What happens after treatment for prostate cancer?

After treatment for prostate cancer has been completed, your doctor will advise how often check-ups are needed. These will gradually become less frequent if you have no further problems. After treatment you may have problems related to continence, sexual functioning, and fertility, though there are practical ways to improve most of these.

Ask what you should look for

Many people worry that any pain or illness is a sign that the cancer is coming back. This is usually not the case, but if you are worried about whether the cancer is going to come back, ask your doctor what to expect. You may feel less worried if you know exactly what to look out for and what you do not have to worry about.

If the cancer returns, you may need further treatment. It is important to report any new symptoms to your doctor.

Improving incontinence

A man may have continence problems after a radical prostatectomy (surgical removal of the prostate gland), one of the options in treatment of prostate cancer. Problems with continence after this procedure are usually temporary. Very few people continue to have significant incontinence on a long-term basis.

Kegel exercises that involve exercising the muscles of the pelvic floor help many men regain bladder control after prostate surgery. It is advisable to start these exercises before starting treatment as normal sensations may be confused for several weeks afterwards.

Ask your doctor, a nurse or a physiotherapist for information about pelvic floor exercises. In some areas there are specialist continence advisory nurses. Rarely, men may need further surgery to implant an artificial sphincter (shut-off valve) if incontinence persists or worsens.

Sexuality and prostate cancer

Men who have had treatment for prostate cancer may experience changes in their sexual functioning and fertility. Ask your doctor what is likely to be the outcome in your case.

It is often assumed that sexual intercourse involves the successful penetration of one’s partner and that this is the only way to achieve the pleasure of an orgasm. However, men can still enjoy a sexual relationship and have an orgasm without the need to have an erection or achieve penetration.

Men may find it difficult to talk to their partners for fear of failure or rejection, but these fears are often mistaken. Sexual relationships are built on many things like love, trust and common experiences.

Developing different skills

Following radical prostatectomy or radical radiation treatment a man will no longer ejaculate semen, so he will have a ‘dry’ orgasm. Some men say this feels totally normal, while others say the orgasm does not feel as strong, long lasting or pleasurable.

Sexual partners need to develop different skills to achieve a non-penetrative orgasm. It will probably take longer to reach an orgasm, which means there will be more time to enjoy the mutual pleasures of intimate bodily contact. This is often dismissed as foreplay when penetrative sexual intercourse is seen as the goal of sexual activity.

Keep in mind that no matter what kind of cancer treatment you have, you will almost always be able to feel pleasure from touching.

Practical solutions for impotence

There are practical ways to help overcome impotence, including:

• Physical devices such as vacuum pumps and constriction rings can help you to achieve and maintain an erection.
• Drug treatments, such as:
  -injections given straight into the penis to achieve an erection work on many men
  -oral drugs (such as Viagra, Cialis or Levitra) are options to discuss with your doctor. These drugs cannot be used by men who take nitrate-based medicine for heart problems.

Sexual counselling

If you find the loss of your sex life or changes in your sex life disturbing you should discuss this with your doctors and, if you are in a relationship, with your partner. It may be helpful to have some sexual counselling – ask your specialist, your GP or your local Cancer Society if there are any counsellors in your area who specialise in sexual counselling.

There may also be a specialist impotence advisory service in your area where you can discuss treatment options.

Talking to another man who has had this experience following treatment for prostate cancer may be helpful.

Cancer support

Cancer support groups offer mutual support and information to people with cancer and their families. It can help to talk with others who have gone through the same experience. Support groups can also offer many practical suggestions and ways of coping.

In addition, the Cancer Information Helpline is a Cancer Society service where you can talk about your concerns and needs with specially trained nurses (contact details under 'Further information and support' below).

Original material provided by the Cancer Society of New Zealand, 2008. Reviewed by everybody, July 2010.