fbpx After the Trials of Prostate Cancer Treatment, Finally, Recovery
Man in green is surrounded by floating yellow puzzle pieces.
Man in green is surrounded by floating yellow puzzle pieces.

After the Trials of Prostate Cancer Treatment, Finally, Recovery

The weeks and months after intervention can be trying, even if all goes well.
Kurtis Bright
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Kurtis Bright

The good news for men facing prostate cancer is the odds are vastly in their favor. It's true that about 250,000 men will be diagnosed with prostate cancer in the United States this year alone, making up more than 13 percent of all new cancer cases.

However, modern urology has an entire system of exhaustively researched and thoroughly road-tested techniques and protocols in place that give those men the best shot possible at recovery.

Consider this crucial data point: The five-year relative survival rate for prostate cancer is 97.5 percent, according to the National Cancer Institute. This means out of every 100 men diagnosed with prostate cancer, about 98 of them live at least five more years.

That's an astounding statistic. To get an idea of how much progress has been made in the field, if you turn the clock back 40 years, the five-year survival rate drops to about 70 percent. Two generations ago, about 30 in 100 men diagnosed with prostate cancer died within five years; today, only 2 in 100 might not be expected to live that long.

But there's more to surviving prostate cancer than merely getting through treatment. The recovery process is ongoing and often involves challenging lifestyle changes and adaptations.

Here, we'll discuss what men can expect while they're recovering from the most common types of prostate cancer interventions—prostatectomy and radiation therapy—and what they need to talk about with their medical team.

Recovery from prostatectomy

Prostatectomy, the removal of the prostate gland and sometimes the surrounding lymph nodes, is a relatively common and safe procedure. The nerve-sparing version—in which the man's ability to get an erection may be preserved—was first developed in the early 1980s and has since been continuously improved.

The procedure has been developed to the point where almost all prostatectomies are performed robotically. Previously, the standard method was to make a long incision that extended from near the belly button down to the pubic bone, and have the surgeon and their assistant explore the area with their hands.

Today, the robotically assisted laparoscopic prostatectomy involves making a series of small incisions in the belly and inserting instruments and a camera, which are then operated from outside the man's body.

While a prostatectomy is a routine, low-risk procedure often performed on an outpatient basis, a recovery period should be anticipated. You're going to experience trauma whenever you have anything removed from your body, particularly a gland that is located deep inside the pelvis and is so closely tied to urinary and sexual function.

The two most common side effects of surgery are less-rigid erections and urinary incontinence: leakage of urine when you cough, laugh, lift something heavy or sneeze, said Petar Bajic, M.D., whose urology practice is affiliated with the Cleveland Clinic.

"For the vast majority of men, these two issues—if they experience them—are short-lived and generally improve very quickly after the procedure," he said.

Urinary function
Illustration by Jaelen Brock
Illustration by Jaelen Brock

According to medical literature, incontinence rates for men following prostate surgery range from 4 percent to 8 percent; the Cleveland Clinic pegs it at 6 percent to 8 percent. That's because, during the procedure, one sphincter that shuts off urine flow is removed. The prostate is also a component of what's called the "proximal sphincteric unit," and is itself part of the urinary control mechanism.

One of the ways guys can help themselves to a quicker, easier recovery period—perhaps with less incontinence— is to be proactive about it beforehand.

"If it's an option, I strongly recommend guys see a pelvic floor physical therapist to really just start early, even before surgery, to help strengthen the pelvic floor muscles," said Neel Parekh, M.D., who specializes in men's sexual health and fertility with the Cleveland Clinic. "Doing things like Kegel exercises can really improve the continence rate after surgery. And after surgery when you're recovering, it can be really tough to do all these things."

He is a proponent of men learning the exercises before surgery so they can do them correctly after surgery, which can be beneficial.

Another important aspect of your recovery to keep in mind is that following a prostatectomy, you'll need to use a catheter for about a week. During the surgery, the doctor must detach and then reattach the urethra in a new spot because the prostate is no longer present, which also helps explain why urinary function is almost certainly going to be affected afterward, at least for a time.

Remember, however, that when doctors are using modern surgical methods to preserve the surrounding structures, most men recover urinary continence after six to 12 months following robotically assisted laparoscopic surgery.

