Treatment Side Effects

 

Rev B

This segment will include:

Treatment Side Effects
Overcoming Side Effects
Other Important Side Effect Considerations
References

 

Treatment Side Effects

     Topic                                                                                                              Paragraph

Introduction 1.0
Androgen-Deprivation Therapy (ADT) 1.12, 1.13
Cognitive Changes as result of ADT 1.14
Diabetes & Heart Disease as result of ADT 1.15
Cryotherapy (Freezing) 1.11
Chemotherapy 1.16
Radiation –Brachytherapy (Seeds) 1.8
Radiation-External Beam 1.9, 1.10
Surgery, Standard 1.1, 1.2
Surgery, Robotic 1.3, 1.4
Surgery, Size of Erection 1.5, 1.6
Surgery Nerve Sparing 1.7
Family and Social Relationships 1.19
Gynecomastia (Breast enlargement) 1.17
Biopsy 1.18
Treatment selected by the Side effects 1.20
Side Effects Minimized 1.21, 1.22
Percent of, and Duration of Side Effects 1.23, 1.24, 1.25
Side Effects as a Function of Age 1.26
Sexual Dysfunction Regardless of Treatment 1.27
Rarer Side Effects 1.28
A Doctor’s Story 1.29

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Overcoming Side Effects

   Topic                                                                                                                          Paragraph

Incontinence-Kegel Exercises 3.1
Impotence 3.2
Radiation Burns 3.3
Radiation-Seed Migration 3.6
Cryotherapy Damage 3.4
Androgen-Deprivation Therapy 3.5
Biopsy Infections 3.7
Chemotherapy Side Effects 3.8
Shortened Penis 3.9
Family and Social Issues 3.10
Rare Side Effects 3.11

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Other Important Side Effect Considerations

Topic                                                                                                                  Paragraph

Stan’s Comments 2.0
Skill of doctor more important than experience 2.7
Accept Consequences of treatment 2.13
Obtain other patient references 2.11, 2.12
Self Imposed Hibernation and Why 2.8, 2.9
Support Groups tell it as it really is 2.14, 2.15
Business is Business 2.3, 2.4, 2.5, 2.6

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Treatment Side Effects


Introduction:
These articles represent a small portion of the documentation that I have accumulated, but they include all the facts that you, the reader, probably need to know, to help you decide how to proceed with your very specific situation. —Stan

There is no treatment that does not have one or more side effects. Some last a very few weeks, others many months, and others may remain for years. Some, a person can easily live with, and others may drastically alter a person’s quality of life. As you will read, the two most prevalent side effects as a consequence of treatment for prostate cancer are incontinence and sexual impotence. By far these outnumber all the others combined.
Another observation you will read, is that the side effects occur much more frequently, and are more severe than the medical profession admits to.

Many of the side effects can be overcome, but many require a surgical procedure. I hope you will use this information to help you decide what treatment, if any, to have, if you or someone you love, is diagnosed with this terrible illness. 
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1.1 Surgery, Standard
Surgery- The most common side effects for men who have been treated with surgery, is incontinence, erectile dysfunction (Impotence), and a small shortening (1/4 -1/2 an inch) of the erected penis length. These side effects start immediately. The type of surgery is immaterial.

1.2 Men with prostate cancer who have their prostate removed cite sexual dysfunction as the most common side effect after surgery, but urinary dysfunction troubles these patients most, reports a University of Florida researcher, Bryan Weber, Ph.D., A.R.N.P. What’s more, many aren’t emotionally prepared to face these complications.
“The effects of surgery are quite immediate and can lead to depression and frustration” Dr. Weber, who is study’s lead author continued. “After an initial diagnosis of prostate cancer, men may be so focused on eradicating the disease that they don’t realize the effects the treatment will have on their quality of life, both for them and their families.” (R 193A)


1.3 Surgery, Robotic
A study conducted by a medical team from The Brigham and Women’s Hospital, Boston, MA, concluded that Men undergoing robotic vs standard open surgery, experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction. This was reported in the JAMA 2009 (R389)

1.4 Men having Robotic Surgery (Radical Prostactomy) generally experienced more genitourinary complications, incontinence, and erectile dysfunction. (R106) JAMA. 2009;302(14):1557-1564 www.


