Living with the consequences

Early detection means that there are now more prostate cancer survivors than ever. But it comes at a price. Annie May reports.

When a man is diagnosed with prostate cancer the focus is most often on treating the disease and not the post-prostate cancer issues that can arise.

And while these issues may not be life-threatening they can be just as distressing to the patient as the cancer itself.

Every year in Australia about 20,000 men are diagnosed with prostate cancer, the most common type of cancer in the nation’s men.

Survival rates are high, at about 95 per cent in cases where it’s caught early and is still localised.

However a number of recovering patients suffer from the debilitating side effects such as erectile dysfunction and incontinence issues as a result of the life saving surgery.

Impotence after prostate cancer can be as high as 97 per cent from some treatments, according to new research. The five-year population wide study compared sexual function and sexual bother in more than 1600 patients and 500 controls.

Dr David Smith, lead researcher and Cancer Council epidemiologist, says the findings shed a new light on the extent and duration of one of the most common side-effects of prostate cancer treatment.

“There is a widespread perception that symptoms ease with time, but there has been little in the way of research to confirm whether this is the case.”

“Our study shows that for conventional prostate cancer treatments, with the exception of low dose brachytherapy, patients experience high levels of impotence which is still evident after five years.”

Androgen deprivation therapy fared the worst, with 94 per cent of patients impotent after two years and 97 per cent after five years. High and persistent levels were also evident with radical prostatectomy (79/77 per cent) and external beam therapy (68/70 per cent), with worse outcomes when the treatments were combined (77/82 per cent).

Smith says nerve sparing surgery improved outcomes slightly, but only low dose rate brachytherapy had relatively low levels of impotence, with 38 per cent impotent after two years and 43 per cent after five years.

“Clinicians tend to underestimate side-effects following prostate cancer treatment and invariably are surprised when they learn of the extent and duration of impotence following treatment,” he says.

Professor Bruce Mann, Clinical Oncological Society of Australia president, says the study is important in clarifying the level of risk associated with prostate cancer treatment.

“Clinicians can use the findings of this study to more accurately inform their patients of the benefits, as well as the potential consequences of testing and treatment for prostate cancer,” says Mann.

“While there are new technologies for prostate cancer treatment in recent years, we need a follow-up study like this to confirm whether these developments have been able to reduce side-effects like impotence.”

And for those who decide to undergo surgery, if successful, surviving prostate cancer is only part of the battle for some. Timely rehabilitation is key to minimising post-surgery issues that often cause emotional and psychological problems for patients and their families, says Dr Michael Gillman, St Andrew’s War Memorial Hospital men’s health expert.

“Of10 post-prostate surgery men and their partners don’t see sex as a priority straight away. They figure they’ll worry about it later, but men need regular erections to keep oxygenated blood flowing to their penis. This often doesn’t happen naturally post-prostate surgery as the nerves which switch blood supply to the penis often go into hibernation if they are disturbed which is common when the prostate gland is removed.”

“If the penis doesn’t get enough oxygenated blood flowing to it, corporal fibrosis and erectile scar tissue can develop. When that occurs there’s a possibility that the man can become permanently impotent, even after the nerves recover.”

Luckily, there are a number of options available to men to keep the blood flowing where it needs to and maintain erections during this period.

They include medications known as PDE-5 inhibitors, like Viagra, which improve blood flow to the penis. But PDE-5 inhibitors only work if the nerves to the penis are intact post-surgery. If they’re not, penile injection therapy is a more suitable option, as it also stimulates blood flow into penis, says Gillman.

There isn’t yet a consensus or a set of guidelines on exactly what protocol works best. However, Gillman says that may not be as important as it sounds. “It probably does not matter what treatment is used as long as it is producing regular erections until spontaneous erections reoccur,” he said.

“Men don’t need to suffer in silence, there is help available and they should be proactively counselled to seek this assistance.”

Prostate cancer: the facts
* Each year in Australia, close to 3300 men die of prostate
* Each day about 32 men learn news that they have prostate cancer
* One man every three hours will lose his battle against the disease
* One in 9 men in Australia will develop prostate cancer in their lifetime
* Prostate cancer is the most common cancer in Australian men and is the second most common cause of cancer deaths in men
* As many men die from prostate cancer as women die from breast cancer but a national survey by PCFA in 2002 showed that while 78% of women felt well informed about breast cancer only 52% of men felt informed about prostate cancer
* For every 100 men who die of prostate cancer in a metropolitan area of Australia (such as Melbourne or Sydney) 121 men will die in rural Australia. Various factors may include lack of awareness and education about prostate cancer, distance from testing and treatment, poor GP awareness and limited access to specialists.

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