August 17, 2009
Prostate Cancer Affects Younger Men Too
While many people think prostate cancer is an older man's disease more younger men are being diagnosed every day. I know this from experience because my husband was diagnosed at the age of 49 and he didn't have a family history of prostate cancer or any other risk factors.
Twenty years ago, the peak age for diagnosis of prostate cancer was 70. Today it is 60 or younger, according to a study conducted by researchers at Duke University Medical Center. Recently the American Urological Association suggested that all men should be offered a baseline PSA test and a digital rectal exam at age 40, regardless of their risk.
Physicians are now looking at ways to risk-stratify men to determine their chances of developing prostate cancer in an effort to avoid unnecessary biopsies and overtreatment. There has been a great deal of debate about the value of PSA testing in the media recently, but the fact remains that there is no other screening tool currently available to help men know if they are at risk for prostate cancer.
Prostate cancer is often called a silent disease because of the lack of early symptoms. If it weren't for PSA testing, my husband never would have learned that he had prostate cancer.
Choosing treatment is a difficult decision
Once a man has been diagnosed with prostate cancer, making a treatment choice is often a difficult decision. This is largely because all of the conventional treatments for prostate cancer carry the risk of long-term side effects, most notably incontinence and impotence. While no man (or his wife or partner) relishes the idea of never being able to have sex again, this may be a bigger factor in the decision process for a man who is age 50 versus a man who is 70 or 80.
In his book, Saving Your Sex Life, Dr. John P. Mulhall stresses that men should not base their treatment decision on future sexual function because he states that based on current clinical data, the incidence of erectile dysfunction three years after radical prostatectomy and radiation are about the same.
After treatment for prostate cancer
A man's sexual recovery after treatment for prostate cancer depends on a number of factors and age is one of them. It is expected that a younger man who has no other health problems, and is able to have normal erections prior to treatment, will have a better chance of sexual recovery following treatment than an older man or a man who already has erectile dysfunction.
However, if a man undergoes surgery for prostate cancer (such as traditional radical prostatectomy, laparoscopic or robotic-assisted laparoscopic radical prostatectomy), even if both his nerve bundles are preserved, there will still be some trauma to those nerves and recovery will take time.
In fact, a recent study showed that it can take as long as 4 years for men to see the most improvement in their erectile function after surgery for prostate cancer. You can read the abstract to this study at (www.ncbi.nlm.nih.gov/pubmed/19091349).
One question that men should ask prior to treatment is what a physician's definition of impotence is. Some physicians believe that if a man has the ability to have an erection, he is not considered to be impotent, even if his erection is not sufficient for sexual intercourse.
Keep your expectations low
Part of the challenge is that when physicians counsel couples prior to surgery, they often describe the best case scenario, which is a return in sexual function within 3 to 6 months. While this may happen with some men, the reality is that many men will not experience a return in sexual function that soon. Sadly, I hear from many couples who get frustrated and give up on sex altogether because they think there is something wrong if they don't see a return in sexual function within the first year after surgery. I tell them that it's important to be patient-and persistent.
Even if you do not see any results right away, physicians say that you should keep trying. The medical term for this is penile rehabilitation. Studies suggest that men who use medications for erectile dysfunction, penile injections, and urethral pellets soon after radical prostatectomy may see greater improvement in their sexual function.
Intimacy has many forms
Despite all of the available medical interventions for erectile dysfunction, some younger couples may have to accept that their sex lives will not be the same as it was before treatment for prostate cancer. This is often an emotional process and you may need to redefine your perception of sex and intimacy.
I would encourage couples to learn more by visiting the section of our website that is devoted to this topic at (www.hisprostatecancer.com/sex-after-prostate-cancer.html).
Dana Kababik is editor of http://www.hisprostatecancer.com, an information and support website specifically for wives and partners of men with prostate cancer.