The media is full of articles about prostate cancer and just recently we had another scare when researchers at the Fred Hutchinson Cancer Research Centre in Seattle apparently found that men who take too many fish oil supplements or eat too much fatty fish may be likely to develop prostate cancer. Do we really need all these scare campaigns?
I rather would like to pay attention to the alarming fact that’s often overlooked when men learn they have prostate cancer.
Australia has one of the highest rates of prostate cancer diagnosis in the world, the result of regular testing.
Unfortunately, this means many men who are diagnosed receive unwarranted treatments that can leave them impotent, incontinent or both.
Men usually undergo needle biopsies when they have elevated levels of a blood test called prostate-specific antigen (PSA).
If the biopsy reveals cancer cells, a pathologist measures the severity in a range between one and 10. This is known as the Gleason score. Most prostate cancers score between six and seven. Several top urologists now agree that prostate cancer below a Gleason score of six should be watched but not treated.
At the Prostate Cancer World Congress in Melbourne last month, 14 opinion leaders agreed on a prostate cancer testing schedule. They believe that all men in their 40s should have a baseline PSA test to help predict their risk of developing prostate cancer.
Men who have a low risk won’t need to be tested again for five to seven years. Those who have a reading above the median for their age will be put under “active surveillance” with regular biopsies and blood tests. But they will have treatment only if the disease shows signs of progressing.
Testing should be decoupled from treatment which could have unwelcome outcomes for many men. Men with low-risk prostate cancer do not need aggressive treatment, which can leave them with sexual dysfunction or incontinence.
Until 1982 most men who had radical prostate surgery became impotent but then Patrick Walsh, a urologist at the Johns Hopkins Medical Institutions, performed the first deliberate nerve-sparing prostate surgery.
Nerve sparing is now widely available, but it remains a demanding operation to perform and it is difficult to assess if all the nerve fibres are spared.
The consensus is that when nerves can be preserved during surgery, they have the capacity to repair themselves and a man will not lose his potency.
But several urologists admit that even after a successful operation, there is no objective data to confirm what has been preserved and it is always possible that nerves have been injured.
If there is permanent nerve damage maintaining an erection will be difficult. But nerves can repair themselves slowly and it is therefore extremely important to start penile rehabilitation the day after surgery. This ensures that the tissues in the penis stay healthy while the spared nerves recover and that all the blood vessels are open to the blood flow that produces erections.
To encourage blood flow, the doctor often prescribes low doses of Viagra or Cialis for about three months, and may suggest using a vacuum device, penile injections or masturbation to keep the “machinery” running.
For some prostate treatment can lead to a psychological barrier to sex. Many men feel a loss of masculinity and sadness about their inability to sustain an erection. It’s therefore important for men to know they can seek help when they have problems with sex after their operations.
But it’s even better to be as informed as possible before starting treatment. I suggest to partners that they go together to see their sexual health physician and surgeon to get all the information they need. I also refer them to a physiotherapist who teaches special pelvic floor exercises before treatment, which can help to get rid of incontinence after surgery.
A new support program, PROSTMATE, funded by Australian Prostate Cancer Research will provide online intervention and self-management strategies after it starts in November.
Matty Silver is a sex educator and writer for the lifestyle section of the Sydney Morning Herald in Australia. Though she’s Downunder, she writers about issues we all face. We’re pleased to have her join us and share her thoughts and articles.
Reprinted with permission from Matty Silver and Sydney Morning Herald. All pictures copyrighted to her and/or photographer. Click here to see original article here.