advent of robotic surgery and brachytherapy, these side effects are greatly reduced. The incidence of long-term urinary incontinence is less than 5 percent, and preservation of sexual function is as high as 70 percent to 80 percent. The patient's pre-treatment health and age will certainly have an effect on the post-treatment outcomes.
Will they improve on their own, or do they require treatment? And what kind of doctor would address them?
These side effects will improve with time. It may take as long as six months for urinary incontinence to resolve after surgery. It may take longer, usually six months to a year, for return of normal sexual function after surgery. After radiation treatment, these urinary issues (including frequency and urgency) usually will resolve in a shorter period of time, although the sexual problems tend to occur in a delayed fashion, usually presenting at six months to 1 year after radiation. Certainly if either of these problems persist, it is best to be treated by one's urologist. There are several treatments for incontinence/ including medication, urethral injections and, if necessary, surgical correction. There is also a broad array of options to treat impotency. Again, the spectrum will range from medical intervention to ultimately surgical correction if necessary.
How often do men need follow-up exams or testing to ensure there is no recurrence of cancer?
Because of the advances in urology, cure rates for localized prostate cancer have become extremely high, approaching 90 percent. Continued follow-up is quite important. Usually, men should be seen every six months for the first five years after treatment and then yearly after that. The follow-up usually includes a physical exam as well as continuous monitoring of the patient's PSA blood levels. Further testing may be necessary if the PSA levels do start to increase. Additional treatments may be necessary if there appears to be a recurrence. It is quite important that this be done at an early point in time for more successful outcomes.
Is there support for men who have side effects or anxiety following care?
There are prostate cancer support groups available. It is often quite helpful to hear that other men have gone through similar issues during their recovery. Other patients with similar problems are a great resource for information. These support groups are generally found through various websites, including the Prostate Cancer Foundation and the American Urological Association. Also the Mercy website can be used as a link.