How Will Sex After Prostate Cancer Be Different
One of the treatments of prostate cancer is to remove a portion of the prostate or the totality of the gland before cancer spreads beyond it You may have heard that the tumor is inside the capsule, but moving fast.
The procedure is known as radical prostatectomy and involves incisions, either above the perineum or on the lower abdomen.
Newer surgeries are sometimes robot-assisted, and we also have laparoscopic prostatectomies that do not require a large incision.
The end result is the removal of a portion or the totality of the prostate, and certain surgical approaches may be associated with a lower risk of nerve damage than others. Youll see this referred to as nerve-sparing prostatectomies throughout this guide.
As soon as a man is informed that he will need to go through a Radical Prostatectomy, the likelihood is that one of the very first questions will be about the effect that it will have on their sex life. In a lot of mens minds, the surgery is thought of like its castration.
However, now that there are multiple types of nerve-sparing prostate surgery, many men have found they can maintain sexual activity after surgery.
Likewise, there are plenty of sexual activities open to those who do find they still have the desire, even with some physical changes. We want to help you understand the changes that men can experience after prostate surgery, whether that is physical or mental.
For more information on prostate surgery, click here.
What Typically Increases The Risk Of Complications From Prostate Cancer Surgery
Complication risks can be increased if prior surgery for unrelated reasons was done in the area or if we have to do extensive surgery to remove the cancer. But complication rates also go up dramatically when we do surgery on patients who have failed other prostate cancer treatments, such as radiation therapy.
Radiation is a very effective treatment for prostate cancer, but it doesnt work for everyone. In these patients, we often believe the cancer has recurred or persisted in the prostate without spreading, so removing the prostate following failed radiation treatment a procedure called salvage prostatectomy is potentially curative.
Salvage prostatectomy is more technically challenging than radical prostatectomy. Patients who have already had radiation therapy often have scarring in and around the prostate, which can make tissue in the area very difficult to separate while performing the operation. As a result, patients undergoing salvage prostatectomy have a much higher risk of urinary incontinence, and a higher rate of developing more scar tissue, strictures which is a narrowing of the urethra that blocks urine flow or injury to adjacent structures like the rectum.
While In The Hospital
It’s important to your recovery to start moving as soon as possible. Most men are out of bed and walking around the unit on the same day as their surgery. Your nurse will assist you until you can manage on your own. When you first get up, raise the head of your bed, take a couple of deep breaths, and allow your body to adjust to the change in position. Dangle your feet over the side of the bed for a few minutes, then slowly stand up. Be careful because getting up too quickly can make you light-headed.
Get out of bed at least three times each day preferably more. This helps prevent lung infections and blood clots. You may be prescribed an injectable blood thinner to further reduce the risk of blood clots. The more time you spend out of bed, the faster you will recover and the faster your bowel function will return to normal. Your nurse will also give you an oral stool softener and mild laxative to prevent constipation.
In addition to walking, you will be encouraged to do two other things that help prevent complications: Use an incentive spirometer , and wear compression stockings while in bed. Both will be provided and the nurses will instruct you on how to use them.
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Considerations When Opting For Surgery
Before agreeing with any surgery, knowing its benefits and risks is vital. It is even more important when the surgery is not urgent, like in the cases of proctectomy.
Thus, one should ask a doctor about various treatment options, prostate surgery recovery, and what to expect after prostate surgery.
Sometimes prostate surgery is one of the options. Thus, it is important to ask a doctor if it would be better to have some watchful waiting.
If one goes for prostate removal, one should know about the benefits, prostate surgery complications, the side effects of living without a prostate, how long prostate cancer surgery is, its impact on sex life, etc.
Additionally, one should inquire about all the surgical options available and consider the risk and benefits of each of the options.
Quite often, doctors may also help in making the decision. Here good communication with a healthcare provider is the key.
I Dont Have Erections After Surgery Am I Impotent For Life
Think of your erections as a well conditioned athlete, who has been injured. This injury is going to take time to heal. You should try to remain patient, and remember that this will be an ongoing battle for many months and even years. Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.
