Effects of prostate removal

Men with prostate cancer who have their prostate removed cite sexual dysfunction as the most common side effect after surgery, but urinary dysfunction troubles these patients most, reports a University of Florida researcher. What's more, many aren't emotionally prepared to face these complications.

The study findings, published in a recent issue of Urologic Nursing, underscore the need for health-care practitioners to educate their patients about the physical and psychological effects the surgery will have on their everyday lives.

“The effects of this treatment are quite immediate and can lead to depression and frustration,” said Bryan Weber, Ph.D., A.R.N.P., an assistant professor in the UF College of Nursing and the study's lead author. “After an initial diagnosis of prostate cancer, men may be so focused on eradicating the disease that they don't realize the effects the treatment will have on their quality of life, both for them and their families.”

Prostate cancer is the No. 1 cancer among men, excluding skin cancer, and with more baby boomers reaching their 50s and 60s, it's expected to grow even more prevalent, with more than 200,000 cases diagnosed in 2007. Given the various treatment options for prostate cancer, men who undergo radical prostatectomy may initially decide that the risk of physical dysfunction is worth the benefit of improved likelihood of survival. But many don't know what to expect in the months after surgery, Weber said.

Physical side effects of prostate cancer treatment limit daily activities and may interfere with a man's sense of masculinity and self-confidence. Urinary incontinence, for example, requires the use of pads that add considerable bulkiness to clothing and create concern about leakage and odor. Sexual dysfunction interferes with a man's sense of self and may limit the relationship he has with his significant other, Weber said.

In the study, UF researchers evaluated 72 men six weeks after they underwent prostatectomy. In addition to measuring participants' physical function and assessing whether they had urinary and bowel symptoms and sexual dysfunction, the researchers also evaluated measures of self-confidence, social support and uncertainty about the disease and treatment. Most participants were white, married and employed full-time or retired, and most had some college education.

Fifty-seven percent of the men reported low to moderate social support, indicating that many of the topics proved embarrassing for them to discuss with others, Weber said. The level of social support was significantly related to urinary problems, revealing that men with urinary incontinence may need more support than those with more control.

“Within the first 100 days of diagnosis, men may be so distressed and so focused on curing their cancer that they don't focus on these side effects, which is what makes it imperative for health-care professionals to educate them on ways that their lives will change and how they can cope,” Weber said. “Almost immediately after treatment, men may experience depression, awkwardness and emasculation, which will have a great effect on their quality of life.”

Weber suggests that clinicians assess men and their support systems, identify changes in physical function that may occur as a result of treatment, and direct them to products and services designed to help them cope with the immediate effects of sexual dysfunction and urinary and bowel incontinence.

For example, Weber said numerous medications aim to ease sexual dysfunction, but many men may not realize the great expense associated with these drugs or be aware of their potential side effects. Similarly, a number of options for urinary incontinence exist, such as boxer shorts that are designed to hold urinary pads, lessening the embarrassment of having to wear such items.

“Education and counseling should be provided to these men to better inform and prepare patients for the physical side effects they are likely to experience postoperatively,” Weber said. “Since we know that men are less likely to rely on support groups or be more embarrassed to discuss these items with family and friends, it's even more vital for health-care professionals to stress these issues and include options for patients. Men need to be introduced to different options, make choices and regain control over their lives.”

Health practitioners need to remember to thoroughly discuss the consequences of treatment with patients, and information should be tailored to each individual's needs, said Joyce Davison, Ph.D., R.N., an assistant professor at the University of British Columbia Department of Urologic Sciences.

“Once diagnosed with prostate cancer, men vary with regard to the type and amount of information they wish to access and the degree of decision control they wish to have,” Davison said. “It is up to health-care professionals to assess and provide information and support accordingly.”