1.5 Surgery, Size of Erection
Size of an erection. Penis shortened as result of various prostate cancer treatments Another side effect is many men state that after the radical prostatectomy, their penis is shorter. It may only be ¼ to ½ inch, but by the very nature of removing the urinary sphincter, and then reconnecting the two parts, the length is shorter. I assure you, no man feels good about this, and says little outside a support group. R714

1.6 Penis shortened as result of various prostate cancer treatments.
This study was to report the relative incidence of the perceived reduction in penile size across prostate cancer treatment modalities and to describe its effect on quality of life and treatment regret.
The incidence of patient complaints about reduced penile size was calculated for 948 men.
Complaints about a reduced penile size were more common with radiation therapy plus ADT or surgery rather than radiation alone and were associated with greater interference with close emotional relationships and increased treatment regret. Physicians should discuss the possibility of this rarely mentioned side effect with their patients to help them make more informed treatment choices. UROLOGY 81: 130e135, 2013. _ 2013 Elsevier Inc.
The shortened penis length is most often a result of non-nerve sparing surgery, which can cause fibrosis and atrophy of erectile tissue due to nerve and vascular damage, the study authors explained.(R714, R715)


1.7 Surgery Nerve Sparing
Impotence and nerve Sparing. Impotence after surgery may depend on whether Nerve Sparing was attempted. The erectile nerves are attached on both sides of the prostate, and sometimes the surgeon will try to spare these nerves. If the doctor believes the cancer is very close to the erectile nerves, he may not try to spare these nerves, and impotency is guaranteed. Nerve sparing may be attempted on one side, depending on where the cancer appears to be located. If nerve sparing is attempted, it often does not succeed, or it may take up to a few years for the nerves to overcome the trauma of the surgery to succeed. This surgery also depends on the surgeon, and his experience.(Read Stan’s Comment: The Surgeon’s Skill is very vital) Al, Jump to Para 1.4 in Treatment Options.
Often, nerve sparing does not work. To quote a Memorial Sloan Kettering Cancer Center article, “—-and suggests that even minor nerve trauma significantly impairs the recovery of erectile function after procedures classically regarded as having achieved nerve sparing.”
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1.8 Radiation –Brachytherapy (Seeds)
Radiation, Brachytherapy (Seeds) -With radiation the most common side effect is erectile dysfunction (Impotence) which usually starts about 18 or 24 months after the radiation, as it usually takes that long for the radiation to attain full effectiveness to kill the cancer cells. External Beam Radiation usually has more side effects than Brachytherapy. Radiation also kills or damages non-cancer cells and may damages the erectile nerves. The seed only radiate the prostate. External Beam Radiation radiates both the prostate and the surrounding tissue, the Fossa.
Other side effect complications from seeds may be burning after urination, and sometimes seeds migrate into the urethra, when a catherization is necessary. The seeds may led to sexual problems too, but more often involve discomfort in urinating. The research, was published in 2008 in The New England Journal of Medicine (R194).


1.9 Radiation-External Beam
External Beam Radiation may cause Bowel problems, (Fecal Incontinence), as a possible long term side effect This could occur 12 or more years after treatment.

1.10 External Beam Radiation (EBR), will have a greater side effects effect than the seeds.
Not as common a side effect may be, burning of the bladder neck, or rectal wall and a long term effect may be fecal incontinence, as a result of burning of the rectal sphincter muscle.
Rectal toxicity is a concern with radiation treatment ( PubMed PMID: 20980135 –Oct 25, 2010 Clin Oncology
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1.11 Cryotherapy (Freezing of the prostate), has impotency as the most prevalent side effect, and a high amount of urinary incontinence, starting shortly after the treatment. Irritation (burning sensation when urinating), and Genital Swelling, and Rectal bleeding are other side effects.
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1.12 Androgen-Deprivation Therapy (ADT)
Androgen-Deprivation Treatment (ADT) Side Effects usually causes hot flashes, night sweats and loss of libido, is often used with some forms of radiation to improve the efficiency of the radiation. Longer term use of ADT will decrease muscle mass, anemia, cause bone loss, and in some instances breast enlargement. Cognitive changes are reported in many instances. There are ongoing studies saying that Diabetes, and heart conditions are worsened in older men (in their 70s).

