Second Malignancies after Radiation Therapy: Update on Pathogenesis and Cross-sectional Imaging Findings

Treating Erectile Dysfunction After Prostate Cancer - KRDO

September marks the start of the Fall season and is also prostate cancer awareness month. Prostate cancer is quite common in men; In fact, it is the most common gender-specific cancer for men.1 Thankfully today, with over half of prostate cancers that are diagnosed, we can monitor them or watch them with what is called active surveillance.

However, a meaningful number of men continue to present with significant prostate cancer that requires definitive treatment. These treatments can include surgical removal of the prostate or radiation therapy in various forms to eradicate the prostate cancer.1 While these treatments are effective at treating or eliminating the prostate cancer, they do have side effects.

It is important to remember that for normal erectile function, there are nerves that connect stimulatory pathways in our brain to the penis. When these neural pathways are stimulated, blood flow can then be released into the penis to initiate the erection process.2  When surgery or radiation therapy is performed to treat prostate cancer, some men will have significant damage or irritation to these nerves.1 If normal stimulatory signals to enhance blood flow for the normal erectile process do not take place, then these men will develop erectile dysfunction. Obviously, it is important to treat the prostate cancer and ensure that it is under control. But for men who suffer from erectile dysfunction after treatment for their prostate cancer, there is hope. I often tell patients there are many options that can be tailored to their needs. For some of these men, they retain a partial ability to stimulate the natural erectile process. Simple solutions, such as oral therapies, with or without testosterone treatment if indicated, can be very effective.

However, for some of these patients with erectile dysfunction after prostate cancer therapy, their penile blood flow to have a natural erection is significantly limited.3 Just like any other patient experiencing erectile dysfunction, there are several treatment options available: vacuum erection devices, urethral suppositories, vasodilating medications directly injected into the penis, or penile implants.

Personally, I get excited about penile implants as a treatment option, and I have another blog post that goes more in-depth about the implants here. Patients report high satisfaction rates from a penile implant, as do their partners.4  In my opinion, penile implants provide a solution to treat erectile dysfunction after prostate cancer because many of these men do have significant nerve damage and blood flow limitations from the cancer treatment process.1 The penile implant restores the patient's ability to have an erection, relationships, and emotional confidence.5,6 Some men are worried that they might not be a candidate for a penile implant procedure because they've had surgery for prostate cancer or radiation. This is NOT always the case for these men. These men can still expect a straightforward outpatient procedure, meaning come in, go home the same day, and return to normal routine daily activities within one to two weeks. Of course, there are always possible risks to procedures, but the risks for penile implants and men with prostate cancer therapy are the same as for men who have not had prostate cancer treatment.5 There is a possibility of mechanical malfunction of the implant, and over a prolonged period, usually 10 years, these implants can stop functioning.5 There is also a risk of infection, as there is with any device implanted in the human body.5 But for men I see in my clinic, the ability to achieve complete control over erectile function as an individual and as a partner in a relationship with spontaneity and satisfaction for both the patient and their partner, the penile implant is an option.

To learn more about the connection between erectile dysfunction and prostate cancer treatment visit EDCure.Org/understanding-ed/prostate-cancer or visit my website TheMensMD.Com, to make an appointment.

References

American Cancer Society. Prostate Cancer. 2014. Http://www.Cancer.Org/cancer/prostatecancer/index. Accessed November 3, 2015.

Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2005 Nov;32(4):379-95.

Haglind E, Carlsson S, Stranne J, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective controlled nonrandomized trial. Eur Urol. 2015 Aug;68(2):216-25

Bernal RM, Henry GD. Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol. 2012;2012:707321.

Data on file with Boston Scientific.

Otero JR, Cruz CR, Gómez BG, et al. Comparison of the patient and partner satisfaction with 700CX and Titan penile prostheses. Asian J Androl. 2017 May-Jun;19(3):321-5.

EDCure.Org is a website sponsored by Boston Scientific.

Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Your doctor is your best source for information on the risks and benefits of the AMS 700™ Inflatable Penile Prosthesis. Talk to your doctor for a complete listing of risks, warnings and important safety information.

The AMS 700™ with Inflatable Penile Prosthesis is intended for use in the treatment of male erectile dysfunction (impotence). Implanting a penile prosthesis will damage or destroy any remaining ability to have a natural erection, as well as make other treatment options (oral medications, vacuum devices or injections) impossible.

Men with diabetes, spinal cord injuries or skin infections may have an increased risk of infection. Implantation may result in penile curvature or scarring. Some AMS 700 devices contain an antibiotic (InhibiZone™ Antibiotic Surface Treatment). The device is not suitable for patients who are allergic to the antibiotics contained within the device (rifampin, minocycline or other tetracyclines) or those who have systemic lupus, these patients should use one of the devices that do not contain InhibiZone antibiotic surface treatment.

