Quality of life after treatment. The impact of prostate cancer treatment on your quality of life depends on the type of treatment and the severity of your cancer. In general, treatment for localized prostate cancer that is confined to the prostate impacts your urinary function, bowel function, and sexual function. Most studies of quality of life in localized prostate cancer show minimal impact of treatment on general physical or mental health. The urinary problems men face after prostate cancer treatment range from urinary incontinence, or leakage of urine, to difficulty emptying urine from which patients experience increased frequency of urination, or urgency where one feels a rush to get to the bathroom. Urinary incontinence is more common after surgery with a radical prostatectomy. Emptying problems are more common after radiation. Sexual function is impacted because the erection nerves pass alongside the outer border of the prostate. And bowel function is impacted—most commonly by radiation therapy—because the rectum passes immediately behind the prostate. These areas of quality of life are more affected in men with more severe cancers, because the surgery may need to involve removal of the erection nerves, or the radiation field may not to be broader and cause more of an innocent bystander effect to the bladder or rectum.
Preventing the recurrence of prostate cancer. The definition of cancer coming back, or recurrence, is based on the results of the prostate-specific antigen (PSA) test. A rising PSA after surgery or radiation therapy for prostate cancer usually indicates that the cancer has come back. The best way to monitor for a recurrence is to maintain follow up visits with your prostate cancer doctor at which time the PSA checks are usually scheduled.
Patients often ask about lifestyle changes they can make to try to keep their cancer from recurring. In general, we advocate regular exercise, maintenance of a low fat high fiber diet, and smoking cessation among active smokers.
Staying healthy after cancer. Prostate cancer can be a distracting diagnosis. What I mean by that is that a prostate cancer diagnosis can lead patients to forget about maintaining the other aspects of their health. Importantly, most men with prostate cancer die of other health problems, and the most common of these is cardiovascular disease. So regular checkups with your primary care doctor are critical to staying up-to-date with your preventive care, like getting regular lipid panel checks, blood pressure measurements, screening for other cancers such as colon cancer, and influenza and other vaccines. Exercise and a heart healthy diet are also important to maintenance of a healthy lifestyle.
How do you know if your cancer has returned. Usually, among patients that underwent surgery or radiation therapy for localized prostate cancer, the first sign that the cancer has recurred is that the PSA blood test begins to rise. After surgery, the American Urological Association (AUA) definition of a recurrence is a PSA rise to above 0.2 ng/mL that is confirmed on a second measurement. After radiation therapy, the American Society of Therapeutic Radiation Oncology (ASTRO) defines a recurrence as a rise of at least 2 ng/mL after the PSA has reached its lowest level. In the overwhelming majority of patients with a recurrence after surgery or radiation, there are no symptoms beyond the abnormal blood test. This highlights the need to be vigilant with regular checkups with your prostate cancer doctor for PSA tests.