1.13 ADT helps extend the lives of many men with prostate cancer. But by blocking the effects of testosterone, the ADT treatment throws men into a state that bears a striking resemblance to menopause, with symptoms such as hot flashes, night sweats and weaker bones. “ADT is a great treatment for prostate cancer, but it comes at a cost,” Matthew Smith, a Medical Oncologist at Massachusetts General Hospital and Harvard Medical School, told the Health Blog. As we noted last year, some have likened the therapy to castration and called for more attention to the trade-offs of the therapy. (R133)


1.14 Cognitive Changes as result of ADT
A study published in April 1, 2005 issue of Cancer found Hormone therapy may cause temporary cognitive changes.

Cognitive problems in patients on ADT: A qualitative pilot Study Androgen deprivation therapy (ADT) is a well-established treatment for prostate cancer patients with rising prostate-specific antigen (PSA), levels after localized treatment, and for those with metastatic disease.
The neurological impact of ADT has been likened to that of aging and is therefore theorized to impair cognitive functioning in prostate cancer patients.
The Study conclusion illustrates the potential negative effects of ADT on cognitive and neurobehavioral functions, and their impact on patients’ work and in their daily lives.
PubMed Abstract PMID: 22975107 (Ref R637)


1.15 Diabetes & Heart Disease as result of ADT.
ADT Side effects- Diabetes,and Heart Disease, become worse if older men receive Hormones. People on ADT for a year or longer usually require medication to minimize bone loss. ( R77, R272)
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Chemotherapy
1.16 Chemotherapy Side effects depends on the drug(s) used. Men with advanced High Grade cases of PC using chemotherapy may experience weakness, nausea, hot flashes and night sweats, bone loss, diarrhea, neuropathy in feet and sometimes in the hands after prolonged treatment etc.


1.17 Gynecomastia (Breast enlargement)
Gynecomastia ( Breast Enlargement) occurs in some men receiving androgen deprivation therapy (ADT) for prostate cancer. See Ref 18


1.18 Biopsy Side effects
The adage that every treatment has some side effects is shown here. The Journal of Urology (2010) reports that even a biopsy has side effects. These urination and erection dysfunction problems are temporary, ranging from one to 12 weeks, depending on the number of needle cores taken. (US TOO Hotsheet October 2010).
Infections after prostate biopsy on the rise.
Serious infections after prostate biopsies appear to be on the rise in the U.S., possibly fueled by antibiotic-resistant bacteria, a new study of elderly men suggests. More than a million prostate biopsies are done each year, often to investigate suspicious results from prostate cancer screening. But the majority of those are false alarms, and some doctors worry that many men could be suffering needlessly due to screening.
Last week, a government-funded expert panel concluded that prostate cancer screening saves few or no lives, but causes harm through treatment or further invasive testing such as biopsies. In the new study, published in the Journal of Urology, 6.9 percent of men who had a prostate biopsy landed in the hospital within a month. Among a group of men who didn’t get a biopsy but were of similar age, the rate was only 2.7 percent
According to the U.S. Preventive Services Task Force (USPSTF), up to one in five men will have abnormal screening results that trigger a biopsy over a decade, and prostate biopsies cause fever, infection, bleeding or temporary urinary difficulty in about 68 men per 10,000 biopsies.
“There is no away to confirm that this is biopsy-related,” Dr. Stacy Loeb, a urologist at the NYULangoneMedicalCenter in New York, told Reuters Health. However, the results do show an uptick in infections of the urinary system, such as prostatitis and kidney infections, in men who’ve had a biopsy.
About four out of 1,000 in the biopsy group were hospitalized as a result of such an infection in the month following their procedure, compared to two out of 1,000 in the comparison group.
If a cancer is found, treatment such as radiation or surgery leads to common side effects such as incontinence and impotence. Yet many prostate tumors will never cause trouble if left alone, the panel cautions. By Frederik Joelving NewYork Oct 13, 2011 Reuters Health)

SOURCE: bit.ly/rgVfTP The Journal of Urology, online September 23, 2011.
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1.19 Family and Social Relationship Side Effects
Another terrible side effect of treatment is not a medical one but is a psychological one that greatly affects the relationship between the man and his mate, and often his family.

