HCA Virginia - March 11, 2019

How life may change after diagnosis and surgery

Timothy Bradford, MD

When you hear “prostate cancer,” it’s easy to focus solely on the word “cancer.” You may feel as though you have a ticking time bomb inside you. The truth is, the vast majority of men who are diagnosed with prostate cancer will not die from it.

Prostate cancer is quite common, with nearly 60 percent of cases diagnosed after age 65. Most are nonaggressive tumors in early stages confined to the prostate, and the 10-year survival rate is around 98 percent. A low-risk tumor may cause no harm for 10 or even 20 years. Still, prostate cancer is the second leading cause of cancer death for men. Screening, prompt follow-up and timely treatment can save your life.

Know your options

The first step after a prostate cancer diagnosis is to know your options, including possible side effects. For many men with low-risk tumors, the best course may be active surveillance, or watchful waiting, with regular checks for any changes. Depending on your cancer, age and overall health, other options may include radiation treatment, surgery or both. More aggressive or advanced tumors may require chemotherapy or hormonal therapy.

Radiation therapy and surgery both have risks and side effects to consider. Patients tend to worry most about urinary incontinence and erectile dysfunction. Most men do experience some degree of both temporarily. It can take several months to a year or longer before full function returns. If necessary, urinary incontinence and erectile function can be surgically corrected. I always advise patience and keeping in mind that there are many ways to be intimate with a partner in the meantime.

Prostate cancer surgery: what to expect

Surgery for prostate cancer usually involves a prostatectomy (removal of the prostate). Many of my patients are candidates for robotic surgery, a much less invasive option than open surgery. In some cases, a nerve-sparing procedure can help prevent erectile dysfunction and incontinence or help speed the recovery process.

Overall, the surgery is safe and low-risk. It usually takes about three hours, and most patients spend the night in the hospital and have a catheter in place for about a week. You can usually resume light activity right away, and more strenuous activity after four to six weeks. After surgery, you may need other treatment depending on your cancer’s stage and other factors. Or, you may only need regular monitoring for recurrence.

Life after prostate cancer — or with it

In some cases, prostate cancer can be thought of as a chronic disease. If you have a low-risk tumor — especially if you are older or have other health conditions — your prostate cancer may be something you simply live with, and not something you are likely to die from.

If you do have treatment, you’ll probably never have prostate cancer again — though it does recur in a small percentage of cases. Regular monitoring is important for five to 10 years after treatment. If prostate cancer does recur, you may need additional treatment, depending on your age, health and other factors.

It’s normal to fear recurrence or any kind of tumor in your body — even a low-risk one. Keep in mind that many treatments are currently available, and more are in development. Many men live for years after a recurrence even with no treatment. If you’re comfortable doing so, talk to others or seek a support group or counseling. Most of my patients are surprised to learn how many friends have experience with prostate cancer.

Most importantly, do what you need to do to stay as physically and mentally healthy as possible. Keep appointments for monitoring and follow-up. And don’t let fear keep you from enjoying life.