Men with prostate cancer can have healthy sex lives after surgery

There's a perception that surgery to treat prostate cancer will spell the end of a man's sex life.

And while that often used to be the case, survivorship programs, like the one at the University of Michigan Rogel Cancer Center, offer counseling and interventions to promote sexual recovery after cancer treatment.

"Prostate cancer, especially if it's caught early, is a highly treatable disease," says Daniela Wittmann, Ph.D., LMSW, an associate professor of urology and social work at U-M, and a certified sex therapist with more than 30 years of experience. "But that also means that men are often living for a long time and dealing with the side effects of treatment."

U-M's David and Jan Brandon Prostate Cancer Survivorship Program is devoted to helping men -; and their partners -; manage those side effects, the most disruptive of which are urinary incontinence and erectile dysfunction.

What we do is that we help men and their partners manage expectations for what the side effects of treatment are going to be like. Before treatment, we tell them about the rehabilitation that's available, and then after treatment, we are there as a team to support them and to help them with rehabilitation -; the physiological, emotional, relationship aspects as they relate to intimacy."

Daniela Wittmann, Ph.D., LMSW, associate professor of urology and social work at U-M

While more than 90% of men will largely recover bladder control within a year, recovery of erectile function is a longer and more variable process, she says. It can take two or more years to recover, depending on a patient's starting level of function, age and the specifics of their surgical procedure, she says.

Before surgery, patients and their partners are invited to hear from a multidisciplinary team, as well as other prostate cancer survivors, about side effects and rehabilitation opportunities. And starting about six weeks after surgery, patients and their partners are invited to meet with members of a care team that includes a sex therapist.

"The goal is to understand what the patient is experiencing and to assess how their side effects are evolving," Wittmann says. "We help men and their partners feel emotionally supported, to process any sense of grief and loss, which are natural and common, and to help them re-engage sexually if that's important to them."

Without such support, men are far less likely to try available interventions, she notes.

Rehabilitation interventions often include:

• Creating blood flow to keep penile tissues healthy with the use of a vacuum device, which assists in creating erections.
   
• Continuing to stimulate oneself to orgasm to maintain the sexual response, which is possible even without an erection.
   
• Taking a low dose of a medication known as a PDE5 inhibitor -; often sildenafil, the same medicine that's in Viagra -; to promote oxygenated blood flow.

"Penile rehabilitation doesn't necessarily help men recover erectile function, but it helps keep the tissues healthy while they're waiting for a natural response to return," Wittmann says. "It also helps men remain engaged in their sexual recovery."

The psychological and emotional side effects can weigh as heavily as the physical side effects, she says.

"It sometimes means overcoming barriers because people experience feelings of loss around spontaneous sex -; like sex is too much work when they have to use sexual aids," Wittmann says. "We tend to say to them, spontaneity can be replaced with anticipation. You can have dates where you know you're going to be making love and you can plan something fun."

Bladder cancer patients also often experience similar side effects, she notes. And may have additional body image issues that would benefit from support if they now have a stoma on their stomach.

Not all hospitals and cancer centers offer similar survivorship programs, and Wittmann recommends that men and their partners speak with their doctors about what resources may be available in their area.