10 questions about prostate cancer
Will you be treated or not for non-metastatic prostate cancer? And what is the risk of erectile dysfunction after surgery? Ten questions for Anja Ladenberg, psychologist and case manager.
1. Can you get prostate cancer from too much sex?
Some men think that, but it’s nonsense according to Anja Ladenberg. “There is even a study that seems to say the opposite, that regular ejaculation actually reduces the risk of prostate cancer, although there is no evidence for this. I notice that few people know exactly what the prostate is for. The prostate produces seminal fluid, which is used for the transport of sperm cells, so you can still ejaculate without a prostate, but then ‘dry’. That feels different, sometimes even more intense.”
2. What are the warning signs of prostate cancer?
“That’s the trouble with prostate cancer,” says Ladenberg. “In most men, the disease does not cause any complaints. It is thought that of the men who die in old age, about 80 percent prostate cancer has. Most didn’t notice at all. You usually don’t die from prostate cancer. However, it becomes more serious when the tumor spreads, initially to the lymph nodes, and later to the bones. Back pain could therefore indicate prostate cancer, but then the disease is already at an advanced stage. I also recommend going to the doctor if you have blood in the urine or a burning sensation when you urinate, although such signs do not necessarily indicate prostate cancer.”
3. Can the doctor check you for prostate cancer?
In contrast to colorectal cancer, there is no reliable screening for prostate cancer yet. Nevertheless, the GP can do something, Ladenberg knows. “He can do a rectal exam and have blood drawn to measure the PSA. PSA stands for Prostate Specific Antigen. A PSA value higher than 3 for people over 65 (for men around 60 2 is normal) in combination with an abnormal rectal examination, may indicate prostate cancer. As I said before, many men get prostate cancer without ever having symptoms. So it is really not necessary that everyone has their PSA value checked immediately. I recommend discussing this with your doctor. Especially at an increased risk, for example if there are several prostate cancer cases in the family, regular check-ups can’t hurt.”
4. When do men come to you?
If prostate cancer is nevertheless suspected, the GP will refer the patient to a hospital or specialist center, such as the one in Delft where Ladenberg works. “I am involved in almost the entire treatment process. From the moment the doctor tells the patient the bad news, and also after the treatment, I remain the fixed point of contact. Patients and their partners find such a familiar face very pleasant.”
5. Do you recommend men to bring their partner?
“Absolute. Two people hear more than one. This is useful if the doctor provides information, but it is also nice that they can support each other. People can react very differently to the bad news. The patient himself is startled, then mainly wants to know what can be done about it. His partner is sometimes very emotional, already thinking of the worst. I always focus on both, look at them both. Those are very intimate moments. After all, it is about life and death. I often walk out of the room after a while to get coffee, so they can grab each other.”
6. What treatment options are there?
“There are several treatment options. In the Netherlands these are active surveillance (active monitoring), surgery, internal (brachytherapy) and external radiation (radiotherapy). These treatments are aimed at healing. In addition, there is of course the choice to forgo a treatment. After all, every treatment carries risks.”
7. What are the biggest risks of a treatment?
“A treatment is no fun,” warns Ladenberg. “It takes about a year to recover both physically and mentally from a treatment. Unfortunately, there is a risk of complications. Both radiation and surgery make them extra sensitive to prostate cancer. A small percentage (1 to 2 percent with radiation, 5 to 10 percent with an operation) of men can develop permanent incontinence complaints. That varies from a few drops to a whole puddle. Intestinal complaints, such as thinner stools or blood in the stools, are also possible in a few cases. A larger percentage (40 to 60 percent) will be able to get erectile dysfunction or even no erection at all after treatment. That percentage depends on the treatment method, the health of the patient and the location of the tumor.”
8. Do men sometimes dare to forgo an operation?
“My practical experience is that the most important thing for men is that the cancer is gone. In second place is the prevention of incontinence. Maintaining their erections comes in third place. But no choice is wrong.”
9. If you opt for surgery, what should you pay attention to?
Ladenberg advises paying attention to where and by whom the operation is performed. “Preferably choose a hospital or specialist center with good results and a lot of experience. Here in Delft we have been working with a new method, Neurosafe, for a year and a half. We try to spare the nerve, something that succeeds in 60 percent of the cases. With a successful operation, the chance that a man with a good erection will maintain that erection is about 50 percent. This method of surgery depends on the location of the tumor and is therefore not suitable for every man. The method is not available in every hospital.”
10. What do men struggle with after the treatment?
Even after successful treatment, when the tumor is gone, Ladenberg continues to follow the men and their partners from the sidelines. “Often they come back to me with personal questions, especially about sex. It’s good to talk about that. After all, sex contributes to the quality of life. Penetration is difficult without a (good) erection and some partners do not find urine leakage a pleasant idea. In short, couples have to find a balance in intimacy and sexuality again in their own way. Sometimes it comes naturally, sometimes it takes hard work.”
This article previously appeared in Plus Magazine November 2019. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!
Sources):
- Plus Magazine