When a man loses his capability to have an erection, and have sexual intercourse with his mate, there is a terrible feeling of loss of his manhood, and self esteem. Very often the man takes his aggression out on the mate, and ignores her advances or anything to do with hugging and holding and words of endearment and love. The mate feels terrible because she cannot help, because his attitude has so drastically changed. The women at the support group are often at a loss of how to help and are despondent, because of their mate’s rejection and desire to be alone. They relate horror stories of growing apart from the man they love. This aspect of treatment is rarely considered when considering the side effects of treatment. Our support group has a separate Women’s Group to help the mates and partners of men with PC.
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1.20 Treatment selected by the Side effects
One of the first large quality-of-life studies on today’s prostate cancer treatments suggests that for some men, it’s a matter of picking your side effects and hoping the problems will be minor and short lived. Of the choices studied — surgery, standard radiation, hormone therapy or radioactive seeds — the seeds seemed to carry a lower risk of several of these side effects.
Many men with low to moderate grade prostate cancer cases, who decide to be treated, select the side effects they believe they can tolerate, and choose the treatment based on these side effects. In the great majority of cases, the outcome is likely to be the same, says Dr Glenn Bubley, a Medical Oncologist at the BIDMC.
No procedure was clearly best or worst across the board. The wives of about 13% of men who had brachytherapy said they were distressed by problems with their partner’s erections one year after treatment. The spouses of about 22% of the men in the traditional radiation group and 44% in the surgery group reported the same concern. (R194)
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1.21-Side Effects Minimized.
Professor Peter Scardino from the Memorial Sloan-Kettering Cancer Centre in New York told an international conference that while doctors mention the possibility of sex problems they often tend to gloss over them. (R170). .”Since all the treatments for prostate cancer can have an adverse affect on sexual function, doctors tend to be reluctant to overly describe the possibilities because patients can become frightened about having the treatment.
“There has been a bit of a tradition in the field of minimizing the side effects and quoting only the best possible results, or talking about partial sexual function as though its full sexual function.”

1.22 Saying something doesn’t make it true. Heightened risks for post-operative incontinence and impotence may outweigh any benefits from minimally invasive “keyhole” surgery for prostate cancer, a new study suggests. The presumed good results from the robotic technique are being oversold to a public that is all too willing to believe, said Dr. Jim C. Hu, a genitourinary surgeon at Brigham and Women’s Hospital in Boston who led the study. (R106A) “Given the expense of the procedure and the hype around it, expectations are being raised that are too high,” said Hu, whose team published the findings in the Oct. 14 Journal of the American Medical Association.
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1.23 Percent of, and Duration of Side Effects.
The urethra, a tube that carries urine and semen out of the body, runs directly through the middle of the prostate gland. Nerves that control erectile function run alongside, directly attached to the gland walls. Because of this anatomy, treatment of prostate cancer can cause erectile dysfunction, urinary incontinence, and bowel dysfunction. (R168)

1.24 One of the main possible side effects of a prostatectomy is incontinence, or involuntary loss of urine. Men have two sphincters (rings of muscles) to control the flow of urine, called the proximal (internal) and distal (external) sphincters. During a radical prostatectomy surgeons typically remove the proximal sphincter. But if the distal sphincter is weak or damaged, it may not hold back urine flow, leading to leakage.
Researchers estimate as many as 60 percent of men who have had a prostatectomy have some symptoms of incontinence. In most cases, the degree of urine leakage is minimal. However, the American Cancer Society reports about 29 percent of men wear continence pads to stay dry. Roughly 15 percent have experienced frequent leakages or dribbling or have no bladder control at all. (R96).

