Prostate Cancer FAQs
What is the prostate, what does it do?
The prostate is a gland that sits just below the bladder in men. It is about the size of a walnut and surrounds the urethra (the tube which your urine passes through as it leaves the bladder) and plays an important role in fertility. It produces seminal fluid which contains enzymes, zinc, citrate and fructose which helps sperm survive within the fluid.
What are the risk factors for developing prostate cancer?
Age: Increasing age is the main risk factor for prostate cancer. For white men with no family history, the risk for getting prostate cancer increases significantly after the age of 50. This is why routine screening investigations are recommended from age 50 onwards.
Family history: Having a close relative diagnosed with prostate cancer is another risk factor. Having multiple relatives diagnosed (such as a brother and a father) further increases this risk. Risk is further increased if those relatives were diagnosed at a younger age. The increased risk has been reported to be up to 2.3 fold increased likelihood of a prostate cancer diagnosis.
Several lifestyle factors have been identified as modifiable risk factors associated with prostate cancer development and prognosis such as smoking and physical activity. Smoking cessation and engaging in physical activity has shown to have positive impacts on reducing the risk of developing prostate cancer and improving outcomes with a prostate cancer diagnosis.
What are the symptoms of prostate cancer?
Urinary symptoms are the most typical symptoms one may experience with prostate cancer and include:
- Weakened flow whilst urinating
- Difficulty commencing urination
- Painful urination
- Difficulty fully emptying the bladder
- Increased frequency of urination
- Painful orgasm/ejaculation
- Difficulty achieving or maintaining erection
Many men can also be asymptomatic.
How is prostate cancer diagnosed?
A PSA test (prostate specific antigen) and/or a DRE (digital rectal examination) are used to routinely screen for prostate cancer. Elevated PSA indicates an increased risk of prostate cancer, however, is not definitive as there are other factors which may increase PSA levels. A medical practitioner may perform a DRE in conjunction to feel for abnormalities of the prostate.
If prostate cancer is suspected with the above screening tests, a biopsy will usually be done. This involves taking a part of the prostate tissue and examining it under a microscope for cancerous cells. This is the only way in which prostate cancer can be confirmed.
What are the treatment options for prostate cancer?
There are two main treatment options for prostate cancer. Each having varying side effects.
- Surgery (prostatectomy): This involves removal of the whole prostate gland.
- Radiation: This involves targeted radiation at the cancerous cells in the prostate gland
What are the side effects of prostate cancer treatment?
- Incontinence: Most men have urinary incontinence initially after surgery, however this can and typically recovers over time and with physiotherapy. Due to its proximity to the prostate, the removal of the internal urinary sphincter is necessary. This is one of our muscles we rely on to maintain our continence. It is under involuntary control, meaning it requires no active thought from the brain to make it contract and acts to constrict the urethra preventing the flow of urine. After its removal during the surgery, we need to rely on other pelvic floor muscles to compensate for this. Our pelvic floor muscles play an important role in helping us control our bladder.
- Sexual dysfunction: Prostatectomy can also result in changes in sexual function. This can include problems with erections, pain with orgasm, difficulty reaching orgasm and decreased sensation. A nerve called the cavernous nerve supplies the penis and is responsible for sexual function and being able to achieve erections. Due to the proximity of the cavernous nerves to the prostate, they are impacted during surgery. These nerves form a bundle which surrounds the prostate gland and can be spared during the operation. However, during the procedure they are moved out of the way and become ‘shocked’, losing their function due to the irritation. Over time and with stimulation of these nerves, there is potential for recovery.
- Penile shortening - as the prostate is removed so is the portion of the urethra that passes through it - the urethra is then attached at the bladder neck, shortening it. Over time, the bladder drops down, lengthening the portion of the urethra external to the body.
- Side effects with radiation are similar to that one would experience with surgery, however, there are a few differences. Typically side effects from radiation therapy will occur later, about between two and five years. This is due to radiation destroying the cancerous and surrounding prostate tissue over time rather than immediately as occurs in surgery.
- Incontinence: Incontinence is a common side effect with radiation as well, however, the type of incontinence is varied. With radiation, urge incontinence is predominant versus stress incontinence. Urge incontinence is where the communication between the bladder and the brain is compromised causing extremely strong urges to pee when the bladder isn’t full, and frequent urination which can be very disruptive to our daily lives.
How can physiotherapy help with prostate cancer treatment?
Physiotherapy with prostate cancer focuses on optimising outcomes with urinary and sexual dysfunction post operatively. This largely consists of pelvic floor muscle training exercises in order to re-train them to function properly. With the removal of the internal urinary sphincter, we must train the brain to activate other pelvic floor muscles to contract to help us remain continent. A physiotherapist will help guide you in how to achieve this and provide feedback on how you are going with training this.
It is also valuable to see a physiotherapist for education around what to expect before and after your surgery. Having a good understanding of this can help set you up for success. This stuff can be hard to talk about. Having a physiotherapist whom you see regularly and have a good rapport with can help provide a space for you to discuss these sensitive topics.
Lifestyle changes such as weight loss, improving your diet and engaging in a regular exercise program can help improve your outcomes with prostate cancer. A physiotherapist can also help guide you here.
What will physiotherapy pre-operatively entail?
What will physiotherapy post-operatively entail?
How long will it take to regain my continence after prostate surgery?
Most men will recover continence within 6-9 months after prostatectomy. At 12 months, about 90% of men usually have recovered their continence. These are general timeframes, and each person is unique. Consult with your urologist, general practitioner and physiotherapist to gain a fuller understanding of your recovery timeframe.
How long will it take to regain my erectile function after prostate surgery?
Erectile function can take a while to recover - usually between 12 and 24 months. Nerves are very sensitive and recover slowly. The impact from the ‘shock’ during surgery means it takes a significant amount of time for their function to be restored. The change to your ability to obtain and sustain arrousal can be quite confronting. Undoubtedly, this will have a large impact on your sexual life. Yet, it's important to navigate this part of your recovery in an open and intentional way, seeking the guidance of your physiotherapist, and medical professionals. There are many ways to improve the odds of you having a full sexual recovery after prostatectomy, starting as early as a few weeks post-operatively.
If you need help with any of this, we would love to help you out!
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