Hi, I'm Dr. Scholz. Let's talk about prostate cancer.
In today's video, we're going to talk about treatment-related side effects for surgery
or radiation therapy for prostate cancer.
The prostate gland is within millimeters of the nerves that control erections, the rectal
wall, and the urinary passage which goes directly through the middle of the gland.
So specifically, we're talking about three types of side effects that men may have to
deal with after surgery or radiation: Impotence, the loss of ability to get an erection; incontinence,
some degree of leaking urine; or gastrointestinal problems, because the rectum is right near
there's a possibility for burns and things like that that can create difficulties with
bowel movements.
So side effects from treatment then can be a pervasive problem on a daily basis since
men's normal physiological function incorporates urinary, gastrointestinal, and sexual activity.
The reason why we can talk about side effects in the context of prostate cancer treatment
is because in many men with prostate cancer it's not necessary to have treatment. About
50% of men with prostate cancer are diagnosed with a low-risk variant we call "Sky" that
doesn't spread and can be safely watched.
Let's take a minute and define a few terms. Impotence, meaning the inability to get an
erection, in the prostate cancer world interestingly means that if you can get an erection using
Viagra, you're not impotent. So most of the men out there think that if you need Viagra
to get an erection that you have a problem with erectile dysfunction or impotence. But
when you're looking at studies of outcomes after treatment the doctors that publish these
studies don't consider you impotent if you have to take Viagra. In fact, most men after
treatment do need to take Viagra. So, as you evaluate the side effects of treatment, you
have to put that in context that the majority of men are going to need Viagra to be able
to function at all, and that isn't called impotence. It's only called impotence if men
are taking Viagra and they can't get an erection.
The other interesting definition in this realm, where all these studies are done looking at
side effects, is that any type of erection that can be achieved with Viagra is considered
an adequate erection. Men get varying quality erections after surgery or radiation and very
very few men describe the quality of erections as matching what it was like before treatment.
So there's a lot of loss of erectile quality after treatment that also needs to be considered
and isn't factored into the studies when your doctor tells you that there's an 80% chance
that you're gonna have sexual activity afterward he's not revealing that you will be taking
Viagra and that the quality of your erections will be greatly reduced.
When we talk about incontinence, the loss of urinary flow, they're only talking about
where men have gross constant leakage, and that means that they're using pads. Even using
one pad a day for minor leakage isn't considered incontinence in many of the studies. More
importantly, stress incontinence where men are coughing, jumping, or sneezing and having
squirts or leaks is not considered in the equation when doctors quote the risk of incontinence
after surgery. So typical top-notch surgeons will tell you that the risk of incontinence
is anywhere from 5-15% depending on your age, but that is only for the men that are using
two or more pads a day. It doesn't include stress incontinence and it doesn't include
another type of incontinence that is rarely mentioned called "climacturia," which means
ejaculating urine after treatment which occurs in about 20% of men who have surgery. So it's
very important to nail down the definitions when you're talking with different practitioners
about the potential side effects.
The third thing that men can run into (and it's much less common because it's more commonly
related to radiation than surgery) and that has to do with burns of the rectum, and this
used to be a big problem with older technology, and even prior to the recent advent of something
called "SpaceOar," which moves the rectal wall away from the radiation field, the doctors
were reducing the incidence of proctitis—that is, inflammation of the rectum—to a very
dramatic degree. And so, in the past proctitis used to be a big risk. It continues to be
a risk in unskilled hands. That risk can usually be eliminated altogether with the use of this
new product called SpaceOar.
So as you can see, treatment for prostate cancer is fraught with a number of problems.
The men that have the low-risk "Sky" variant or prostate cancer shouldn't be pursuing treatment
and being faced with all these risks. They can safely watch the condition, and if there's
a sign that the disease is changing, consider therapy at that point, and for the men that
do need treatment, consider that all these physicians have different skill levels. Good
practitioners have a lower risk of side effects, but it never is zero risk, and certainly,
the old claim that surgery or radiation are essentially the same is not true. You have
to carefully look at the side effects of each type of treatment and decide which one is
best for you.
Thanks for watching. Subscribe to our Youtube channel and visit our website at PCRI.org