Life After Prostate Cancer: Regaining Continence and Sexual Function

Prostate cancer is the most common cancer in men, affecting 1-in-8 men in their lifetime.

The good news is that the survival rate for prostate cancer, when diagnosed early, is over 99%.

However, many prostate cancer survivors experience concerning side effects from treatment, including Urinary Incontinenceand Erectile Dysfunction, that can greatly impact quality of life.

In a recent webinar, renowned urologist Dr. Paurush Babbar shared valuable insights and advice for men navigating these challenges. Read on as we highlight some of the key takeaways that can help guide you or a loved one on their journey post-cancer.

Prostate Cancer Survival is a Rollercoaster

A prostate cancer diagnosis can feel like a gut punch. “When you get this diagnosis of cancer, you hear the C word – all the patients are thinking about, and rightfully so, is how can I make it out of here alive,”Dr. Babbar said. “Because cancer has such a stigma in our society.”

he initial focus is (rightly) on eliminating the cancer— but that shouldn’t be the end of the story. Dr. Babbar emphasized that it’s also important to think about quality of life on the other side of treatment.

“What we find is that prostate cancer, generally speaking, is very treatable,” he noted.

“But at the time of diagnosis and treatment, patients are not thinking about what will my life be like a year after my prostate removal or three years after my radiation therapy.” Common treatments for prostate cancer including, surgery to remove the prostate, radiation therapy, and hormone therapy can all lead to issues like urinary incontinence, erectile dysfunction, and loss of libido.

The road to recovery once the cancer is in remission can be daunting, especially if you’re dealing with embarrassing leaks or frustrating problems in the bedroom.

“Fortunately, there is plenty that can be done to manage incontinence and sexual dysfunction after prostate cancer treatment,” said Dr. Babbar.

“It’s never too late to see a urologist who specializes in prostate cancer survivorship. We have a wide range of options to help patients regain control and confidence.

Understanding Urinary Incontinence after Prostate Cancer

Urinary incontinence is a common side effect after prostate cancer surgery, affecting up to 10% of men.

Since the prostate houses the main sphincter which is important in men being able to hold their urine Dr. Babbar explained, some degree of incontinence right after prostate surgery in the weeks after is expected.

“In most cases, patients are down to no pads or maybe a small liner pad a day within a few weeks after prostatectomy,” Dr. Babbar said. “But in some patients, this is persistent.” Thankfully, there are both non-surgical and surgical treatment options available.

Treatment Options for Urinary Incontinence

Some non-surgical options Dr. Babbar discussed for managing urinary incontinence include:

• Absorbent pads/underwear: ProTech Dry – Look for hyper-absorbent, washable products for the best protection
• Penile clamps: Lunderg Confidence Clamp – A clamp around the penis can prevent leakage, though some may find it uncomfortable
• Pelvic floor exercises: Strengthening the pelvic floor muscles with Kegel exercises before and after surgery can improve continence
• Medications: Drugs that target the bladder muscles can help with urgency incontinence

“Certainly [your primary care provider will] have a general understanding of incontinence and can prescribe medications,” Dr. Babbar noted. “But it’s important to see a urologist who specializes in prosthetic urology, as we can offer all of the options.”

For men with persistent moderate to severe incontinence after trying conservative treatments, surgery may provide the best long-term solution. Dr. Babbar covered two common procedures:

• Male Urethral Sling: A small “hammock” of mesh is placed under the urethra to provide support and improve the angle. Best for men with mild leakage who have not had radiation.
• Artificial urinary sphincter: A small pump is placed in the scrotum that controls a cuff around the urethra. When the pump is squeezed, the cuff opens to allow urine to pass. This is what Dr. Babbar called the “workhorse” treatment for severe incontinence.

These are not first line treatments. Rather, these are prescribed for men who are having significant quality of life issues.

“[These surgeries] can change a man’s life, to be honest with you,” Dr. Babbar said, “If you’re incontinent to this degree, you can’t have sex, you can’t go in a swimming pool, it’s hard to play golf. Until a man loses his continence, you don’t know how important it is.”

Reviving Your Sex Life After Prostate Cancer

Erectile dysfunction (ED)is another common and distressing side effect of prostate cancer treatment, whether you’ve undergone surgery, radiation, or hormone therapy. While it’s normal to feel frustrated or embarrassed, it’s crucial to know that you have options for regaining sexual function. “One thing I like to bring up is there are different levels of care for ED,” Dr. Babbar explained. “Your PCP can prescribe basic ED medications like Viagra. A general urologist can provide more advanced options. But a prosthetic urologist specializes in treatments specifically for ED after prostate cancer.”

When it comes to treating ED after prostate cancer, your urologist is your best ally. They can work with you to find the solution that fits your individual needs and preferences. “It’s important to see someone in the medical field,” urged Dr. Babbar. “I think a lot of times there are these pop-up men’s health clinics that you have to be a little wary of. Seeing someone who can offer you all of the options, and not just one, is key.”

Treatment options for Erectile Dysfunction after Prostate Cancer

Typically, your urologist will recommend starting with the least invasive treatments and moving up to more advanced options if needed.

• Oral Medications (Viagra, Cialis, etc.)
• Vacuum Erection Devices
• Penile Injections
• Intraurethral Gels

“Pills like Viagra or Cialis are first line, but there are many patients who don’t respond well to them or have side effects,” said Dr. Babbar. Iforal medicationsdon’t do the trick, your doctor may suggest the following:

• Vacuum Erection Devices (VEDs): These mechanical pumps create an erection by drawing blood into the penis.
• Penile Injections: Injecting medication directly into the penis delivers a potent dose that has the highest success rate of the non-surgical treatments. “Up to 90%,” noted Dr. Babbar.
• Intraurethral Gels: For men who can’t stand the idea of needles, an intraurethral gel containing similar medication can be inserted into the opening of the penis. While not as effective as injections, this can be a good middle ground for some.

If the above treatments fail to restore satisfactory sexual function, a penile implant is the gold standard solution. An inflatable device is surgically placed inside the penis, allowing you to create an erection on demand.

“A penile implant has over 95% patient and partner satisfaction,” said Dr. Babbar. “In skilled hands, it’s an outpatient procedure that takes about an hour. And no one can tell by looking at you that you have an implant.”

Conclusion

If the idea of surgeries for either incontinence or erectile dysfunction give you pause, consider this powerful anecdote from Dr. Babbar:

“Most patients say ‘I wish I did this sooner.’ If your knee or your heart needed surgery to function properly, you would do it. [These are] real, functional solutions to a problem that has a huge impact on quality of life.”

We’ve only scratched the surface of the wealth of information Dr. Babbar shared in his presentation. To learn more about how to maximize quality of life after cancer, you can check out the full presentation on our YouTube page.

As Dr. Babbar put it, “I just see too many patients who had their prostate out 25 years ago and no one told them about these options. We need to spread the word that help is available.”

If you’d like to watch the full ‘Prostate Cancer Survivorship Online Clinic’ recording, click here.

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