Advances in prostate cancer treatment have boosted survival rates. Most men with the disease won’t die from it. The question then becomes how to best live with it. While your quality of life and sexual health will change, you can make the best of the challenges and have a full life.
Manage Urinary Incontinence
Depending on the treatment you choose, there’s a good chance you’ll have this problem, at least for a while.
And while leaking urine is a physical problem, it also can affect you mentally.
“From the fear of having an accident to the worry about odor, the daily concern is an emotional drain,” says Gene Reynolds, who still has incontinence 5 years after surgery to remove his prostate.
There are many products designed to help manage your symptoms, from pads to catheters and compression devices. You can also make lifestyle changes:
Cut down on citrus juices and drinks with caffeine or alcohol. They can irritate your bladder and make you have to go more often.
Drop that spare tire. Belly fat pushes on your bladder. Slim down and your control could improve.
Eat a healthy, high-fiber diet. When you’re blocked up, there’s pressure on the muscles that control urination.
Quit smoking. You’ll ease bladder irritation, and it may curb coughs, which can cause bladder leakage.
Talk to your doctor about all medicines, vitamins, herbs, and supplements you take. Some may affect urine control.
Empty your bladder before bedtime or strenuous activity. To be sure you’ve really emptied it, try something called double voiding. When you’re done, wait a few minutes, and then go again. This makes sure you get all the urine out of your bladder.
Build Up Your Muscles
Exercises called Kegels can help strengthen your pelvic floor muscles. They support your bladder and rectum and help control the flow of urine. Doctors disagree about the best way to do them. Ask yours what he thinks before you start.
One technique: Imagine you’re peeing. Squeeze the muscles that would stop the flow. Hold it for a second or two, let the muscle rest for 5 to 10 seconds, and then repeat.
To be sure you’re working the right muscles, try to stop midstream once or twice when you are going. You can do Kegels before and after treatment. Do a set of 10 contractions four times a day -- usually at breakfast, lunch, dinner, and bedtime, says William J. Catalona, MD, professor of neurology at Northwestern University Feinberg School of Medicine.
This isn’t a case where more is better, so don’t overdo it. “More than 50 reps can tire out your muscles, Catalona says. And that will make your control worse.
When you’re out in public, you can take steps to feel more in control. Bring some extra absorbent pads or underwear just in case you need them. Learn where public restrooms are in advance.
Schedule restroom breaks. That can help you avoid leaks and reduce odor, says Wendy Poage, administrator of urologic oncology at the University of Colorado Health Sciences Center.
She suggests you go every 2 hours. If you’re worried about unpleasant smells, opt for disposable pads and garments with a material that won’t let odors form.
Give It Time
It takes time for the muscles in your pelvic floor to recover from treatment -- usually from 3 to 12 months. If your symptoms aren’t better, see a urologist who specializes in male incontinence.
“One man might feel it’s a problem to wear one pad a day; another might wear five pads and feel OK about it,” says John Hairston, MD, associate professor of urology at the Feinberg School of Medicine.
There are several surgical options. When Frank Hodge’s incontinence became severe after prostate surgery and radiation, his doctor implanted a sphincter valve. That’s an inflatable cuff that helps control when you pee. Some guys who have this surgery have complications that require a redo. Hodge was pleased with his.
“The outcome was good, and it was a life changer,” he says.
Solve Sexual Problems
Treatment for prostate cancer can zap your sex life -- at least temporarily.
“Everybody is different,” Poage says. “Some guys will have no issues, while others will be impotent. Still others will have problems maintaining an erection and penetration.”
Another possibility: Your libido may disappear or wax and wane.
Not surprisingly, some reactions to these changes may be extreme.
“They can make you question your masculinity,” says Scott Mayhew. He was put on hormone therapy, which cuts off testosterone, the hormone responsible for your sex drive. It also creates side effects similar to those some women go through during menopause.
One way to help regain potency after surgery is to get an erection as soon as possible once your body has had a chance to heal, usually after about a month. “Getting blood into the penis helps keep the tissues healthy,” Catalona says.
There are several methods of “penile rehabilitation”:
- Medications like sildenafil (Viagra)
- A vacuum erection device
- Injections of drugs to increase blood flow
- Traditional sexual stimulation
Talk to your doctor about using one or all of them.
If you’re having erection problems, there are many ways to restore your sexual function. You might try medication, a vacuum pump, a suppository, an injection, or an implant.
“It’s really just what a man feels comfortable with and how far he’s willing to go,” Poage says.
There are pros and cons to each method, and you should consider your own likes and dislikes when deciding which is right for you.
“I’m not into taking drugs and I didn’t want to need ‘equipment’ to have sex,” says Roger Bradshaw. He chose a penile implant, which allows him to have an erection at any time.
Talk to your doctor about the pros and cons of each option.
Be sure to include your partner in any discussion about your plans to regain potency.
“Considering the age that most prostate cancer patients are, it’s a good time to rethink what intimacy looks like anyway,” Poage says. Many women are going through menopause or are postmenopausal and may have their own problems with sex.
Ditto incontinence, which is common women who’ve had children.
Women understand, says Lucy Mayhew, Scott’s wife, because they’re having similar problems. “That’s why open communication between partners is so important.”
The bottom line: Just because your sex life may not be the same as it was before cancer doesn’t mean you can’t have pleasure.
Explore other ways to be intimate. You don’t need a penis to bring your partner to orgasm. And you can achieve orgasm without an erection if your partner stimulates the right spot.
Learn to express yourself in sensual ways as well -- hold hands, hug, dance, give each other massages. The key, Poage says, is to be open to new things and use your imagination to figure out what they might be.
“Keeping some kind of physical closeness alive, in whatever ways possible, can protect or even improve your relationship,” she says.
Cancer is a scary word. Choosing a treatment and then managing any side effects can be stressful.
Communication with your loved ones is especially important. After all, they’re going through this as well. Sometimes just talking about what you’re going through can ease your mind. But a lot of men won’t do that because they don’t want to burden their family and friends or cause them to worry.
“These can be very difficult conversations for men to have because they weren’t raised that way,” Poage says. Sometimes it’s easier to connect with other people who are facing prostate cancer, so ask your doctor about support groups in your area. Online support groups and discussion forums are another option.
What else can you do?
Get physical. Exercise boosts your mood. It could also lower the odds that your cancer will come back. You don’t have to join a gym, either. Even a brisk walk a few times a week can do the job.
Follow your passion. Do something you love. A hobby can help you stay happy and relaxed.
Music is therapy for Tim Horan, who’s had both prostate and testicular cancer.
“Playing, writing, and recording music is my passion, so it’s been an invaluable daily outlet in my recovery,” he says. And doing something you’re good at can make you feel more positive.
Set goals. It’s easy to feel good when you have something to look forward to, even if it’s as simple as finishing a book or trying a new recipe. Plus, the sense of pride you’ll feel when you achieve a goal can go a long way toward reducing stress.