No one wants to hear the word "cancer" in a medical diagnosis. It’s a word that often brings a lot of fear, anxiety, and uncertainty. For men diagnosed with prostate cancer, these feelings are compounded by concerns about their sexual health.
Vanessa Snow, Head of Medical Affairs at Janssen South Africa, explained that “when the diagnosis is prostate cancer, men experience the additional stress of having to contemplate their sexual wellness.”
South Africa is grappling with an epidemic of cancer, and prostate cancer is one of the most prevalent forms affecting men in the country.
As the world observes Breast Cancer Awareness Month, it’s essential to shine a light on the ongoing challenges posed by prostate cancer. The impact of this disease on men’s health, particularly their sexual health, is a significant aspect often overlooked in discussions about cancer treatment.
Men diagnosed with prostate cancer are quickly confronted with the potential side effects of treatment, many of which directly affect sexual performance. A loss of sex drive, difficulty achieving or maintaining erections, and changes in orgasm are common concerns.
As Snow pointed out, “a loss of sex drive, or the inability to achieve a firm, or long-lasting erection, are two prominent concerns.”
Additionally, some men may experience a decrease in ejaculation volume or even an absence of ejaculation after orgasm.
These side effects not only affect the individual but can also strain relationships. Stress and anxiety over sexual performance can lead to emotional distance between partners.
In such cases, Snow advised that counselling, including couples therapy, can be an essential part of managing the psychological toll of prostate cancer and its treatment.
Moreover, patients should thoroughly explore their treatment options, weighing the pros and cons of each, including how they might affect sexual function.
Treatment options for localised prostate cancer
When it comes to treating localized prostate cancer, there are several different approaches available, each with its own impact on sexual health. Here’s a look at the most common options:
Active surveillance: For men with low-risk, early-stage prostate cancer, one option is active surveillance, closely monitoring the disease rather than immediately starting treatment.
This approach can avoid the risks and side effects associated with more aggressive treatments, allowing men to maintain a more normal sex life for longer. However, this option carries a risk.
A recent study showed that men who opted for active surveillance had a higher chance of the cancer spreading beyond the prostate compared to those who chose immediate treatment.
Watchful waiting: Watchful waiting is another option, but it’s reserved for men with localized prostate cancer who are not good candidates for curative treatment, often due to age or other health conditions.
Unlike active surveillance, watchful waiting doesn't involve frequent monitoring but rather focuses on managing symptoms as they arise. This option is typically considered for men with a life expectancy of less than 10 years.
Prostatectomy (Prostate removal): Prostatectomy, the surgical removal of the prostate, is often seen as the most definitive treatment for prostate cancer. Many men choose this option in hopes of preserving sexual potency.
However, the nerves responsible for erections are located very close to the prostate, and if the cancer has spread to these nerves, they may need to be removed, leading to permanent erectile dysfunction.
Radiation therapy: Radiation therapy has long been a standard treatment for prostate cancer, but it has been known to cause damage to the nerves and blood vessels involved in erectile function.
"Radiation hasn’t always enjoyed the best reputation in this regard," Snow commented.
However, advances in radiation technology, such as stereotactic body radiation therapy (SBRT), offer more precise targeting of the tumour, potentially sparing nearby healthy tissue, including nerves and blood vessels crucial for sexual function.
While prostatectomy has historically been favoured by many patients, Snow cautioned that it’s not necessarily the best option for everyone.
Recent studies have shown that sexual function often declines more after surgery than after other treatments, though some men may experience improvement over time.
The key takeaway from all of this is the importance of individualized care. Snow emphasized that men should not rely solely on anecdotal advice from friends or family members who’ve gone through similar experiences.
“Take pains to discuss options with medical personnel who are best informed about your specific circumstances,” she advised. Every case of prostate cancer is unique, and what works for one person may not work for another.
Thanks to recent advancements in treatment, men diagnosed with prostate cancer today have a much better chance of managing the disease while still maintaining a fulfilling sex life.
“With strides that have been taken in recent years, there’s a very good chance that you will be able to treat your condition while still managing to enjoy a vibrant sex life,” Snow said.
South Africa, like many other nations, is facing a rising tide of cancer cases, and prostate cancer is one of the most common forms impacting men.
No man should have to choose between life-saving treatment and a healthy sex life. With the right medical advice and support, it’s possible to have both.