Prostate Cancer
Hello, Bestie! It’s another Sunday, which means another pelvic health chat! Today, we’re talking prostate cancer. Let’s go ahead and jump right in.
What is prostate cancer?
Prostate cancer is the cancer of the prostate gland in males. The prostate gland is a small gland found only in males that functions to produce fluid which aids in sperm transport. It sits below the bladder and surrounds the urethra. Prostate cancer is one of the most common types of cancer; in fact, the American Cancer Society reports that 1 in 8 men will get prostate cancer in their lifetime (1). It is rare in men under the age of 40 and becomes especially more common after age 65 (1). It’s also the second-leading cause for cancer death in American men (1). Despite all of this, prostate cancer has some high survival rates, especially when it is caught early (2).
What are the signs and symptoms of prostate cancer?
Prostate cancer can be slow to develop and, therefore, many folks don’t experience any symptoms early on. In later stages, common symptoms include difficulty urinating (see urinary retention), weak stream of urine, blood in the urine or semen, erectile dysfunction, or losing weight without trying (3).
How is prostate cancer treated?
Early interventions for prostate cancer may include “watchful waiting” and “active surveillance.” Both of these states of intervention involve keeping a close eye on the cancer and associated symptoms to ensure it is not spreading. If neither waiting or surveilling are appropriate, the prostate cancer is treated with one or a combination of the following: radiation, hormone therapy, and surgery (4). Let’s talk about each of these treatment techniques:
- Radiation therapy: There are two main forms of radiation therapy used for prostate cancer. The first is probably what you envision when you hear the term “radiation therapy.” It’s called external beam radiation therapy (EBRT) and involves a targeted beam of radiation that is aimed at the cancerous region. The beams of radiation come from a machine outside the patient’s body. The other type of radiation used is called brachytherapy. Brachytherapy, also called interstitial seed radiation, is where small, radioactive pellets/seeds are placed within the prostate near the site of cancer. These seeds give off radiation and aim to kill the cancer cells nearby.
- Hormonal therapy: Hormonal therapy for prostate cancer is focused on androgen deprivation. Androgen deprivation treatment slows or stops the production of male hormones. Testosterone (an androgen) can encourage prostate cancer cells to grow and spread, so reducing testosterone production can slow cancer growth. One way to stop androgen production is through orchiectomy, or testicle removal. This can also fall into the “surgical treatment” category, but I’m placing it in this category since the goal of the surgery is to impact the hormones present in the body. Medications can also be used for androgen deprivation. These include 5-alpha reductase inhibitors (e.g. Proscar and Avodart), leuteinizing hormone releasing hormone (LHRH) agonists (e.g. Leuprorelin) and antiandrogens (e.g. Firmagon).
- Surgical treatment: A radical prostatectomy may be performed to remove the prostate cancer. There are a lot of different techniques that can be used to complete this surgery and outcomes depend on the skill of the surgeon (5).
Unwanted effects of prostate cancer treatment:
Prostate cancer treatment can have adverse effects, depending on the type of treatment used and the duration/intensity of the treatment. Radiation therapy can result in urinary urgency/frequency, dysuria, nocturia, urinary incontinence, diarrhea, hemorrhoids, erectile dysfunction, lymphedema, and more (4). Hormonal therapy can be linked with decreased sex drive, erectile dysfunction, depression, fatigue, osteoporosis, hot flashes, and more (4). Radical prostatectomy surgery can be linked with urinary incontinence and sexual dysfunction among others (4).
Pelvic health physical therapy after prostate cancer treatment:
Pelvic floor rehabilitation has been shown to be beneficial in folks who have received prostate cancer treatment. In some cases, your surgeon may even refer you to a pelvic floor specialist to be assessed prior to prostatectomy surgery. This will allow you to gain an understanding of the pelvic floor and start working on activities that will benefit you after surgery (6). In cases of urinary incontinence after radical prostatectomy, pelvic floor muscle training (PFMT) has been shown to improve symptoms alone or in combination with biofeedback (7). Lots of studies report improvement in urinary symptoms (incontinence, difficulty initiating stream of urine, etc) with the use of biofeedback (8).
If you are suffering from the above-mentioned symptoms, make sure you have been checked for prostate cancer or benign prostatic hyperplasia (BPH). Remember that you can be assessed and treated in pelvic health physical therapy even before you go through prostate cancer treatment and doing so may improve your outcomes after treatment. While there are many adverse effects associated with prostate cancer treatments, pelvic health physical therapy can help you manage most of them as you work toward returning to a high quality of life.
XOXO,
Your Pelvic Bestie
References:
1. Key statistics for prostate cancer | Prostate Cancer Facts. American Cancer Society. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
2. Prostate cancer prognosis. Johns Hopkins Medicine. Published November 6, 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prognosis
3. Prostate cancer - Symptoms and causes - Mayo Clinic. Mayo Clinic. Published December 14, 2022. https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087
4. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 Mar 20;358(12):1250-61.
5. Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B. Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience. Rev Urol. 2010 Winter;12(1):35-43.
6. Tienforti D, Sacco E, Marangi F, D'Addessi A, Racioppi M, Gulino G, et.al. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU internat. 2012; 110(7): 1004-1010.
7. MacDonald R, Fink HA, Huckabay C, Monga M, Wilt TJ. Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Internat. 2007; 100: 76–81.
8. Ribeiro LHS, Prota C, Gomes CM, deBessa J, Peres Boldarine M, Dall'Oglio MF,et.al. Long-term effect of early postoperative pelvic floor biofeedback on continence in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. The Journal of urology, 2010; 184(3): 1034-1039.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
