Men and Cancer

Prostate cancer survivorship: Options for improved quality of life

Prostate cancer is an all-too-common disease. Current estimates indicate that 1 in 9 men will face the illness over the course of their lifetimes. Fortunately, it’s also subject to early detection and eminently treatable with a range of effective, gentler approaches. Today, close to 100% of patients can expect to survive five years after diagnosis.
Among the growing ranks of survivors, however, many will face lasting issues that touch their lives daily, and intimately. Urinary incontinence — which can affect up to 2 out of 5 survivors — and erectile dysfunction — affecting 85% in the short term and as many as 1 in 3 over the long haul — both erode quality of life. And while there are well-known ways of dealing with both problems, they also come with their drawbacks.
City of Hope surgeon Jonathan “Nick” Warner , M.D., is concerned that many survivors may not know about better and more durable ways of addressing side effects.
Jonathan Warner
Jonathan "Nick" Warner, M.D.
“A lot of guys assume that their current state, if it’s not perfect, is as good as it gets,” said Warner, assistant clinical professor of urology and urologic oncology. “That’s definitely not the case. I would even go so far as to say that we can cure these problems.”
When it comes to getting to the most out of life after prostate cancer, knowledge is power. And Warner wants to ensure that more men are empowered with a fuller sense of their options.

Incontinence Solutions

Stress urinary incontinence has a way of summoning feelings of anxiety, shame and embarrassment, drawing a constrictive border around some prostate cancer survivors’ lives.
“Men stay at home because they’re afraid of a leak in their pants,” Warner said. “They worry about where the bathroom is. They might cut back on their fluids. It definitely impacts their recovery and quality of life.”
Wearing pads to capture leakage is one typical workaround. Warner notes, however, that this adds up to an ongoing expense that medical insurance doesn’t reimburse. Meanwhile, City of Hope experts offer a pair of outpatient procedures usually covered by insurance — alternatives that, after about four weeks of recovery, can alleviate incontinence permanently:
  • Artificial urinary sphincter implant: In this 40-year-old “gold standard” approach, a device to control urination is put in place. Patients activate the device to urinate once every four hours or so, with no leakage in between.
  • Sling procedure: An option best suited for mild-to-moderate incontinence, this surgery involves embedding fiber that gently compresses the urethra. After recovery, men typically void when they feel the urge, as before their encounter with cancer.
“These are definitive cures for stress incontinence,” Warner said.

Sexual Intimacy Is Recoverable

The advent of pills that treat erectile dysfunction by stimulating blood flow was a great boon for prostate cancer survivors going through sexual side effects from treatment. However, these medicines aren’t a universal panacea. Certain types of nerve damage can render them ineffective. If they’re unsuccessful for a given patient, he may retreat into hopelessness.
“I think people assume that the pill is the only option,” Warner said. “When the pill demonstrates it’s not working, people often give up. And there are good studies showing that patients who aren’t engaging in regular intimacy have a lower quality of life on a global scale.”
For restoring erectile function, he outlines three other approaches available at City of Hope that are less publicized but likely to help those who find that oral medications don’t work:
  • Penile injection therapy: Patients with good blood flow and healthy penile tissue might consider drugs such as Edex that can be administered directly to the genitals via a very small needle. This strategy usually results in an erection within five to 10 minutes.
  • Vacuum erection device: This medical device comprises a pump and ring that are applied to the penis in order to mechanically cause an erection.
  • Penile implant: With a brief, outpatient procedure, surgeons put an inflatable device in place; after recovery, patients activate the device to effect an erection. Although this is the most invasive option, it also allows for the most spontaneity, requires no ongoing cost and earns the highest patient satisfaction ratings.
With these alternatives out there, fewer and fewer men need to feel like a part of their lives is over after defeating prostate cancer. From Warner’s perspective, survivors have the opportunity to be their own advocates by working with physicians to chart a course back to a “new normal” that enables them to feel whole again. He sees fulfilling his role in the journey as a type of honor.
“The oncologist is interested in curing cancer; from the reconstructive side, my goal is getting people back to normal,” he said. “When you see the joy you can bring somebody by curing them of their leakage or restoring their erectile function — not only the patient, but also their partner — it’s just as rewarding.”