Because of the close proximity of the prostate to several vital structures, prostate cancer and its treatment strategies can disrupt normal urinary, bowel, and sexual functioning.
Urinary function—Under normal circumstances, the urinary sphincters (bands of muscle tissue at the base of the bladder and at the base of the prostate) remain tightly shut, preventing urine that’s stored in the bladder from leaking out. During urination, the sphincters are relaxed and the urine flows from the bladder through the urethra and out of the body.
During prostatectomy (the surgical removal of the prostate) the bladder is pulled downward and connected to the urethra at the point where the prostate once sat. If the sphincter at the base of the bladder is damaged during this process, or if it’s damaged during radiation therapy, some measure of urinary incontinence or leakage will occur.
Bowel function—Solid waste that’s filtered out of the body moves slowly down the intestines, and, under normal circumstances, the resultant stool is excreted through the anus following conscious relaxation of the anal sphincter. Damage to the rectum caused by radiation, or more rarely, by surgery, can result in bowel problems, including rectal bleeding, diarrhea, or urgency.
Sexual function—If the erectile nerves are damaged during prostatectomy, which was standard during this type of surgery up until the mid 1980s, the ability to achieve erection is lost. Sexual desire is not affected, but severing or otherwise damaging the nerves can lead to erectile dysfunction. These nerves can also be damaged by radiation, though this process usually occurs much more slowly over time.
Modern techniques in surgery (nerve-sparing), radiation (intensity modulated radiation therapy, positioning devices, 3-D conformal technologies), and seed placement (brachytherapy) have been developed to try to minimize these side effects, and this process continues to improve.
Fertility—About 10% of men with prostate cancer have what is known as seminal vesicle invasion. This means the cancer has either spread into the seminal vesicles or has spread around them. If that occurs, seminal vesicles are typically removed during prostatectomy and targeted during radiation therapy. The loss of the prostate and the seminal vesicles renders men infertile. After surgical removal, ejaculation is dry, but orgasms may still occur.
November is Prostate Cancer Awareness month, and I am participating in No Shave November. Are you? My scruffy look is to help others become aware. (By the way, I don’t recall this many “highlights” in my beard the last time I grew one.)