PROSTATE CANCER

( By JASCAP )

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Living with prostate cancer

Follow-up after treatment for prostate cancer

After your treatment has finished, you will have regular checkups, usually involving a PSA test. These will probably continue for many years.

Many people find that for a while they get very anxious before the appointments. This is natural and it may help to get support from family, friends or one of the useful organisations we have listed.

If you have any problems, or notice any new symptoms between check-ups, let your doctor know as soon as possible.

People whose treatment is over apart from regular check-ups might find our booklet about adjusting to life after cancer helpful.

Dealing with side effects of treatment for prostate cancer

Unfortunately, treatment for cancer of the prostate can cause unpleasant and distressing side effects, both short and long-term.

Sexual problems/erection difficulties

Any prostate cancer treatment can make you less interested in sex. This is known as loss of libido and is common to many illnesses, not just cancer. Erection difficulties (impotence) are also a fairly common side effect of prostate cancer treatment.

Many men find it difficult to talk about such personal subjects as erection problems, particularly with their doctor or other medical staff. The problems may not be permanent and can sometimes be caused by anxiety rather than the treatment. Some men also find it difficult to talk to their partner for fear of rejection, but these fears are often unfounded. Sexual relationships are built on many things, such as love, trust and common experiences. You may find it helpful to read our information about relationships and communication.

If you find the effect on your sex life difficult to deal with you could discuss this with your doctor. Although you may worry that this will be embarrassing, doctors who deal with prostate cancer are very used to talking about these issues and will be able to give you advice. There are practical ways to help overcome impotence and your doctor will be able to give you further information about them. Most hospitals also have specialist nurses who can discuss the issues with you.

Medicines

If you have problems getting or maintaining an erection there are many options to help. They may give you a hard penis but won't necessarily increase your feelings of arousal.

The tablets sildenafil, vardenafil and tadalafil have similar benefits and risks. They all require sexual stimulation in order to achieve an erection and can all cause erections that last a long time. If the erection goes on for more than two hours it can damage the tissues of the penis, so if this happens you should get medical help as soon as possible. The tablets shouldn't be taken if you are taking some types of heart medicines (nitrates).

Sildenafil (Viagra®) tablets can help produce an erection by increasing the blood supply in the penis. They are usually taken an hour before lovemaking, and an erection then occurs following direct sexual stimulation. These tablets should be prescribed by your GP. They can cause side effects for some men, which include heartburn, headaches, dizziness and visual changes.

Vardenafil (Levitra®) tablets are similar to sildenafil. They normally work within 25-60 minutes. The most common side effects are headaches and flushing of the face.

Tadalafil (Cialis®) tablets can be taken up to 24 hours before lovemaking. Your doctor may be able to prescribe them on the NHS. Tadalafil works by increasing the blood supply to the penis.

Injections

Injections of alprostadil (Caverject®, Viridal®) or papaverine directly into the penis, using a small needle, can cause an instant erection. The drugs restrict blood flow and trap blood in the penis. Experimentation is often needed at first to get the dose right. One of the possible side effects is that if too much of the drug is given the erection stays for too long and there is a

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danger of damaging the tissues. If the erection lasts longer than two hours you should get medical help as soon as possible.

Some men who use these injections say that the head of the penis doesn't get as hard as the shaft.

The injections are prescribed by your GP. Usually this method is recommended to be used not more than once a week, which may not be enough for some men.

Pellets of alprostadil (MUSE®) can be inserted into the penis. The pellets melt into the urethra, and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that the pellet is uncomfortable at first.

Pumps

Vacuum pumps can also be used to produce an erection. They are sometimes called vacuum constriction devices.

The pump is a simple device with a hollow tube that you put your penis into. The pump makes the penis fill with blood by creating a vacuum. A rubber ring is then put around the base of the penis to give an erection.

The erection can be maintained for about 30 minutes. Once you have finished making love the ring is taken off and the blood flows normally again. The advantage of this device is that it doesn't involve inserting anything into the penis or taking any drugs, but it can take a few tries to get used to using it. It's particularly helpful for people who are not able to take other medicines.

Your partner may find your penis slightly colder than usual. The ring should only be worn for half an hour at a time.

Pumps can be used as often as you want, as long as you allow half an hour between each use. They are available on the NHS.

Most men who have erection problems after prostatectomy or radiotherapy will probably gain some benefit from the treatments described above, but everyone is different. Specialist advice and counselling is available and can be useful for many men. You can ask your doctor to refer you.

Any medical treatment for sexual problems caused by prostate cancer is available on the NHS.

Our booklet on sexuality and cancer discusses all of the above methods in detail. It also discusses the effect that sexual problems may have on your relationship.

Urinary incontinence

Losing control of your bladder may be caused by the cancer itself, by surgery, or rarely by radiotherapy. A lot of progress has recently been made in dealing with incontinence, and there are several different ways of coping with the problem. You can discuss any worries with your doctor or nurse. Some hospitals have specific medical staff who can give advice about incontinence. The Bladder and Bowel Foundation can also offer useful information.

It's important to recognise that these problems don't affect all men. You can ask your doctor, or specialist nurse about your treatment and its possible side effects. Then you'll be better prepared to cope if problems arise.

Infertility

Most treatments for cancer of the prostate are likely to cause infertility, which means that you will no longer be able to father a child. This can be very distressing if you want to have children. Your doctor or radiotherapist can talk to you about this before you start treatment and if you have a partner you may wish to discuss the issue with them. It is sometimes possible to store sperm before treatment starts. The sperm may then be used later as part of fertility treatment.

We have information on ways of preserving fertility.

Breast swelling

If your doctors recommend hormone treatment that may cause breast swelling, they may advise a short course of low-dose radiotherapy to your breasts, before you start the drugs. This will very often prevent any breast swelling, and causes very few side effects or none at all. Alternatively, taking a low dose of another hormonal drug called tamoxifen may prevent breast swelling.

Living with and after cancer

Cancer can affect many areas of your life such as your finances, work, your emotions and relationships. Find information and advice about what the effects might be, how to deal with them and how we can help.

Emotional effects

Information on the emotions you might experience as a result of your cancer diagnosis, ways that you might manage them and other sources of support.

Relationships and communication

Advice on how to talk to other people, talking to children, relationships and sexuality.

NOTE: JASCAP has booklets on the above subjects.

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