Life After—Yes, After!—Prostate Cancer

A man's prostate cancer story isn't necessarily over just because his prostate has been removed or otherwise treated.

One of the biggest worries for men recovering from prostate cancer treatment is that cancer may reappear in the prostate or develop elsewhere.

That is not a misplaced worry. Up to 33 percent of men who survive prostate cancer have a recurrence, and studies show that men who have had prostate cancer may be more susceptible to a second cancer in another part of the body.

Follow-up exams and tests are important both for men who've had a radical prostatectomy—removal of the prostate gland—and those who have had radiation treatment or focal treatment and kept their prostate.

During the first five years after treatment, you're likely to be put on a schedule of biannual exams that may involve PSA tests, digital rectal exams and more, depending on whether you still have your prostate. Bone scans and other tests may also be indicated, again, pending your situation.

During these visits, it's important to report any new problems or symptoms, because they could indicate prostate cancer is coming back or a new cancer is developing.

"The worry is that even if there's an area of the prostate that doesn't have cancer, it may be predisposed to developing cancer later on because of whatever the biological reason is the cancer formed in the first place," said Petar Bajic, M.D., who specializes in men's sexual health with the Cleveland Clinic.

For this reason and others, it's crucial to your long-term health to stick to your follow-up schedule and not skip any appointments for tests, exams or even check-ins with your medical team.

After any kind of prostate cancer treatment, you're likely to face short- and long-term bodily changes. The prostate is closely tied to urinary and sexual function, so there are bound to be physical repercussions once it is removed or otherwise aggressively treated.

Urinary problems

With prostate cancer surgery, one of the sphincters that holds in urine until you're ready to urinate is routinely removed, which often results in "stress incontinence," or urine leakage, when you laugh, cough, lift a heavy object or sneeze.

For most guys, this is just a short-term annoyance. One study indicated 92 percent of men achieved continence within six months after a radical prostatectomy, though up to 8 percent experienced longer-term issues.

Radiation therapy can cause urinary problems, too, but in this case, the issues have to do with irritation of the lining of the urethra and the bladder. The result for most men is what feels like a urinary tract infection (UTI), causing them to need to urinate more frequently and with more urgency for a time. The effects usually pass shortly after treatment ends.

Erectile function

Apart from facing another bout of cancer, the biggest trepidation for most men following prostate cancer treatment is the possibility of losing erectile function.

"That's a pretty popular topic," said Neel Parekh, M.D., who specializes in men's fertility and sexual health with the Cleveland Clinic. "Most cancer surgeons are pretty reluctant to talk about complications, and one of those complications is erectile dysfunction. After cancer surgery, they really like to focus on just the cancer, and oftentimes they don't talk too much with their patients about their sexual health."

The good news is that advances in prostate surgery, such as nerve-sparing techniques, give healthcare professionals the precision they need to preserve the nerves and blood vessels critical to men's erectile function.

"For men who undergo prostate removal and for whom we're able to spare the nerves on both sides, they are going to be the most likely to recover normal erectile function, or at least sufficient for sexual activity," Bajic said.

However, the bad news for men who undergo prostatectomy is they are likely to lose their natural erectile function for about two years before they slowly regain it. With medication, such as daily-dose Cialis or Viagra, exercises to work the pelvic floor muscles, and the possible use of a vacuum pump, men may be able to keep their penis' elasticity and blood flow working in the interim.

Men who opt for radiation treatment face an opposite trajectory. They usually retain erectile function following treatment, but over the course of several years, it tends to decline.

Given a time frame of 15 years, the two types of treatments tend to even out in rates of erectile dysfunction (ED).

"It's not quite as abrupt of a drop in erectile function, but they do, over time, have similar rates of ED," Parekh said. "With surgery, you're not going to get an erection the next day, but with radiation, there might be a little bit of lag time."

Penis length

One other long-term effect of prostatectomy you may not hear much about is a shortening of the penis. When the prostate is removed, the surgeon must also sever and then reconnect the urethra, which often costs the patient a centimeter or two of penile length.

A small Italian study suggested this post-op penis shrinkage continues over the course of the subsequent year, resulting in an average loss of half an inch of length when the penis is flaccid and nearly an inch when stretched. The researchers attributed the phenomenon to not only the cropped urethra, but also the death of nerve cells following the procedure and reduced blood flow.

However, they also noted men who received nerve-sparing surgery lost less length. A separate study indicated the use of a vacuum pump preserves length and improves sexual function.

Dry orgasm

The removal of the prostate gland and seminal vesicles during a radical prostatectomy means the man no longer has the ability to ejaculate. When he reaches orgasm, he will experience a condition called anejaculation: the sensation of orgasm without semen being ejected from the penis.

Despite retaining their prostate gland and the surrounding structures necessary for ejaculation, many radiation treatment patients find they, too, are unable to ejaculate.

One study found 72 percent of men who received pelvic radiation treatment for prostate cancer lost the ability to ejaculate by the time their treatment had ended. Notably, while anejaculation occurred in just 16 percent of the men within the first year of their radiation treatment, by the time five years had passed, 89 percent of them were affected.

While cancer has many causes out of your control, some choices can help you stay healthy following treatment.

Stop smoking

Your lungs may seem a long way from your prostate, but smoking has been linked to prostate cancer and all cancer recurrence in men. One study indicated a reduction in rates of smoking in four states between 1999 and 2010 paralleled a similar decline in prostate cancer deaths.

Another study showed that men who smoked had increased mortality rates for prostate cancer. Conversely, men who had quit smoking for 10 or more years had similar mortality risks as those who never smoked.

Exercise

While regular exercise is important for anyone's health, research shows it can be especially beneficial for men coming off prostate cancer treatment.

A 2015 study suggested that men who were physically active following prostate cancer treatment had a lower overall death rate, as well as a lower death rate due to prostate cancer. A 2008 study indicated that men who were obese or overweight had poorer outcomes if their cancer returned.

Eat healthy foods

Although there's not enough evidence to prove it conclusively, some preliminary evidence suggests a possible correlation between reducing the amount of animal proteins and fats you eat and reduced chances of developing prostate cancer, as well as other cancers.

It is certain, however, that a diet rich in vegetables, fruits, legumes and nuts, and low in processed sugar and animal products, contributes to overall health.

There's more to the cancer journey than just your body. Any kind of treatment to battle a life-threatening disease or condition is bound to have a psychological effect. These unseen wounds can cut deeper than you might imagine, even in men who seem to have come through prostate cancer treatment physically sound.

For instance, it's important for men who have completed prostate cancer surgery, radiation therapy or another form of treatment to remember to take it easy on themselves emotionally. Developing a sense of sympathy for yourself and having patience can go a long way toward helping yourself get through the trauma and stress of treatment and recovery with your mental health intact, as well.

Make sure you seek the help you need in the form of support groups or individual therapy, as well. The Prostate Cancer Foundation provides a list of groups that cater to different types of men.

At the end of the day, the prostate cancer journey continues long after your prostate cancer is gone. It's a chapter in your life that will always be marked in bold. It will surely have an impact on the subsequent stories you live.

Take care of yourself throughout the process and keep your loved ones close as you traverse these paths, and you'll come out the other side healthier, happier and more appreciative of life than you ever were before your diagnosis.