What Women Should Know About Prostate Cancer Surgery

By Dr. Dan Sperling

It’s been said that prostate cancer is a couple’s disease. This is true. As the Sexual Medicine Society of North America (SMSNA) reminds us, “When a man has prostate cancer, his partner may feel the effects, too.” Part of this shared effect has its roots in the history of prostate cancer surgery.

Surgical removal of the prostate called a prostatectomy, was developed to remove prostate cancer by taking out the entire gland. This operation goes back about 150 years, with many advances in method, approach, and technique along the way. It is very effective as long as the cancer is still localized, meaning it has not started to spread beyond the gland.

Historically, more prostate cancer patients have had a prostatectomy than any other treatment, since radiation as an effective modality did not emerge until the 1950s. Thus, prostatectomy has the largest body of published statistics of all treatments. This is why it’s called the “gold standard,” not because it’s the best but because the success and side effects of all other treatments are measured against surgical removal.

Despite its track record of cancer control, prostatectomy has left many patients with short- or long-term incontinence, or the inability to control urination. This in itself may impact a patient’s quality of life as the patient adjusts to wearing pads or diapers, and his feelings about his situation can affect his loved one. However, couples struggle even more with a common side effect of surgery that frequently occurs: impotence, the inability to have an erection.

During surgery, removing the prostate disturbs the nerves and blood vessels that “hug” the gland and must be delicately separated from it. Think of this as traumatizing the nerves, which takes time to recover from. Sometimes the nerves are permanently damaged. It may be short- or long-term, like incontinence. When the nerve signals aren’t firing, a man’s inability to achieve erection can be a challenge to a couple’s physical and emotional intimacy.

Thankfully, medical science and technology have come a long way. Since the mid-1980s when the first nerve-sparing prostatectomy was introduced, and then more recently the use of precise robotic-assisted nerve-sparing techniques, a larger number of patients retain potency, or regain it within 6-18 months, if not sooner. It’s important to keep in mind that to qualify for nerve-sparing surgery, a thorough diagnostic workup is needed to ensure that the cancer is still localized, or has not penetrated the nerves.

Nerve-sparing surgery for qualified patients is hopeful news for couples. After surgery, good communication, empathy and patience may bring the desired reward; meanwhile, medications, mechanical pumps, injections and lozenges enable lovemaking—though some spontaneity may be lost.

How partners can help

The experience of erectile dysfunction or impotence following prostate cancer surgery can be discouraging or even depressing but it need not be a disaster. There are many good books and articles written by couples who openly share how they got through it. The SMSNA and other experts offer wise encouragement and advice. Here are some important points for each partner:

• Open and honest discussion about each partner’s unmet sexual needs helps identify where expectations are in harmony and where they are not.
• It’s his body, so his wife/partner should reflect a positive and supportive listening attitude.
• As a couple, inform the patient’s doctor about the realities of your situation; the partner can often add things the patient may not think of, and she can encourage the patient to not give up if what the doctor recommends doesn’t work the first few times (practice makes pleasure).
• Keep an open and creative mind about exploring other ways to have pleasure.
• Consider seeking professional help (the SMSNA patient website offers resources).
• Don’t isolate. You are not alone! Join an online peer support forum to read what others are going through, and only post if you feel comfortable doing so (remember: they are not intended for medical advice).

More recent prostate cancer treatments with fewer side effects 

One final word. There is no single prostate cancer treatment that is right for every patient. In today’s world of prostate cancer diagnosis, innovative MRI scans offer high-resolution visual information on the location, size and aggression level of each individual’s prostate cancer tumor. Together with information about a patient’s cancer cell line, a portrait of his disease allows the creation of a treatment plan matched to his case. There are now minimally invasive, image-guided focal therapies customized to the tumor itself.

For example, Focal Laser Ablation provides precise cancer destruction by inserting a laser fiber into the tumor and encapsulating it with controlled heat. Treatments like this are monitored in real-time, and the destroyed tissue is confirmed by MRI at the end of the treatment. Not only are such methods done on an outpatient basis, they greatly reduce the risk of incontinence and erectile dysfunction.

Best of all, published studies reveal they can control cancer with success rates comparable to surgical removal. Like nerve-sparing surgery, patients must be carefully qualified during the diagnostic work-up for a focal treatment—but unlike surgery, a focal approach leaves future treatment options open if cancer comes back.

It is very appealing to patients and partners to explore treatments that have very low rates of urinary and sexual side effects. It would be great if all treatment side effects could be avoided. That said, if surgery, radiation, or focal therapy results in an unexpected side effect, every couple can use it as an opportunity to strengthen their union. After all, prostate cancer is a couple’s disease.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have health concerns or questions of a personal medical nature.