After Prostate Cancer: Wearing the Badge of Survivor, Fearlessly

Other than skin cancers, prostate cancer is the most common cancer in American men.

The American Cancer Society estimates that nearly 200,000 new cases of prostate cancer were diagnosed in the U.S. during 2008. Because of advancements in detection, diagnostics, and treatment, fewer than three in every hundred men diagnosed with the cancer will die of it, although the chances of being diagnosed are one in six over a man's lifetime. Many prostate cancers are discovered at an earlier stage and treated more effectively than in years past. As a result, over two million men in this country who have been diagnosed with prostate cancer at some point in their lives are still alive today (1).

What do survivors face? It is not unusual for lack of bladder control to be a problem for the first few months and up to one year following a radical prostatectomy. "Radical" refers to the removal of the entire prostate gland and neighboring seminal vesicles, responsible for semen production. In fact, studies have indicated that as many as 90% of men report leakage in the first few weeks following surgery after removal of the temporary catheter. Over the course of the first year following surgery, continence returns in the majority of men. However, in 5-20% of men some degree of urine leakage will continue to be a significant problem.

Many complain that the leakage of urine is a much bigger threat to quality of life than erectile dysfunction, another adverse side effect of treatment that affects the majority of men undergoing surgery.

In medical terms, the leakage is referred to as stress urinary incontinence, or SUI. It occurs during activities that exert pressure on the bladder such as coughing or sneezing. While SUI is far more prevalent in women than men, largely because of pregnancy and childbirth, the problem of urine leakage can occur in men when the sphincter muscle, or valve at the bladder neck, is damaged and too weak to prevent urine from leaking from the bladder through the urethra to the body's outlet.

To help these muscles regain their strength and functionality, behavioral therapy involving pelvic floor muscle exercises (PMEs) can be helpful. PMEs, along with other behavioral training prior to prostatectomy surgery, may decrease the time it takes to regain continence after surgery. It is important to prepare for surgery by strengthening these muscles to improve the chances of regain continence following a prostatectomy.

In research, only 6% of men routinely performing PMEs prior to surgery experienced continual leakage six months after surgery. In a comparable, control group of men who did not practice PMEs prior to surgery, more than three times as many, or 20%, reported continual leakage after the same period of time.

Still, for some, simple PMEs, even with the help of biofeedback and electrical stimulation, are not enough to fully restore continence. The fear of others smelling urine, seeing wet trousers, or witnessing your accident in public can be overwhelming.