If you see any fullness in your erections in the months after your robotic prostatectomy surgery, this is a positive sign that some of the nerves are working or re-growing. You are taking the first steps down the potency recovery path. Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.
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What Is Considered Rising Psa After Prostatectomy
After radical prostatectomy, it takes the PSA quantities in patients blood to drop to undetectable levels in four to eight weeks. Within this timeframe, the doctors will perform the first PSA test after prostatectomy in order to determine whether there are any signs left of prostate cancer.
So, the question is: Can you have a PSA reading after the surgical removal of the prostate gland? Since PSA is a type of protein produced only by prostate cells and prostate cancer cells, when you eliminate one of the two sources of PSA, any trace of PSA presence can indicate the only source left: a prostate tumor.
This usually happens when the tumor is advanced at the time of surgery and could have already spread its cancer cells to other parts of the body.
It is considered elevated PSA after prostatectomy a PSA greater than 0.2 ng/ml. If the prostate cells are grown enough to generate detectable levels of PSA, this could be an alarming point both for the patient and the doctor.
It is important to note that a 0.2 ng/ml level of PSA is not alarming when first diagnosed with prostate cancer. Thats because the prostate gland generates a certain level of PSA by itself, even in healthy men. However, the same reading becomes a reason for concern after a radical removal of the prostate gland. The PSA level after prostatectomy is expected to be zero or at undetectable levels unless the prostate cancer cells had already spread to other parts of the body.
Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
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What Happens After Radical Prostatectomy
Patients are usually discharged within 24 hours of surgery after radical prostatectomy.
You may have a drain that gets rid of excess fluid from the surgery site. If a drain is placed at the time of surgery, it is typically removed before you leave the hospital.
A urinary catheter continues to drain your urine into a bag. You may need to leave the catheter in place at home for a few days to one week.
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Am I Too Old To Have Prostate Surgery
How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense that is, for the benefits to outweigh the risks you need to be young enough to take advantage of the added survival time that surgery can offer. Thats why I generally dont recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
Can You Live Without A Prostate
Although the prostate is essential for reproduction, it is not essential to live.
In cases where the cancer is contained to the prostate it can be surgically removed through a prostatectomy.
A radical prostatectomy involves removing the entire prostate gland, the surrounding tissue, and some of the seminal vesicles.
Alternatively, laser prostatectomies can be effective as the least invasive type of prostate removal.
The most common prostatectomy is the transurethral resection of the prostate .
TURPs involve removing part of the prostate gland using a resectoscope which is passed through the urethra – this procedure is commonly used for people with an enlarged prostate.
In come cases prostate cancer can be treated with radiotherapy.
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Erectile Dysfunction After Prostate Surgery
At least one in five men over the age of 40 experience some degree of erectile dysfunction, which is the difficulty getting or maintaining an erection. Erectile dysfunction is more common if you have a chronic disease such as diabetes, are overweight, smoke cigarettes or dont exercise.
Prostate cancer treatment increases your likelihood of erectile dysfunction considerably, with up to 85% of men having problems with getting and keeping an erection after surgery2. This is because your prostate is located next to the nerves, blood vessels and muscles that help you have an erection, and surgery to treat prostate cancer can damage these areas. However, surgical techniques and technologies can help prevent damage to the nerves that allow erections and lower the chance of permanent erectile dysfunction. Factors such as your age, erectile function before surgery, other health conditions you may have, how well the nerves are preserved during surgery and the recovery process can influence your outcomes. It can take between 18 and 24 months after prostate surgery for your erections to improve.
The process can be particularly distressing for transwomen. The diagnoses of prostate cancer and the interaction with the health system can be a rather traumatic period for these individuals, Brett-Renes says.
How Common Is Prostate Cancer
Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. A non-smoking man is more likely to develop prostate cancer than he is to develop lung, colon, rectal, bladder, melanoma, lymphoma and kidney cancers combined. In fact, a man is 35 percent more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
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What Are The Long
As per the American Cancer Society, there are two common long-term effects when the prostate is removed urinary inconsistency and erectile dysfuction.