Potential risks may include: device malfunction/failure leading to additional surgery, device migration potentially leading to exposure through the tissue, wearing away/loss of tissue (device/tissue erosion) infection, unintended-inflation of the device and pain/soreness. MH-545411-AB

J. Abram McBride, MD is a paid consultant of Boston Scientific.

This material is for informational purposes only and not meant for medical diagnosis. This information does not constitute medical or legal advice, and Boston Scientific makes no representation regarding the medical benefits included in this information. Boston Scientific strongly recommends that you consult with your physician on all matters pertaining to your health.

IMPORTANT INFORMATION: These materials are intended to describe common clinical considerations and procedural steps for the use of referenced technologies but may not be appropriate for every patient or case. Decisions surrounding patient care depend on the physician's professional judgment in consideration of all available information for the individual case.

Boston Scientific (BSC) does not promote or encourage the use of its devices outside their approved labeling. Case studies are not necessarily representative of clinical outcomes in all cases as individual results may vary.

All images are the property of Boston Scientific. All trademarks are the property of their respective owners.

©2023 Boston Scientific Corporation. All rights reserved. MH-1490713-AA MAR 2023

5 Things That Might Happen After Prostate Cancer Surgery - Rolling Out

While prostate cancer surgery can be a significant relief, it's essential to understand what might happen in the days, weeks, and months following the procedure.

Photo credit: Shutterstock.Com / Monkey Business Images

Prostate cancer is one of the most common forms of cancer among men, but advancements in medical science have made it more treatable than ever before. Prostate cancer surgery is a crucial step in the journey towards recovery. While the surgery itself can be a significant relief, it's essential to understand what might happen in the days, weeks, and months following the procedure. Here are five things that might happen after prostate cancer surgery to help you or your loved one prepare for the road to recovery.

Temporary Side Effects

Prostate cancer surgery, whether it's a radical prostatectomy or a minimally invasive procedure, can have temporary side effects that are part of the healing process. It's crucial to be aware of these potential effects so you don't become overly concerned during your recovery.

Urinary Incontinence: One of the most common side effects after prostate surgery is urinary incontinence. This means you might experience leakage or have difficulty controlling your bladder. However, this is typically temporary and tends to improve with time and pelvic floor exercises. Your healthcare team will provide guidance on managing this issue, and in most cases, it gradually resolves.

Erectile Dysfunction (ED): Another significant concern for men after prostate cancer surgery is the potential for erectile dysfunction. The extent of this side effect varies depending on the surgical technique used and the individual. However, many men experience improvement in their erectile function over time. Treatments such as medications, vacuum erection devices, or penile implants can help in cases where ED persists.

 Bowel Changes: Some individuals may experience temporary bowel changes, such as diarrhea or loose stools, following prostate surgery. This can be a result of changes in the digestive system's proximity to the surgical area. 

Surgical Site Recovery

Recovery from prostate cancer surgery involves caring for the surgical site to prevent infection and promote healing. Your healthcare team will provide detailed instructions, but here are some general aspects to consider:

Incision Care: If your surgery involves an open incision, you'll need to keep the area clean and dry, following your healthcare provider's recommendations for wound care. Pay close attention to any signs of infection, such as redness, swelling, or discharge.

Catheter Management: In many cases, a urinary catheter will be inserted during surgery to help drain urine while the bladder heals. Your healthcare team will guide you on how to care for the catheter and when it will be removed.

Activity Levels: While it's essential to rest and allow your body to heal, your healthcare provider will also encourage gentle movement and walking to prevent blood clots and promote circulation. Follow their guidance on gradually increasing your activity levels.

Follow-Up Appointments

After prostate cancer surgery, you'll have a series of follow-up appointments with your healthcare team. These appointments are crucial for monitoring your progress and addressing any concerns. During these visits, your healthcare provider may:

Monitor PSA Levels: Prostate-specific antigen (PSA) levels in your blood will be monitored to check for any signs of cancer recurrence. A rising PSA level might indicate the need for further treatment or evaluation.

Discuss Continence and Sexual Function: Your healthcare provider will assess your urinary function and discuss strategies to improve continence and address erectile function concerns.

Evaluate Surgical Site Healing: The surgical site will be examined to ensure proper healing, and any issues or complications will be addressed promptly.

Emotional and Psychological Support

Dealing with prostate cancer and the journey through surgery can be emotionally challenging. Many men experience a range of emotions, including anxiety, depression, and fear. It's essential to seek emotional and psychological support during this time. Consider joining a support group, talking to a therapist, or confiding in friends and family who can provide a listening ear.

Lifestyle Adjustments

Life after prostate cancer surgery often involves making lifestyle adjustments to support your overall health and well-being. Here are a few key aspects to consider:

Diet and Nutrition: Maintain a balanced diet rich in fruits, vegetables, and whole grains. Adequate nutrition is crucial for healing and overall health.

Exercise: Gradually incorporate regular exercise into your routine, as advised by your healthcare provider. Exercise can help with physical recovery and emotional well-being.

