Prostate cancer treatments are likely to alter the sex life of patients, but there are solutions that limit these effects (discussed in another chapter). The patient must therefore be followed as a result of these treatments, in order to allow the best management of their side effects.
Main methods of treating prostate cancer
The treatment protocol and the timetable for its implementation are defined by a team led by the urologist. These treatments depend on the type and extent of prostate cancer, its characteristics, the risks associated with it, and the age and preferences of the patient.
There are three main types:
This treatment with curative aim of the prostate cancer, the most frequently proposed, realizes the ablation of the prostate and the seminal vesicles by opening of the abdomen or by laparoscopy – robot assisted in our practice – with minimal openings.
The purpose of irradiation is to eliminate cancer cells and is indicated in the case of localized cancer, as an alternative to surgery. It is also a curative treatment for prostate cancer.
Conformal radiotherapy, ideally in energy modulation, uses X-rays and is coupled with hormone therapy of varying duration depending on the protocols and characteristics of the cancer in each patient, up to 2 years.
The curie interstitial therapy or brachytherapy involves placing radioactive grains directly and under anesthesia in the prostate to irradiate the cancerous tumor by limiting collateral damage.
It collapses testosterone levels in the blood. Prostate cancer is a hormone-dependent tumor: castration stops – temporarily – cell growth. It is a palliative and non-curative treatment of prostate cancer.
The testes, or at least the testicular pulp which secretes the hormones (bilateral pulpectomy), or most often by chemical castration using drugs inhibiting the production of testosterone, can be performed rarely today. Isolated hormone therapy is reserved for elderly or non-operable patients and diffuse, metastatic forms of the disease.
Prostatectomy Side Effects
If the cancer is not too extensive and localized in the prostate gland, the surgeon preserves erectile vasculo-nerve strips according to local conditions and erectile function can be maintained in 40 to 80% of patients. Sexual recovery can occur within two years after surgery with the spontaneous re-emergence of erections, or most often induced by treatments.
If the necessities of control of the cancerous disease so require, the surgeon sacrifices the vasculo-nervous strips. The use of treatments is then indispensable to enable the patient to obtain usable erections.
The urologist will be able to advise the treatments which make it possible to compensate in large part for these problems.
The operation always eliminates the ejaculation of the sperm, but the patient retains however the orgasmic pleasure.
Since reproductive abilities are attained, it is advisable, in case of reproduction, to deposit sperm before the intervention in a sperm bank.
Disorders of the libido
Libido may be affected by the side effects of certain treatments as well as anxiety before or after interventions.
Other possible surgery consequences
– Uncontrolled leaks of urine are frequent in the weeks following the procedure, but usually regress spontaneously or after rehabilitation / perineal gymnastics and / or medications.
It should be borne in mind that all treatments for the treatment of prostate cancer can cause urinary and / or sexual sequelae.
Side effects of radiotherapy
The side effects depend on the location and the irradiated volume as well as the dose of radiation.
The erectile nerves and erectile vascular tissues are also irradiated. Erectile dysfunction depends on the dose of radiation administered, the age and quality of the patient’s sexuality before surgery.
Erectile function gradually decreases for 2 years after radiotherapy, but nearly half of the patients retain their capacities in the following years. For the others, the urologist is led to advise treatments to compensate in large part for these problems.
The ejaculation of sperm is also often diminished or suppressed by irradiation.
This does not prevent the feeling of a “dry” orgasm quite satisfactory for the sexuality of the patient.
Disorders of the libido
Same effects as those presented for prostatectomy.
Other possible disorders during the few months following the operation
– Radioactivity of urine or blood persists temporarily after brachytherapy.
– Difficulties in urination, linked to inflammation of the bladder and urethra, must lead the patient to drink a lot; The urologist can administer alpha-blockers. The perenniality or accentuation of disorders, often associated with the emission of bloody urine (haematuria) corresponds to the classic sequelae of radiotherapy: radiation cystitis.
– Edema results from lymphatic obstruction and water retention.
– Difficulties in going to the saddle or the presence of blood in the latter are the consequence of an inflammation of the rectum which can also be perennial in the form of a proctitis
– Intestinal problems or diarrhea may occur as a result of the local effects of irradiation.
– Narrowing of the urethra has also been reported.
Side effects of hormone therapy
Suppressing the secretion of testosterone, it causes a loss of libido and impotence for which there are appropriate treatments for motivated patients.
Other side effects of treatments acting on testosterone
The following possible effects are reported:
– Fatigue, decreased tone, adynamia, anxiety, mood swings, migraines and hot flushes.
– Decreased muscle mass, hairiness and increased fat mass.
– Insulin resistance (which can interfere with the treatment of a diabetic).
– Edema, hypertension, cardiac arrhythmia or liver damage are also reported.
Some bibliographic elements:
Presentation of possible treatments and side effects
Prostatectomy Side Effects
Side Effects of Radiation Therapy
Side Effects of Hormone Therapies