Side effects persist after prostate cancer treatment.
Men who are treated for prostate cancer may still suffer side effects from treatment up to a decade later, a new study finds.
Researchers found that more than 500 men with cancer ended up with poorer sexual function and more bladder control problems for up to 10 years afterward. The findings do give men more information on the long-term side effects of prostate cancer treatment – whether it’s surgery, radiation or hormone therapy.
Up to 10 years after treatment, more than 95 percent of men had some degree of sexual dysfunction, the study team found. And about half had urinary symptoms.
Past studies have found such lingering side effects, too. But they have been shorter-term – following men for as long as five years. And they’ve left some question as to whether the sexual and urinary problems could just be a product of aging, rather than prostate cancer treatment.
These latest findings, reported in the Journal of Clinical Oncology, suggest it’s not simply the aging process that’s to blame. And when they accounted for the men’s age, overall health and other factors, the group treated for cancer had worse sexual and urinary function up to 10 years later.
Once prostate cancer is detected, men have another big decision said Kathryn L. Taylor, of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C. If the cancer is early-stage, they can choose to put off treatment and instead have the cancer monitored to see if it’s progressing – what doctors call “active surveillance.”She suggested men “get educated” about prostate cancer and make a screening decision based on a careful discussion with their doctors. (Stan’s Comment: A good Prostate Cancer Support Group is a wonderful learning source).
According to the National Cancer Institute, about half of all U.S. men diagnosed with prostate cancer in 2009 fell into the “low-risk” category – meaning their cancer was unlikely to progress.
SOURCE: bit.ly/MU6YjL Journal of Clinical Oncology, online June 25, 2012. (Ref R583)

1.25 Side Effects Long Lasting After Prostate Cancer Treatment Data from a Michigan Prostate Cancer Survivors Study showed A majority of prostate cancer survivors reported long-term treatment-related adverse effects with surgery or radiation therapy. About 70% of 2,500 survey respondents reported ongoing problems with adverse events, some of whom were more than 15 years removed from primary treatment.
Sexual symptoms predominated, as most men in each age group reported problems with the frequency, reliability, and quality of erections. Among urinary symptoms, frequency was reported by a majority of men in all age groups. Few men reported bowel or vitality symptoms.
“Without question, sexual symptoms were the most common and the most troubling to the men,” said May Darwish-Yassine, PhD, of the Michigan Public Health Institute in Okemos. “It’s a very significant issue, and primary care providers are not very attentive to it.
Analysis of specific symptoms by type of therapy and age showed that after prostatectomy a majority of men with urinary symptoms reported urine leakage, regardless of age, and 44% reported frequency problems. Urgency problems were also reported. Bowl urgency problems were reported by 31%, of the men, and. 30% of men reported a lack of energy and vitality.
Primary source: American Association for Cancer Research Frontiers in Cancer Prevention Research, October 28, (Ref: R470)
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1.26 Side Effects as a Function of Age.
Age matters. Men who are younger, up to about mid fifties in age, usually have less incontinence, and less impotency because it takes these younger men less time to heal, but men of all ages may suffer for years or forever with the side effects.
Age is not a factor if nerve sparing was not attempted. Sometimes it is the patient who does not heal well, and sometimes it is the inexperience of the doctor. It could also be the combination that determines the outcome.


1.27 Sexual Dysfunction Regardless of Treatment.
The sexual dysfunction seemed to be present for all of three types of treatment; surgery, radiation and seed implants,. Bowel problems were greatest after radiation. Urinary irritation was worst after radioactive seeds. (R193, R194)

1.28 Rarer Side effects
There are other complications to a lesser degree with many treatment modalities. This is the state of medicine today. Some are rare and are being omitted


1.29 A Doctor’s Story
A story from a doctor with a personal interest.
Almost every article written in the media, are written by doctors working in the field of PC. Very few tell the factual details about side effects. One exception is Mary Pickett, M.D, (R188). It just happens that her father had PC. Believe the survivors, and their families, not doctors who publish articles.
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2.0 Stan’s Comments

2.1 There is rarely a treatment that does not have at least one side effect. The optimum situation is when the side effect(s) last for only a few months after the treatment, and are mild. Unfortunately, many side effects last for years, and some for a lifetime. Many are severe, and need further surgery or other corrective treatment. Side effects are the result of the treatment, and the experience of the doctor. There are times when the doctor has to do more than the originally plan, because the cancerous situation was worse than originally believed.