Stress Management: Finding healthy ways to manage stress, such as meditation, relaxation techniques, or hobbies you enjoy, can positively impact your recovery.

Life after prostate cancer surgery is a journey that involves overcoming temporary side effects, focusing on surgical site recovery, attending follow-up appointments, seeking emotional support, and making lifestyle adjustments. While the road to recovery may have its challenges, with the right support and a positive outlook, many men go on to live fulfilling lives as prostate cancer survivors. It's essential to maintain open communication with your healthcare team, as they are your allies in this journey toward better health and well-being.

This story was created using AI technology.

Patients, Clinicians Often View Prostate Cancer Surgery Outcomes ...

Patient assessments of functional outcomes after robotic-assisted radical prostatectomy (RARP) often differ from those of clinicians, but the discrepancy does not affect the management of symptoms, according to a new study.

Corinne Tillier, MSc, of Antoni van Leeuwenhoek Hospital in Amsterdam, The Netherlands, and colleagues examined the discrepancy between patient-reported outcome measures (PROMs) and clinician-reported outcomes (CROs) and the subsequent impact on the management of urinary incontinence (UI) and erectile dysfunction (ED) in 312 men with localized and locally advanced prostate cancer. Clinicians assessed the men using the International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) and the International Index of Erectile Function (IIEF-EF).

Clinicians (either urologists or nurse practitioners) underreported UI in 58% of men at 8 months and 59% at 12 months, Tillier and colleagues reported in Urologic Oncology. Among men with an ICIQ-SF score of 13-18, clinicians underreported UI in 29% and 23% of men at 8 and 12 months after surgery. Clinicians significantly overestimated recovery of erectile function (normal erection), especially among men with an IIEF-EF score 6 to 16. Independent of ICIQ-SF and IIEF-EF scores, discrepancies between PROMs and CROs did not affect the rate of medical care offered to patients.

"In this study we compared the PROMs with the CROs concerning the urinary continence and EF after RARP," the authors wrote. "The differences between the PROMs and the CROs did not affect the treatment of these symptoms. However, it is incorrect to conclude that PROMs are not needed in clinical practice since some side effects clearly seemed underestimated."

Urologic oncologist Michael Abern, MD, of the Duke Cancer Institute in Durham, North Carolina, said the new study confirms that results from validated functional questionnaires can differ from the outcomes or concerns that patients relay to their physician. His institution uses validated questionnaires routinely. "At our center, patients are asked to fill out validated questionnaires at the start of every visit after prostatectomy and the result is discussed," he said. "Perhaps quality improvement studies to facilitate patient compliance with questionnaires, especially in those with lower health literacy, would ensure effective communication and accurate assessments."

Daniel D. Joyce, MD, assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee, pointed out that the study was limited by selection bias due to its retrospective design. In addition, the findings are from univariable analyses, so confounding is likely to be present. "Nevertheless, the authors should be commended for drawing attention to an important aspect of surgical management of prostate cancer," Dr Joyce said. "We as surgeons are often over-optimistic about functional outcomes in our patients. Even so, it is encouraging that despite our rose-colored glasses, patients still received interventions for the negative side effects of surgery when they occurred."

The study highlights the need for diligent assessment of patient outcomes after prostate cancer surgery and for the surgeon to constantly be evaluating and working to improve his/her surgical technique to improve the patient's quality of life, according to Dr Joyce. "PROMs are a straightforward way to ensure our surgeon bias is not clouding the assessment of our outcomes and can be used to more accurately understand how modifications in surgical technique impact erectile and urinary function," Dr Joyce said.

"I think it is important that we in urology use more objective measures to define quality of life outcomes after prostate cancer treatment," said urologic oncologist Kris E. Gaston, MD, associate professor of urology at UT Southwestern Medical Center in Dallas. "We all have a very general idea how our continence and erectile function are postoperatively as individual surgeons, but rarely are we comparing patients properly with pre-op and post-op questionnaires."

Continence is poorly categorized because validated postop questionnaires are not used routinely. Surgeons will subjectively use their own definitions for continence (eg, no pads vs 1 pad per day). "Additionally, if we are going to get patients to the right surgeons to get the best outcomes, there needs to be transparency of these outcomes," Dr Gaston said. "A patient can never truly know how good or how poor their surgeon is because there is no transparency. Until that time occurs many men will be rendered incontinent and impotent by poor quality surgeons."

There is an urgent need to have better documentation of postop functional recovery using validated questionnaires, he said. "Only with honest and objective patient-reported questionnaires can we truly know where to make improvements either by individual surgeons or programmatically by institutions to achieve the highest standards of surgical care," Dr Gaston said.

Reference 

Tillier CN, Boekhout AH, Veerman, H et al. Patient-reported outcome measures compared to clinician reported outcomes regarding incontinence and erectile dysfunction in localized prostate carcinoma after robot assisted radical prostatectomy: Impact on management. Urol Oncol. Published online September 9, 2023. Doi:10.1016/j.Urolonc.2023.08.001

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