Prostate Cancer - A frustrating response to why some men do well after treatment and others do not.

This blog is dedicated to the men who have been diagnosed with prostate cancer. And to their families and all of those that are involved in their care.

When I entered the field of pelvic health physical therapy, I honestly thought I would be treating elderly women pretty exclusively. Obviously, that wasn’t the case at all. A large portion of my client base was young women. More to my surprise, a good portion of my case load was men who had been treated for prostate cancer. I had a lot to learn.

I think what really stuck out to me when I started treating men post-prostate surgery was how much it affected their entire world. Women tend to know that later in life we might have urinary leakage. We are going to go through menopause at some point. But men are often blind-sided by the diagnosis and treatment of prostate cancer. Not to mention the side-effects of the treatments that save their lives.

The other interesting thing I noticed was how each man’s journey to healing looked completely different to the next.

So why is there a difference in healing person to person? And why do some side-effects last longer?

1. To state the obvious, there are several treatment options for prostate cancer. There’s surgery, radiation, chemotherapy, androgen deprivation therapy, and probably more. So the type of treatment you have can affect outcomes and side effects.

2. Surgically, when the prostate is removed, things change anatomically. Even very slightly. And this can affect the normal pressure a person has on the urethra.

3. Depending on your cancer, the sphincters that control continence can be damaged either directly or indirectly through nerve damage. Nerve damage isn’t always permanent. But nerve healing is VERY slow.

4. Some may develop (or perhaps bring with them from before surgery) bladder overactivity and decreased bladder compliance. This is basically poor bladder habits. This can affect your progress after treatment.

5. Muscular weakness can also occur in the pelvic floor. Stress urinary leakage occurs when the intra-abdominal pressure is greater than the resistance at the pelvic floor level. This can cause leakage with movement or bearing down.

6. Arterial and nerve damage can occur - whether permanently or not. This affects those muscles and sphincters that keep you continent and get/keep an erection.

7. Bladder function itself can also be affected. There can be decreased bladder storage. There can also be an increased sensitivity to fluid in the bladder which makes you feel like you need to go more often.

8. Having erectile issues prior to surgery or treatment can also make achieving an erection more complicated afterwards.

What can you do to get better faster?

1. Be patient. I wrote a blog on what you can do after prostate surgery - Urinary Leakage After Prostate Surgery - it has some practical things to try.

2. Talk to your surgeon, physician, and/or nurses to find out the specifics of your treatment. Tissue quality? Nerves damaged? Ligaments spared? Understanding your specific treatment can help you understand more about your own recovery.

3. Find a support group. It’s easy to feel isolated and like you’re the only one going through this. That’s simply not true. Sharing and conversing with others can make the journey easier.

ZeroCancer.org is a great resource to find local in-person support groups or virtual support groups, depending on your preference. 

4. Find a good pelvic health physical therapist. There are things we can do to help you through the journey. There is education, exercise, equipment, and more that can make life more pleasant. Research is finally improving in the area of men’s pelvic health and there have been some great outcomes with new protocols, which can decrease or eliminate urinary leakage and help with erectile dysfunction. 

Special thanks to the APTA Pelvic Health courses and Samantha Hughes “Caring for prostate cancer survivors: A biopsychosocial approach in physiotherapy and oncology practice”.

Let’s get better together!

Cortney