If you’ve been diagnosed with prostate cancer, it may have come as a surprise that your doctor didn’t recommend immediate treatment.
“For low-risk disease, we can do active surveillance, and monitor the prostate cancer,” says Hung-Jui (Ray) Tan, MD, a UNC Health urologic oncologist. “This option is associated with the best quality of life as it avoids the side effects of other treatment options.”
If your doctor does recommend treatment, they will want you to understand the possible side effects of your primary options, surgery or radiation. Because of the prostate’s location (below the bladder and in front of the rectum) and its function (it produces a portion of seminal fluid and helps to push the fluid out during ejaculation), treatments put you at risk for changes in sexual, urinary or bowel function.
“We’re sensitive to patient preference,” Dr. Tan says. “The outcomes of the treatments are similar from a cancer standpoint, so it’s important to talk through the side effects of different options and make a shared decision.”
Here’s an overview of what you can expect.
Prostate Cancer Surgery Side Effects
Some people undergo surgical removal of the prostate gland, or prostatectomy. Dr. Tan says the primary long-term side effects of this option are urinary incontinence and sexual dysfunction.
“You may experience urine leakage when coughing or sneezing,” Dr. Tan says. “The vast majority of patients regain control within a year, and we have some different strategies to expedite recovery.”
One strategy is pelvic floor physical therapy. A therapist will provide exercises to strengthen the muscles surrounding the urethra and bladder. Medications may also prove helpful to minimizing leakage.
If you find that incontinence isn’t getting better, Dr. Tan says that there are surgical options. An artificial sphincter can be implanted that squeezes around the urethra, or a sling procedure with mesh can be done to reposition and support the urethra, both preventing leaks.
Erectile dysfunction—difficulty getting and maintaining an erection—is another possible side effect of surgery, Dr. Tan says. “Some men have loss of or difficulty with erections. In most cases, men are still able to have orgasms, but there won’t be ejaculate.”
This side effect can improve over time and depends on your prior history of healthy sexual function and overall health. Dr. Tan says that a patient may start an erection medication at the time of surgery to help with recovery. Your doctor or a pelvic floor physical therapist can provide guidance on the process of regaining the ability to get and maintain an erection. Other treatment options include vacuum devices that cause erections, injections and surgical placement of a prosthesis.
In addition to these side effects, any surgery comes with risks, including bleeding or damage to an internal structure, but Dr. Tan says these risks are very rare.
Prostate Cancer Radiation Side Effects
Your prostate cancer may be treated with radiation, which uses powerful photon beams aimed at the tumor to damage cancer cells. Your doctor will work to minimize the effects of the radiation on the surrounding tissues and organs, but this treatment can also affect sexual and urinary function, as well as bowel function.
“After radiation, men can experience erectile dysfunction, including a decrease in erections and a decrease in ejaculate volumes,” Dr. Tan says; again, your doctor or a pelvic floor physical therapist can offer strategies to help you recover your ability to have an erection.
Rather than experiencing urinary incontinence, as you do with surgery, Dr. Tan says that it’s more common to experience symptoms of bladder irritation with radiation—you may feel urgency to urinate or like you need to urinate more often. Additionally, you may experience bowel irritation, which includes frequent bowel movements and loose stools. Pelvic floor physical therapy and medication will help with urinary issues, while some lifestyle changes, such as eating more fiber, can help with bowel issues.
The length and severity of these symptoms vary for patients and can depend on how long you receive radiation treatments. Radiation for any cancer can cause fatigue and skin reactions, including soreness, itchiness or dryness.
You may receive hormone therapy during radiation to lower your testosterone levels, which can help to stop the growth of your cancer. Side effects of hormone therapy can include a decrease in libido, erections, energy and muscle mass. Your doctor may prescribe medications or identify lifestyle changes that will help with these side effects.
Understanding Side Effects to Make a Treatment Decision
As you’re deciding on a treatment option, your doctor can help you understand these side effects in the context of your health history, age and specifics about your cancer.
“Counseling is critical before treatment to talk through these risks and identify which will be most bothersome,” Dr. Tan says. “Some men already have some urinary symptoms, so to potentially make them worse is not appealing. For some men, the idea of not having an erection is the worst thing to imagine, while others might not be sexually active. We can work together so the patient makes the best decision for their situation.”
Dr. Tan points out that these side effects can take an emotional toll on men and their partners.
“Partners sometimes have a strong perspective but won’t share it because they don’t want to influence the patient’s decision,” Dr. Tan says. “This disease and its side effects have impacts on both people, so an open and honest conversation about how these things will affect them can be very helpful.”
And while these side effects affect quality of life, they can improve over time.
“This disease is curable, and these side effects are manageable,” Dr. Tan says. “There are medications and surgeries that can be very effective. This really is a situation many can overcome, if they’re honest with their doctor and themselves about expectations and priorities.”
If you have questions about your cancer risk, talk to your doctor. If you need a doctor, find one near you.