Below are the chapters the breast cancer co-ordinators are working on for

Sutter Health Cancer Service Line: Prostate Committee Chapter 12. Recovery & Coping with the Effects of Prostate Cancer

With contributions from Nancy L. Brown, Ph.D., Palo Alto Medical Foundation Research Institute;
and Stan Rosenfeld, Patient Advocate, Marin Cancer Institute, Marin General Hospital.

Recovery
Every treatment option will have different issues related to recovery and the nurse or doctor will
go over what to expect prior to treatment and review it again during therapy as needed and at the
conclusion of treatment. In addition, Chapter 16 in this notebook includes many frequently asked
questions and answers, sorted by treatment. This chapter is primarily about the longer term
effects of many treatments, and how to cope with them.
Remember, the nurse navigator is available whenever you need to ask if something is “normal,”
or if it is after hours, call your physician.
Urinary Issues
It is not uncommon to experience some burning after urinating for about one month after surgery
or radiation treatments.
Incontinence
Some men experience urine leakage for several months after surgery, especially when they stand
up, or if they cough, sneeze, or lift something heavy. This symptom is called stress incontinence
and can catch a person off guard. A light sanitary pad or other padded undergarment can be worn
to catch the urine if the amount is substantial. Other men experience a little urine dripping, which
can also be handled with a pad.
Similar symptoms may also occur during the period during or immediately following radiation
therapy or brachytherapy, but it usually resolves completely unless prior prostate surgery
(transurethral resection of the prostate or TURP) has been performed. Any urinary procedures
after radiation therapy must be carefully considered and discussed with both your radiation
oncologist and surgeon before proceeding.
Frequent Urination
Frequent urinary is common during the course of external beam radiation therapy or in the weeks
following brachytherapy. Some men find that they are still getting up two to three times a night
to urinate, even a year after treatment. The persistence of frequent urination (at night is called
nocturia) depends on pre-existing prostate problems as well as the effects of therapy. You
should discuss these symptoms with your doctor if they remain a problem. Some of the things
you can do to reduce your need to be getting up at night include: 1) not drinking alcohol or
caffeine within four hours of going to bed, and 2) reducing your intake of liquids after dinner
(four hours before going to bed).
Slow Urination
You may not find that you urinate more often, but you may find the stream is slower and that it
takes a long time to empty your bladder. Your doctor may prescribe a medication called an alpha
blocker (Flomax, Cardura, Hytrin, or a similar medication) to help with the flow.
Sutter Health Cancer Service Line: Prostate Committee
Bladder Neck Contracture
A bladder neck contracture is scar tissue that develops in the area where the bladder and urethra
are sewn together during surgery or that develop as a consequence of TURP or radiation therapy.
This problem occurs in about one out of 25 prostatectomies but is relatively unusual after
radiation therapy. Symptoms of this problem include decreased urine stream and pushing (or
straining) to urinate.
Your doctor may diagnose this problem using a telescope-like instrument, called a cytoscope that
is passed through the urethra to the bladder neck. If the opening is small, the area can be dilated
or stretched open after the area is numbed to decrease your discomfort. Usually, once is enough
and the bladder neck remains open, although sometimes the dilation must be repeated, or an
incision can be made to open the scar tissue. Men experiencing bladder neck contracture who
require one of these procedures may experience urinary incontinence after treatment.