2.2 Incontinence and impotence are the evil twins of prostate cancer and its aftermath. While impotence can breed deep melancholy, incontinence is a more primal problem: Only babies and toddlers are supposed to wet themselves. Beyond those ages, it becomes a hushed subject, an object of shame, frustration, loss of self esteem and sexuality, and bad jokes.


2.3 Business is Business
Many doctors play down the possible side effects of prostate cancer treatment on men’s sex lives, for fear the men will be scared off, or try another treatment modality with another medical team, or at another hospital, or will opt for delaying treatment, i.e., Watchful Waiting, which is the only way to guarantee no side effects.

2.4 Contrary to articles in newspapers, books, magazines, and the internet, the actual percent of side effects is greater than stated in these media outlets. Every industry and business wishes to emphasis the good and minimizes any negative aspects.

2.5 Doctors report a 10 percent incontinence rate after a radical prostatectomy, (surgery), whereas patients report 40 to 50 percent. The difference is in the eyes of the beholder.
When a man tells his doctor he uses “only ”three or four pads a day to absorb the leaking urine, many doctors will consider this as trivial, and may report it as “a dry patient” .This is not trivial to the man.
Furthermore, after surgery, when many men sneeze, laugh, exercise, strain physically, as when picking-up a grand child, bag of groceries, or moving an arm chair, etc., he wets his pants. This man is incontinent, regardless of what is officially reported. With surgery, incontinence starts immediately, and may last forever unless treated with another surgical procedure.

2.6 An indication of the huge number of men who are incontinent and / or impotent after their treatment for PC, is in the HUGE number of doctors who now specialize in treating men to overcome these two major side effects. Almost every urologist now performs remedial surgery such as inserting a sling, or an artificial sphincter for incontinence, and performing penile implants, or giving penile injections, or pills for impotency problems.
I am amazed at how HUGE this industry is when one considers “how few men are said to suffer from these side effects”.


2.7 Skill of doctor more important than experience
Avoiding Side Effects.
The surest way to avoid side effects is to avoid being treated, if you meet the Watchful Waiting Criteria. I am not being flippant, I am very serious. That way is to do Watchful Waiting (WW), also called Active Surveillance (AS) also called Delayed Treatment. This is detailed in the Watchful Waiting Chapter.
The second way to avoid side effects is to have treatment with a doctor who is very good at his profession, who can do the surgery, or radiation, so well that any side effects are greatly minimized. (Stan’s Comments: Members of a support group know which doctors are competent). Remember, it is not only how many procedures the doctor has done, but his innate skill. See Paragraph 4.1 in the “Treatment Options” Segment)


2.8 Self Imposed Hibernation and Why
When a man is incontinent and or impotent his manhood and self image and esteem are at stake. His very being is being challenged. Men have been know to hibernate because of incontinence, and refuse to go to public functions, and family parties.

2.9 A reason for discrepancy between what the men report, and books, is that men are so embarrassed to reveal their situation, that they may not be truthful even with their doctor. His self image, pride, and manhood prevent telling anyone – even surveys. HOWEVER, in prostate cancer support groups, where no names are used, the men tell the truth. Also the medical profession, as the song says, “accentuates the positive, and minimizes the negatives.”

2.10 Surveys of men who do not attend prostate cancer support groups have these same terrible side effects, and percentages.


2.11 Obtain other patient references
If you wish to verify how other men have faired using the doctor you are considering using, ask your doctor to have approximately 12 patients he has treated 2, 3, or 4 years ago, call you. Men who are potent will willingly call. The doctor cannot give you their names, but with your permission, his office may ask them to contact you.

