Advanced Prostate Cancer
Erectile dysfunction & incontinence
While all cancer-related symptoms and side effects are undesirable, some are more sensitive and emotional than others.
Many of the treatments used to treat advanced stages of prostate cancer can affect a man’s sexual health as well as the ability to control his bladder. Even if you’re prepared for bedroom and bathroom issues, they can be embarrassing and frustrating.
Erectile dysfunction (ED)
The delicate nerves and blood vessels that surround the prostate gland can be damaged during aggressive treatment, causing men to lose control of sexual function. While erectile dysfunction (or impotence) is a physical problem, dealing with the emotions that come with ED can actually help alleviate the symptoms. Talking about your feelings on the subject with your partner – no matter how awkward – will help you both feel closer and intimate while you manage this side effect.
Many treatment types may cause ED, including surgery, radiation (external or internal) and hormone therapy. ED can also be a side effect of some medications, all of which are commonly used to treat other cancers and treatment-related symptoms. Talk to your doctor about reducing the dosage of these medications or switching drugs to see whether you notice any positive changes.
Many patients experience bladder control problems at some point during treatment or recovery, including urinary incontinence (leakage), frequent or urgent urination, or blood in the urine, which can result from radiation therapy or surgery.
In some cases, a tumor blocks the urethra, causing pain and an enlarged bladder. As with ED, this problem can be short- or long-term, depending on the individual patient and his disease. Incontinence can take weeks to months to heal naturally and may be an ongoing problem.
Talk to your doctor about your options when it comes to managing this problem and about the details and risks associated with each of the following:
- Oral medications can help improve the flow of urine or relieve an irritated bladder. These medications include tamsulosin (Flomax), doxazosin (Cardura), alfuzosin (Uroxatral), silodosin (Rapaflo), terazosin (Hytrin), tolterodine (Detrol) and solifenacin (VESIcare).
- Kegel exercises can help strengthen your pelvic floor muscles and increase bladder control. These muscles may be damaged during prostate cancer treatment, causing men to lose bladder control. As with any other muscle in your body, exercising these muscles after they’ve been damaged by cancer or treatment may help make them stronger and may help improve your symptoms over time. The simple act of contracting and relaxing your pelvic floor muscles is easy and discreet, and can also help with bladder control issues. Download the At-A-Glance Chart for more information.
- Medical devices can be used to prevent leakage. Condom catheters are devices that fit over the penis and drain the urine into a storage bag. And penile clamps are V-shaped foam cushions that press on the urethra and allow patients to have more bladder control.
- Collagen injections can be given via the patient’s urethra, helping to narrow the passageway that transports urine and offering some relief from this problem.
- Surgery can help support the urethra and relieve pressure on the bladder.
Whether your problem is mild or severe, speak with your health care team at the first sign of symptoms.
Ways to Manage ED
While some patients will be able to achieve erections naturally over time, others might need to try several options to see improvements. It’s best to talk to your doctor about potential nerve-sparing surgery techniques before treatment, and equally important to follow-up on a regular basis to ensure all issues are quickly addressed. Some of these solutions also come with their own side effects, so make sure you’re aware of the risks and benefits of each.
Walk, run or bike with your partner to increase intimacy while also staying healthy and happy. Exercise can release natural endorphins – similar to those released during sex – and can help relieve tension and aggression while spending time with your significant other. Make sure you get your doctor’s approval before starting any exercise routine.
Injections or suppositories
These options may increase blood flow to the penis, possibly helping men achieve an erection after treatment. In addition to oral medications, some drugs can also be injected into the penis or placed inside the penis as a suppository.
Drugs such as alprostadil (Caverject) or a combination of other drugs can be given by direct injection into the erectile tissues of the penis using a fine needle, similar to those used to inject insulin into a person with diabetes. The goal of the injections is to produce a functional erection that lasts about 30 minutes when you’re ready for sexual activity.
Vacuum erection device (VED)
This is a clear, plastic tube that fits over the penis with a pump that sends blood to the penis by forcing air out of the cylinder. After an erection occurs, a tight-fitting elastic ring is placed around the base of the penis to help maintain firmness during sex. While this can be successful for some men, make sure that you get detailed instructions from your treatment team to avoid injury.
Anxiety and depression often accompany sexual problems, causing low self-esteem and a low libido. Mental health is an important part of every man’s recovery, so get advice and support as soon as you first notice symptoms of depression due to ED or other side effects. Being stressed and scared won’t improve your situation and can actually make things worse, so try your best to discuss these concerns with your doctors before your health is affected.
Certain medications may be helpful for some patients; the most common include:
- sildenafil (Revatio, Viagra)
- tadalafil (Adcirca, Cialis)
- vardenafil (Levitra, Staxyn)
- avanafil (Stendra)
(These drugs are not an option for men taking nitrates or alpha-blockers for high blood pressure, heart disease or urinary control.)
Surgically inserting an implant into a man’s penis can help restore firmness and function if all other avenues have proven to be unsuccessful. Several types of implants are available, so ask a lot of questions to find out if this is an appropriate option for you.
Share your feelings with your partner! Beware of emotions like denial, frustration, despair or shame, which can come with sexual issues and lead to hurt feelings and bruised egos. Many men become stressed unnecessarily because they assume their significant other is disappointed in their sex life. In reality, your partner is undoubtedly thankful to have you alive, so don’t punish yourself. Tell your partner how you feel, and listen as you both express emotions so that you can work together as a team.