When I first started this column I was warned about writer’s block. However, so far I have been fortunate in that I experience the contrary. I am often in a dilemma on what to share each week, as there is a mountain of information waiting to be consumed by you. This Movember month presents the same challenge in that regard but let’s do our best.
Potency is a big issue for most men and the threat of losing it results in a significant number of men delaying treatment for prostate cancer. In previous articles I have glossed over the general aspects but in this article I will attempt to demystify the different aspects of sexual function
This week one of my patients shared an interesting experience with regard to his potency. He had recently undergone a robotic assisted removal of his prostate gland for a cancer diagnosis but his PSA was persistently raised, so he was sent to us radiation oncologists if we could offer him some radiation to finish off the cancer. Unfortunately, the specimen after the operation showed no cancer in the area where we would normally blast away the remaining cells so we advised that he waits for a scan called a PSMA scan which shows the site of the smallest focus of cancer. Even in the developed world there is a waiting list of up to 3 months for this scan. Of course this waiting will have no particular adverse effect physically but my patient says every time he intends to engage in his conjugal rights it makes him think of his prostate and this triggers stress reaction leading to a very poor erection and all that follows. He says generally he is able to take his mind off the cancer but this activity is a stark reminder therefore overwhelmingly decreasing his quality of life.
The psychological stress that follows a diagnosis of cancer is often under addressed. Especially in our men, where culture teaches us ‘ku kosa ama men’ (to be strong as men). As a ‘Mowoman’ I like the movement because it encourages us to talk about things such as depression in men. Men are human too and should be allowed to freely express their emotions. As designated head of household and in many a circumstance breadwinner, there are many thoughts that go on in a man’s mind when faced with this diagnosis. The patient I refer to here did not really have to come for the said visit this week until he had the PSMA scan results but we accommodated him because we realised he just needed a place to release the build up of steam. Truth be told he could not get through a sentence without watery eyes.
As you will see in the picture that the nerve that supplies the penis is intimately applied to the prostate. As a result surgery if nerve sparing is unavoidable leads to irreversible damage. Radiotherapy given in high doses to this area may also cause dysfunction. However, newer techniques attempt to veer radiation dose away from this area and it helps in certain circumstances. Other medical conditions like diabetes can cause this nerve damage and the risk factors for developing prostate cancer are annoyingly similar in these non-communicable diseases.
Blood vessel damage
The mechanism of erection is highly dependant on the blood vessels of the penis to fill with blood. This in turn is dependant on the ability of the muscles around the base of the penis to relax to allow this inflow. If the blood vessels are unable to expand this leads to inadequate erection. Some none cancerous causes include the vessels clogging up with fat called cholesterol. In terms of treatment related side effects radiation causes the vessels to ‘scar’ and this may affect their ability to expand. This should only happen in roughly 15% of men if they are treated properly. The good news is in about 80% of men the use of drugs such as Viagra and Cialis allow men to achieve reasonable erections. These drugs have received some bad publicity due to the fact that they have been abused by consumers and due to the stigma taken without consultation from medical personnel. It brings us back to talking about issues openly. Erectile dysfunction happens to most men at some point in their life and it should be a topic one should feel comfortable talking about with your doctor.
The prostate gland produces a significant amount of semen together with the seminal vesicles. When radiation is given to the prostate these cells stop producing semen. The same concept applies when the prostate is removed. This should not affect the ability to ejaculate but it takes adjusting to the new state of affairs
This is always a big issue as it comes with a lot of side effects such as hot flashes, reduced bone density and mood swings. Exercise and weight loss does a lot to mitigate these problems. However, one of the biggest side effects is loss of libido. The hormones deliberately block the testosterone in a man’s body. This is necessary as the cancer feeds on testosterone. One sure way of avoiding hormones in treatment is to get diagnosed early. And the only way that can happen is if you are getting a regular screening. As we have discussed in previous articles PSA testing in certain environments is highly criticized as it is deemed inaccurate. However, if done in the correct context it can be life saving. It is generally better to have a PSA profile – this means to have a couple of readings over determined intervals that show a trend in how your values behave, taking into account any urinary tract infections and so on. Only once you have a firm suspicion should you go for further biopsies. Next week I shall touch on the advances in prostate cancer diagnostics so stay tuned! Unfortunately, once advanced hormones are part of the treatment regimen.
Hopefully some of this information helps demystify the issues of sexual health and prostate cancer.