2.12 Another way to obtain a true estimate of side effects is to talk to other men who have been treated for PC. Speak to people at support groups, “man to man” with friends, relatives and children of PC survivors. This is also an excellent way to determine how “good” a doctor is. Believe the survivors. There is no other way to get the true statistics. In summation, believe survivors, not newspapers, books, pamphlets, and well-meaning doctors.


2.13 Accept Consequences of treatment
It is rare that a treatment does not have any side effects. If you are a man, you have a one in six chance of developing Prostate Cancer. If your cancer does not qualify you for, or you choose not to do, Watchful Waiting, you must accept the side effects.


2.14 Support Groups tell it as it really is.
Prostate cancer support groups are a very valuable source of information on the various methods available on how to overcome side effects. There are lectures on these topics, and you can hear, speak, and ask questions of the doctors who perform the various procedures, and to men who have been treated.

2.15 Some side effects occur frequently. Some are rarer, but never-the-less can be very bad and drastically affect the man’s Quality of Life. One of the very best ways to learn about the side effects is to attend a Prostate Cancer Support Group, and talk to the men who have been treated. They are the ultimate source of this type of information.
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3.0 Overcoming Side Effects
When any side effect lasts too long or becomes unbearable, many of them can be treated. Some, by medication others by a medical procedure. Below are some of the possible solutions.


3.1 Incontinence-Kegel Exercises
– Kegel exercises.
See Documents of Interest Segment (Add Page Jump)
For minor leakage a few pads a day can be the solution when sitting or standing.
– A Cunningham style penile clamp can be worn and adjusted according to the activity being done, i.e., lying down, walking, lifting a heavy object etc.
– A Sling may be surgically implanted to overcome “minor” urinary leakage.
– An Artificial Sphincter may be surgically implanted for more severe urinary leakage.


3.2 Impotence (Erectile Dysfunction):
Erectile Dysfunction is the inability to achieve and maintain a penile erection sufficiently rigid for sexual intercourse.
Basically, there are four elements involved in male sexual activity: Desire, erection, organism, and ejaculation. Because one of these functions is missing, doesn’t necessarily mean that the others are. Desire refers to one’s interest or lack of interest in sexual activity; erection is the term used to describe the enlarged and reasonably rigid penis that would be needed to accomplish sexual intercourse; organism is the intensely pleasurable ”feeling” associated with the moment of climax; and ejaculation is the emission of the milky white fluid called semen. The medical term for sexual desire is “libido”. Many medical treatments greatly reduce or eliminate the libido. A man can have an erection and organism without ejaculating any semen.
Ejaculations are no longer possible once the prostate gland is either removed or destroyed by surgery or radiation in cancer treatment, because the prostate makes most of the ejaculation fluid. Organisms without ejaculation are referred to as “dry organisms”

The following are the options available to achieve an erection:
– Oral Erectile Dysfunction Medication pills such as Viagra, Cialis, and Levitra help many men. – Self drug injections just prior to intercourse.
– Muse is a pill easily inserted into the head of the penis, just prior to intercourse.
– The Vacuum Pump System is used by many men with good results, just prior to intercourse.
– The Cadillac of all methods is the surgical implant of an erection system made by a few firms, and is very much “loved” by every man who has had one, because of the spontaneity and  excellent results. The disadvantages are cost and requires a six week surgical healing period. Once used it is impossible to revert to any of the other methods, although I do not know anyone who has even considered going back to a previous method. As with any surgical procedure, you should talk to other men that used the doctor you plan to use.
A man treated with surgery, can have an implanted erection system to not only have an erection, but he will be able to perform better than before because the problem of premature ejaculation is solved, and he will easily satisfy and outlast his mate. This is true whether he has any of the three implant systems ( two malleable rods inserted into the penis, a two piece or three piece system that includes a reservoir of saline solution in the abdomen, and an activation control inserted into the scrotum).