Both these issues are quite common and will last at least three months in all the cases. Most will see improvement in about 12 months.
Nevertheless, some urinary issues and erectile dysfunction may be chronic and last for a few years, requiring continuous care and treatment.
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Risks Of Radical Prostatectomy
Radical prostatectomy has a low risk of serious complications. Death or serious disability caused by radical prostatectomy is extremely rare.
Still, complications from unintended nerve damage can happen after radical prostatectomy. They include:
Urinary incontinence. This means trouble controlling your urine, leaking, or dribbling. If you have incontinence, talk to your doctor about treatments that can help.
Erectile dysfunction . Problems with erections are common after prostatectomy. Still, most men are able to have sex after prostatectomy while using medicines for ED , an external pump, or injectable medications. The younger you are, the higher the chance that youâll be able to get erections after surgery.
Most doctors think you can help yourself regain your ability to get erections if you try to get one as soon as possible once your body has had time to heal â often several weeks after your surgery. This is called âpenile rehabilitation.â Talk to your doctor before you try it.
Much of the skill involved in radical prostatectomy centers on sparing these nerves during the operation. A man undergoing radical prostatectomy by a surgeon at an advanced prostate cancer center has a better chance of keeping their sexual and urinary function.
Other complications of radical prostatectomy include:
- Bleeding after the operation
- Narrowing of the urethra, blocking urine flow
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A Large Role For Radiation Therapy
People diagnosed with localized prostate cancerthat is, disease that hasnt spread outside the prostate regionhave many potential treatment options, depending on the stage and grade . Some may have surgery alone. Others may only have radiation therapy.
And some may have a combination of the two. This often happens when theres concern that surgery hadnt removed all the tumor tissue. Or, if someones prostate-specific antigen levels start to rise months or years after surgery, radiation therapy may be recommended even if imaging hasnt been able to identify tumor growth.
Hypofractionated radiation therapy is already an accepted treatment option for some people undergoing radiation therapy alone to treat prostate cancer. But whether this type of radiation therapy is appropriate for use after surgery has been unclear.
When radiation is used after surgery, its delivered to a larger area of the body, including sensitive areas in the bladder and rectum, Dr. Buyyounouski explained. This raises the possibility that the higher doses used in hypofractionation may cause long-term side effects that could outweigh the benefit of two fewer weeks of treatment for these patients.
And a lot of people do have some urinary complications after surgery, said Dr. Citrin. So even a small increase in urinary or bowel symptoms that persist after treatment with one regimen versus the other could be quite impactful in terms of quality of life.
How To Treat Erectile Dysfunction After Prostate Surgery
Prostate surgery is challenging enough. But to make matters worse, such an operation may impact ones sex life. The prostate is a vital part of the reproductive system. Its responsible for producing fluids that carry sperm.
So when the prostate is affected, this can lead to conditions like erectile dysfunction.
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Making An Informed Decision
There are many things to consider when agreeing to proctectomy. Thus, one should ask healthcare providers various questions, from the cost of prostate cancer surgery to prostate cancer surgery after side effects.
During appointments or doctor visits, take more interest in prostate cancer treatment medications, supplements, how the process is done, whether the doctor would consider hormone therapy, other treatment options, sex life after prostatectomy, diet after surgery, rehabilitation, and more.
When agreeing to proctectomy, one should consider the risk and benefits and explore all non-surgical options. Once the prostate gland is removed, one will have to live with specific issues for a long.
Getting Treatment And Support
Speak to your GP or doctor or nurse at the hospital.
Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether its for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit.
Talking about sex
It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. It can also help you feel more positive and more in control.
You can ask about sexual problems at any stage before, during or after your prostate cancer treatment. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they dont then you may need to bring it up yourself.
Not everyone is used to talking about sex. You might need to bring it up more than once, or with a different person in your team. You can also ask to be referred to an expert in sexual problems or an ED clinic they will be used to talking about sexual problems.
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