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Cancer survivorship is more than just monitoring for the presence or return of your cancer. It is about returning your life back to normalcy, regardless of the status of your cancer.
The most common urologic cancer we see is prostate cancer.
Prostate cancer survivors approach 2.8 million in number and represent over 4 in 10 male cancer survivors in the United States. Treatments include focal therapy (HIFU), radiation treatment, surgical treatment, androgen deprivation therapy, or a combination these.
Regardless of the management option utilized, prostate cancer survivorship remains an important part of your recovery. Our prostate cancer survivorship program focuses on the following:
The frequency with which you will need to be seen depends on the aggressiveness of your disease. In the case of prostate cancer, PSA is the most common blood test used to monitor your cancer.
Guidelines for prostate cancer treatment recommend measuring blood PSA levels every 3 to 12 months for the first 5 years after definitive treatment and then to recheck annually.
After prostatectomy surgery, the PSA usually drops to an undetectable level (less than 0.014 ng/mL) within a 2-month period. Following radiation therapy, the PSA falls slowly and reaches its lowest level (“PSA nadir”) after 6 months to several years; the target PSA is less than 1.0 ng/mL.
Studies suggest that physical activity may decrease the likelihood of your prostate cancer returning, improve your overall survival after prostate cancer treatment, and help to hasten your recovery from the treatment itself.
Once you have been cleared by your surgeon, the ACS guidelines recommend at least 150 minutes of moderate‐intensity exercise per week or 75 minutes vigorous‐intensity aerobic physical activity per week. Research has shown that 3 or more hours per week of vigorous activity among prostate cancer survivors is associated with a 61% reduction in death directly related to your prostate cancer.
Although research is ongoing, findings suggest that dietary patterns high in vegetables, fruits, and whole grains improve survival and decrease the risk of secondary cancers and chronic diseases among cancer survivors. Examples include:
Smoking Cessation:
Smoking after treatment of prostate cancer increases the risk of cancer recurrence and secondary cancers. Consider talking to your primary care clinician about medication support to help you quit smoking.
Erectile Dysfunction is seen in over 15-90% of patients who have undergone prostate cancer treatment. This is because the nerves for the penis are located around the prostate and can be ‘stunned’ or injured (neuropraxia) during the treatment. It can take up to two years for these nerves to recover. Lack of erections and penile blood flow during this recovery period can result in scarring of the erectile bodies within the penis leading to loss of penile length and girth as well as an end stage erectile dysfunction called Veno-Occlusive Disease.
In order to reduce the scarring, we recommend early use of PDE5 inhibitors and a vacuum erection device that will encourage and increase blood flow into the penis until this neuropraxia resolves. Our recommendations are:
If you do not regain your full erectile function within 6 months to 1 year from the time of your prostatectomy, we will perform a penile ultrasound with a one time penile injection. This will allow us to evaluate you for veno-occlusive disease and the recovery status of your penile function. Based on your ultrasound result, we may be able to offer you alternate treatment options including long term oral medications, injection therapy, intraurethral gels or pellets, continued use of your VED, or penile implant surgery.
Strengthening your pelvic floor with Freedom+ after prostate cancer surgery or radiation can expedite recovery of your ED and incontinence. We encourage patients to begin Freedom+ treatments prior to surgery to begin strengthening the floor muscles and again as early as 1 month after surgery to try to restore pelvic floor weakness that is causing ED or Incontinence.
Urinary incontinence (stress incontinence) tends to improve gradually after surgery and generally remain stable after one year. While robotic surgery has improved incontinence rates to less than 10%, leaking is still frequently seen and often times left uncorrected.
Urinary leaking has been shown to improve quicker with kegel (urinary sphincter strengthening) exercises. These exercises should be started prior to your surgery or as soon as possible after surgery to expedite your continence recovery.
To do a Kegel exercise, follow these steps:
If you do not achieve complete recovery within 6 months to 1 year after prostatectomy, it is time to discuss surgical treatment options including a urethral sling or artificial urinary sphincter to help resolve your leaking and restore the quality of your life.
Strengthening your pelvic floor with Freedom+ after prostate cancer surgery or radiation can expedite recovery of your ED and incontinence. We encourage patients to begin Freedom+ treatments prior to surgery to begin strengthening the floor muscles and again as early as 1 month after surgery to try to restore pelvic floor weakness that is causing ED or Incontinence.