Many men understand that when prostate cancer is caught early, it can be treated effectively, and the primary treatment options for localized disease are all excellent choices. However, many men also have significant concerns about the side effects of these treatments.
The concerns are justified, but there are many misunderstandings about how often side effects occur, how severe they really are and what can be done to manage them and counteract their occurrence.
Many of the side effects that men fear most following local treatment are often less frequent and severe than they might think, thanks to:
- Technical advances in both surgery and radiation therapy
- Researchers persistently seeking new ways to help overcome side effects
- Improvements in treatment delivery
It’s still important to understand how and why these effects occur, and to learn how you can minimize their impact on your daily life.
The broad categories of side effects associated with prostate cancer treatments includes:
- Urinary Dysfunction
- Bowel Dysfunction
- Erectile Dysfunction
- Loss of Fertility
- Side Effects of Hormone Therapy
- Side Effects of Chemotherapy
Depending on the treatment strategy used, some or all of these effects might be present. It’s also important to realize that not all symptoms are normal, and that some require immediate care.
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The below table is an attempt to compare three of these side effects across the different local therapies (NNSRP=non-nerve sparing radical prostatectomy, NSRP=nerve sparing radical prostatectomy, EBRT=external beam radiation therapy, BT=brachytherapy).
Each table shows the proportion of men three years after therapy with sexual dysfunction (left), bowel problems (middle), and urinary incontinence (right).
- Yellow indicates normal function
- Blue indicates mild dysfunction
- Red indicates more severe dysfunction
These figures are shown for men with normal function prior to therapy.
Reproduced from the Journal of Clinical Oncology 2009; 27: 3916-3922.
Of course, exact figures will differ across institutions and surgeons or radiation oncologists. The figures here are only meant to be a guide to help understand these risks over time. The numbers will also differ if there is already dysfunction present prior to surgery or radiation, as the risks of side effects are increased in this setting.
If you have erectile dysfunction before either surgery or radiation, the therapy will not reverse that. In contrast, urinary obstruction symptoms can often improve after surgery and occasionally after radiation. Urinary incontinence can also improve after these local therapies.
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