Bowel Issues
Rectal irritation does not occur as commonly as urinary symptoms and tends to improve more
quickly than urinary symptoms. Bowel irritation is one of the potential side effects of external
radiation therapy. It is less common after brachytherapy. Some men do find that they have some
painless rectal bleeding, spasms, or that they can have (urgent) surprise bowel movements after
treatment, so they stay closer to restrooms. These symptoms should be reported to your
physicians so they can be properly managed. Medications can be prescribed to reduce such
symptoms and rectal bleeding should be thoroughly evaluated since there may be other causes
that must be investigated and treated. Seeing the dietician may help you develop a low-fiber diet,
which can help.
Penis Shrinkage
Temporary penis shrinkage can come as a surprise to some men after treatment with surgery or
radiation. You may find you have to pull your penis out to pee, or get some double spray (from
decrease in the diameter and changes in the urethral channel from the bladder out through the
penis). In most cases this is temporary, and your penis will return to its pre-treatment size within
several months.
In addition, hormone therapy can affect the anatomy (size and consistency) of the genitalia.
Erections and Ejaculations
Your ability to have an erection may decrease after surgery or radiation (as described in the
radiation and surgery sections). After radiation treatment, you may experience a burning sensation
and after brachytherapy or surgery there may be some blood in the ejaculate. After brachytherapy
some men experience numbness on the top and end of the penis. This symptom, a consequence of
nerve irritation, often resolves slowly over many months. It is rarely permanent. Some men say that
their erection feels like there is more pressure after treatment, but usually erections will gradually
get back to normal. The amount of material in the ejaculation is usually markedly diminished after
treatment. It is a consequence of reversal in the direction of flow into the bladder (reverse
ejaculation) and decreased production by the seminal vesicles and prostate. It is not a medical
concern.
Sutter Health Cancer Service Line: Prostate Committee Penile Functioning and Options
If you have a prostatectomy or hormone treatment, you may experience impotence (the consistent
inability to achieve an erection that will penetrate) immediately, or if you had brachytherapy or
radiation, the erectile dysfunction may occur sometime later (even a year or more) after the
treatment. It must also be remembered that sexual function naturally declines with age.
Whether or not erections return, men can generally still attain an orgasm, although no semen will
flow if they have had a prostatectomy, and many men report less semen with ejaculation. If
erections do not return naturally, a number of treatment options are available, including oral
medications (i.e. Viagra, Levitra and Cialis), medications placed directly into the penis such as
suppositories or penile injections, vacuum erection devices or penile prosthesis (all of which are
described below).
Whatever method you choose, talk to your doctor before trying it and if available, support groups
may be very helpful if they contain men who have tried the different options. All modalities may
have side effects.
Cialis
Cialis has to be taken 15 to 60 minutes before arousal and may work with a 36-hour period, so
intercourse can happen without the pressure to perform right after taking it.
MUSE
Stands for Medicated Urethral System for Erection (MUSE), which is a suppository (that can be
used only once in a 24-hour period) to induce an erection. The medication is placed into the
urethra via a small applicator. The average cost per dose (without insurance coverage) is about
$25.
Levitra
Levitra helps increase blood flow to the penis and may help men get and keep an erection for
sexual activity. Once a man has completed sexual activity, blood flow to his penis should
decrease and his erection should go away.
Levitra has to be taken 15 to 60 minutes before arousal.

Viagra
is a pill taken (only once during any 24 hours) on demand approximately an hour before
intercourse and requires stimulation of the penis. Some men experience headaches or a quick
heart rate after taking it. The average cost per dose is about $10.
Injections
Prostaglandin and other medications can be directly injected into the side of the penis. These
chemicals tell the blood vessels to open up and increase blood flow to the penis and work in
about 15 minutes after the injection. The average cost per dose ranges between $5 and $25
(without insurance).
Sutter Health Cancer Service Line: Prostate Committee Vacuum Constriction Device
This is a plastic cylinder with a hand or battery-operated pump for inducing erections, usually
used in conjunction with a constricting band placed at the base of the penis to hold blood in the
penis and is removed after intercourse. The device can cost between $150 and $450.
Penile Implants
These are surgically placed into the penis and can be semi-rigid (you bend the penis up to have
intercourse and down to hide it) or inflatable, which include cylinders on each side of the penis
that are inflated using liquid from a small pump that is placed in the scrotum. Implants can cost
between $8,000 and $15,000 (without insurance) and is usually not an option unless other
methods do not work.

Some clinicians believe that Viagra or injections should be used one to two times a week
regularly after prostate cancer treatment to increase the chances of a male having un-augmented
erections again.
Feeling Tired
Feeling tired during the treatment process is to be expected, and you should find a way to take it
easy, take naps if you can and give your body the rest it needs. You are not obliged to minimize
activity if you feel well and wish to continue your normal activities. Heavy exercise should be
avoided until you are well into the recovery phase.
Symptom Checklist
Every time you see the doctor about prostate cancer, someone probably asks you a series of
questions about the symptoms listed below. This is because your experiences with those
symptoms tell the clinician how you are doing.
o Nocturia (waking at night feeling like you need to urinate) o Daytime frequency o Dysuria (painful urination) o Reduced urine stream o Hesitancy o Urgency o Hematuria (blood in urine) o Diarrhea o Rectal or fecal blood o Skin integrity o Pain o Erections o Urinary incontinence

Source: http://www.pamf.org/prostate/resources/binder/Chp12.pdf

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