Survivorship: Living with and Beyond Prostate Cancer – Medical Follow-Up

Kaiser Permanente offers clinical care, support and education to patients who have been diagnosed with prostate cancer.  This Survivorship document provides information on the medical, lifestyle and emotional aspects of life after prostate cancer.  It is important for you to know what to expect after therapy and to understand what you can do to improve your health and quality of life.

Short and Long-term Recovery

Treatment	Recovery	Potential Long-Term Effects of Treatment
Open or Laparoscopic Prostatectomy (surgery to remove the prostate)	Recovery is about 4-6 weeks for open surgery and about 4 weeks for laparoscopic. Incontinence, or leakage of urine, will occur for at least a few weeks to months after treatment.	Most men are fairly dry, and severe incontinence only occurs in 3-5% of patients. Kegel exercises, which is squeezing and relaxing the deep pelvic muscles are recommended to help regain control and prevent urine leakage; these can be done until dry. Some men may always require a pad to protect from small amounts of urine however, most men are dry enough that they don’t need any protection. Erectile dysfunction (see detailed information below)
Brachytherapy	Burning urination or discomfort in first month is likely as is frequent urination and low flow. Urinary side effects normally go away 2-4 months after the procedure. Rectal symptoms such as mild urgency and more frequent bowel movements are common. Medications are given that can help significantly but not always eliminate these side effects.	Sometimes benign temporary rectal bleeding may occur for many months after the procedure. Long term risks of bowel or bladder problems or damage requiring more medical attention or surgery are very rare. Erectile dysfunction may occur in some men. (See information below for more details).
External Beam Radiation Therapy	Slow flow, frequent urination and discomfort during urination can develop over the course of treatment. Occasional diarrhea, more frequent bowel movements Urinary and bowel side effects may persist for two to six weeks, but they will improve over time. You may need to continue some medications to help with these side effects. Fatigue may continue for several weeks but gradually improve within 2-4 weeks following treatment.	Possible rectal irritation, bleeding or leakage and occasional flare-up of hemorrhoids for up to 18 months after treatment.  “Leakage” is rare.  Bleeding and general worsening of hemorrhoids can start later, not so much last 18 months. Leakage is all but unheard of. While still very rare, difficulty urinating to the point of needing a catheter is more common than leaking. Urinary incontinence, which is rare compared to surgery Erection problems or impotence (see more detailed information below) Fluid buildup in genitals or legs, which can occur rarely if the lymph nodes were treated. Urethral stricture, which is scarring and narrowing of the tube that carries urine out from the bladder. In such rare cases, surgery may be needed to relieve the narrowing.

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Follow-up Recommendations

Treatment	Follow-up Recommendations	Who will manage this
Active Surveillance	PSA test every three months Surveillance biopsies every one to two years	Urologist
Open or Laparoscopic Prostatectomy (surgery to remove prostate)	PSA test every six months out to five years PSA test yearly after five years. After the prostate is removed, the PSA should be undetectable, or less than 0.1.	Urologist
Brachytherapy or External Beam Radiation Therapy	PSA test three months after your procedure, and after this, every six months for five years. PSA test yearly after five years.	The Radiation Oncologist that performed the procedure usually manages PSA follow up for at least the first five years.

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Hormone Therapy

In some intermediate risk patients, many high risk patients and in most advanced stage (metastatic) prostate cancers, your doctor may talk to you about using hormone therapy, also called androgen deprivation therapy (ADT) or androgen suppression. This therapy may be used:

• If you are unable to have surgery or radiation or cannot be cured by these treatments because the cancer has spread beyond the prostate gland
• If your cancer remains or comes back after treatment
• Before and/or along with radiation therapy because it has, in some situations, shown to improve the cure rate.

Erectile Dysfunction

Impotence, or erectile problems, is common in most men after prostate cancer treatment. Some prostate cancer treatments may affect the nerves, muscles, or blood vessels that let you have an erection. Other prostate cancer treatments may affect your libido (or sex drive).

With radiation therapy there is increased incidence of erectile dysfunction after either form of radiation. The therapy accelerates the normal aging process in terms of erectile function. If you had strong erections before therapy, it will likely be a while before you start having problems with erections. If you had challenges with erections before treatment, treatment is likely to make it worse.

During surgical removal of the prostate, we try to spare the nerves although even with nerve-sparing surgery, erections can be more difficult and may require assistance in the form of medications, injections or a vacuum device. If nerves are spared on both sides of the prostate, up to 65 % of men may maintain their erections. It can take up to 12-18 months for erections to come back after surgery and erections are more difficult to achieve in men who had trouble with erections before surgery, are obese or have diabetes.

If you have any questions about erectile dysfunction, please contact your Kaiser Permanente primary care doctor or urologist.

Signs of Recurrence

Rising PSA levels may indicate the treatment was unsuccessful or the cancer has come back (a recurrence). It is very important that you go to all of your follow-up appointments so we can monitor your recovery and look for recurrence or any side effects from the surgery. Regular follow-up (sometimes in person and often by blood tests only) is necessary to determine if further treatment is needed.

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