Let's talk about sex

Okay, on to the question we all dread: What's going to happen to my sex life after prostate surgery?

The simple truth of the matter is there will be changes, at the very least temporarily. The prostate gland is a crucial, if often overlooked, component of the male sexual apparatus, and doing without it is bound to have an effect on your sexual capacity. The good news is it's often temporary.

"Most guys will have some sort of ED [erectile dysfunction] after treatment," Parekh said. "But often, they will regain some of their potency and erectile function within about two years. But some guys will have more permanent issues. It's a lot more common than you might think."

The erectile function you have before surgery is going to be the new baseline afterward. In other words, if you already have some issues with ED, they're not going to disappear after you have your prostate removed, and there is at least a chance they'll get worse. Getting healthy in advance of surgery can make a big difference in how much your sexual health is affected.

"The biggest predictor of erectile dysfunction after surgery is patient preoperative erectile function," Parekh said. "We know that guys that have preexisting ED or a lot of other medical problems—like diabetes, high blood pressure, that sort of thing—are potentially going to have worse ED after treatment."

You can take measures to help alleviate the worst effects during the typical two-year period following prostate surgery when erectile function is most likely to be affected.

"I recommend starting a daily PDE5 inhibitor, such as tadalafil or Cialis, postoperatively," Parekh said. "Plus, I recommend using a vacuum device postoperatively."

This is an issue you don't hear a lot about: During the process of reattaching your urethra after the prostate is removed, you're likely to lose a couple of centimeters of urethra.

That can mean a detectable shortening of the penis.

But according to Parekh, a penis vacuum pump can help you keep what you've got left—and, crucially, deliver blood to a temporarily erection-starved penis.

"Using the vacuum pump kind of helps, maybe not restore, but at least maintain some of that length," Parekh said. "Because if you don't use it, you lose it, so to speak. If the penis isn't getting blood and isn't getting stretched out after surgery for a couple of years, it definitely can lead to reduced elasticity and compliance of the erectile tissue."

Recovery from radiation treatment
Illustration by Jaelen Brock
Illustration by Jaelen Brock

Radiation treatment for prostate cancer differs from surgery in that it allows men to keep their prostate gland. If radiation is used as the only form of treatment, it's usually confined to early-stage cancer that hasn't spread outside the prostate.

Many of the possible side effects and recovery issues men face after radiation therapy are the same as those following surgery, but there are some important differences.

Urinary issues

As with surgery, in the weeks and months following radiation treatment for prostate cancer, men may experience:

  • Urinary frequency and urgency
  • Irritated urethra
  • Burning during urination
  • Bleeding during urination
  • Incontinence

With radiation therapy, longer-term urinary issues are possible, too. These include a bladder condition called radiation cystitis, which can occur even decades after treatment. You can also develop scarring in the urethra or the prostate.

Bowel issues

Different types of radiation therapy can affect the bowels, sometimes causing incontinence and irritation. These effects usually pass after treatment ends, but sometimes can last longer. Some men who get brachytherapy experience rectal bleeding, burning or pain, or a longer-term condition called radiation proctitis.

Erectile dysfunction

Both radiation therapy and prostatectomy can affect erectile function, but they generally do so in distinct ways.

In the short term, men who get surgery often experience ED immediately afterward, and it gets better over time.

For men who opt for radiation treatment, the opposite is often true. They have few erectile issues right away following treatment, but down the road, the radiation's damage to the prostate and surrounding structures takes a toll.

"If you look out 15 years or so after treatment, about the same number of men who undergo both types of treatments are experiencing some type of sexual dysfunction and maybe even urinary dysfunction," Bajic said. "In general, surgery is more likely to have side effects at the beginning, and those side effects tend to get better over time, whereas radiation has fewer side effects at the beginning, but tends to have worse side effects down the road. But by the 10- to 15-year mark, it tends to even out as far as the rates of sexual dysfunction under one type of treatment versus the other."

It's not the end of your life—if you act

Be mindful of one other statistic if all this makes you feel like dragging your heels about getting a procedure done: Once prostate cancer has spread to other parts of the body, the five-year relative survival rate drops to 30 percent.

So while considerations such as age, ability to withstand general anesthesia, and preexisting urinary or erectile issues may factor into which form of treatment you choose, it's important to choose.

And do so without excessive delay if a serious form of cancer is indicated.