If a man had Brachytherapy or External Beam Radiation, he too can have a surgical Erectile Implant System to obtain an erection. Note that body tissue that has been radiated may present an issue with healing, however if the patient is a non smoker, and not diabetic, and the radiation therapy was done in the modern era with Intensity Modulated Radiation Therapy, he should heal. The patient must discuss this issue with his doctors.


3.3 Radiation Burns.
If the rectum is burned by radiation, causing fecal incontinence you will have to ask your physicians for solutions. Some men have used a Bariatic Oxygen Chamber Treatments to help with this problem.
– If the bladder neck is burned by radiation, you will need to consult with doctors who treat this type of condition.
– Burning sensations during urination after radiation treatments, usually resolve themselves with time.


3.4 Cryotherapy damage:
– If cryotherapy damaged the rectum or bladder, you will have to ask your physicians for solutions.


3.5 Androgen-Deprivation Therapy
Androgen Deprivation Therapy (ADT) may cause hot flashes, night sweats, loss of libido, decreased muscle strength, anemia, bone loss, breast enlargement, cognitive changes, and may effect diabetes and heart condition if they exist.. Many of these will last as long as the ADT treatment lasts and then for months longer. Some of these items may be lessened by various drugs now available. The breast enlargement is sometimes treated with small does of radiation, and the cognitive changes disappear with time, as the ADT is stopped. As for effects on a man’s diabetes and heart condition, the heart doctor and primary care physician should be involved in any decisions.


3.6 Radiation-Seed Migration
Seed Migration into the urethra after Brachytherapy is usually resolved by a catherization procedure in the doctor’s office, or sometimes done by the patient.


3.7 Biopsy Infections
Infection caused by the biopsy is usually treated with an anti-biotic for about a week or 10 days.


3.8 Chemotherapy Side Effects
Chemo side effects depend on the drugs used, and this needs to be discussed with your medical oncologist and / or the nursing staff treating you.


3.9 Shortened Penis
Shortened penis is something the man must live with. Many women are not aware of the difference, but the man is.


3.10 Family and Social Issues
Family and Social Issues usually need help from an Oncology Social Worker, Psychologist and sometimes with advice from people in a support group. Do not ignore friends and relatives with special capabilities who may have been in similar situations


3.11 Rare Side Effects
Rare or unusual side effects need to be discussed with your doctors
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4.0 References
R77- Article Date: 13 Jan 2008 Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D. In the October 17, 2007 issue of the Journal of the National Cancer Institute JNCI 2007:99;1516-24
R96- Posted February 1, 2008 , by American Medical Systems
R106A Oct.13, 2009 HealthDay News. 2009 Journal of the American Medical Association
R106- Downloaded from www.jama.com JAMA. 2009;302(14):1557-1564 (doi:10.1001/jama.2009.1451)
R133-Old Drug Eases Side Effects of Prostate Cancer Treatment Posted By Jacob Goldstein On February 25, 2008 In Cancer, Drugs.R77 Wall St Journal 2/25/08
R188- By Mary Pickett, M.D., Harvard Medical School, March 25, 2008
R193A From ScienceDailyJan. 31, 2008 and published in a recent issue of Urologic Nursing
R193 From a study published in the New England Journal of Medicine (3/25/2008)
R194 Copyright 2008 The Associated Press. Published in Thursday’s New England Journal of Medicine.
R272 US News HealthDay FRIDAY, Oct. 8, 2010
R389- May 10, 2008,Journal of Clinical Oncology
R470- Findings from the Michigan Prostate Cancer Survivor Study” AACR-FCPR 2011; Abstract B24.
R583- SOURCE: bit.ly/MU6YjL Journal of Clinical Oncology, online June 25, 2012.
R637- PMID: 22975107 Reference: Urol Oncol. 2012 Sep 10. pii: S1078-1439(12)00245-1.
doi: 10.1016/j.urolonc.2012.07.003
R714- http://dx.doi.org/10.1016/j.urology.2012.08.090 UROLOGY 81: 134, 2013. _ 2013 Elsevier Inc
R715-Urology. 2013;81(1):130-135.

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April 24, 2013 Rev A
June 11, 2013 Rev B