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.
For years, the only alternative to absorbent products was the surgical implantation of an artificial urinary sphincter. In use for over 25 years, more than 100,000 AUS devices have been successfully implanted in men to treat SUI. Most men receiving such an implant report a very high level of satisfaction. It is, nevertheless, subject to mechanical failure and eventual replacement. It also requires manual dexterity to operate.
In recent years, the same medical device manufacturer, American Medical Systems, has developed a sling procedure for men. The FDA-approved, AdVance® device consists of a small sling made of synthetic mesh that is placed inside the body through three small incisions. Unlike an earlier generation, no screws or bone anchors are used. The sling supports but does not compress the urethra, thereby decreasing the potential for urethral erosion, or ulceration. In well-selected patients, results have shown that 40% of men are dry and 30% are improved following the AdVance sling procedure. Since it has been available only since October 2006, clinical data on its long-term effectiveness continue to be collected. Nevertheless, early results show the procedure to be safe and effective. Over 10,000 AdVance slings have been implanted worldwide.
With multiple solutions as options, men should not postpone seeking diagnosis and treatment for prostate cancer, over concern with the risk of facing a remaining lifetime of incontinence. Those days are behind us.
Quality of life does not have to be permanently sacrificed in order to wear the badge of survivor. To learn more about treatment options, go to:
Headed for surgery? Get expert coaching on how to do those PMEs by ordering a cassette tape and instruction booklet from http://www.nafc.org/online-store/consumer-booklets-and-kits/nafc-kits/men-s-pelvic-muscle-exercise-kit/.
1 American Cancer Society (2008), available online and accessed on 4 March 2009 from http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_prostate_cancer_36.asp
Published On: April 21, 2009