Questions & Answers about Prostate Cancer

The first step is to talk to your urologist about your concerns. The most common problem following surgery for prostate cancer is erectile dysfunction (ED), or the inability to achieve an erection. ED does not affect your ability to reach orgasm, which is a separate but related process. You should begin to be intimate with your partner when your urologist feels you are appropriately healed. You and your partner’s ability to find other ways to be intimate that do not require an erection can help you on your road to recovery. In the meantime, you can ask to be referred to an urologist who specializes in ED. Some physicians have their patients use an ED medication to help in the recovery process.

Many partners need reassurance that the person with cancer still has an interest in being intimate, and vice versa. Interest is not only about physical attraction but in how you both feel and think about your relationship together. Your partner may be concerned that expressing a wish to be intimate again will be a source of stress and upset for both of you. Being open about these concerns is the best way to examine and explore these feelings together. Talking to other men who have similar concerns may also be helpful. Here are resources to find support group:

• CancerCare offers support groups for men coping with cancer.
• The American Cancer Society offers a supportive program, Man-to-Man for men who have prostate cancer.
• Us TOO International Prostate Cancer Education & Support Network has chapters and support groups.

You can find a counselor who specializes in intimacy issues, by contacting the American Association of Sexuality Educators, Counselors and Therapists.

I hear this question more and more from prostate cancer patients and families who want the best treatment available. It is not infrequent that people seeking a second or third opinion get different treatment suggestions. This often creates frustration and uncertainty by patients and families as to which route to pursue.

With continued research and increasing treatment options, oncologists have many treatment choices and make suggestions based on a number of factors. Some of the most important factors are:

Type of prostate cancer: Adenocarcinoma is the most common type and accounts for 95% of all prostate cancers. Other less common types account for the other 5%.

Stage of prostate cancer: A pathologist stages the cancer based on biopsy results. For prostate cancer stages are I, II, III and IV with IV being the most advanced.

Grade of prostate cancer: Additionally, pathologists grade prostate cancer according to the Gleason score, which assigns a grade from 1 to 5 based on how the cancerous cells look compared to normal prostate cells. The grade refers to how aggressive the type of prostate cancer is.

Once these factors are determined, the surgeon/radiologist/oncologist takes into account a patient’s age, other health issues, and lifestyle to determine the best treatment options for each individual. Potential short and long-term side effects will be discussed with the patient and family at this time, which can strongly impact patient’s quality of life post treatment.

With these factors in mind, patients and families determine what treatments to pursue. Some cancer doctors prefer to be more aggressive based on their experience and others see reason to be cautious, expecting to get similar results while avoiding difficult side effects.

This is often a good time for patients and families to meet with a social worker or nurse to explore their goals post treatment and make an informed decision. Along with the links above, for more information on prostate cancer treatment options and clinical trials it can be helpful to contact the National Cancer Institute at 1-800-4-CANCER (422-6237) and speak to a cancer information specialist who can assemble a packet of information that will help you make the best informed decision for you and your loved one.

And finally, the National Comprehensive Cancer Network (NCCN) provides prostate cancer treatment guidelines.