8 Questions With an Expert: Urinary Incontinence and Erectile Dysfunction After Prostate Cancer

Urinary incontinence and erectile dysfunction are two common side effects from prostate cancer treatment that can be especially burdensome for survivors and their loved ones.

New online programs may help men cope with these side effects both in the short and long term and doctors are receiving instructions on how to discuss such matters with their patients.

Researcher Celestia S. Higano, a professor of medicine division of oncology at University of Washington/ Fred Hutchinson Cancer Research Center, studied the benefits of these programs and presented the findings at the 2016 Annual Meeting of the American Society of Clinical Oncology (ASCO), a gathering of 30,000 oncology professionals in Chicago.

CURE sat down with Higano to discuss the results of the study, the importance of helping men with these side effects and how doctors can encourage men to discuss their symptoms.

What types of side effects do men experience after treatment for prostate cancer?

We know that patients who are treated with surgery or radiation may have some problems with urinary incontinence or erectile dysfunction. Patients who undergo surgery have these problems more immediately after their therapy, whereas patients who have radiation may have these problems further down the line. These are problems that really bother patients, for obvious reasons.

What's being done to help men with these problems?

The Vancouver Prostate Center, which is where the University of British Columbia urologists work, has started a prostate cancer supportive care program to address the multiple needs of patients with prostate cancer. This includes urinary incontinence and sexual health concerns. The clinic is utilized on an as-needed basis, so they can either attend our education sessions that address four specific areas or they can be seen by the clinician who is appropriate for each sub-specialty.

What did your study find?

We were trying to put together our data from this very young program that started in January 2013. We wanted to understand how different modules were utilized by the patient population in the program. The two most commonly used services were pelvic-floor physio services to address urinary incontinence and the sexual health services to address problems with erectile dysfunction.

What do patients and survivors need to know about the aftermath of prostate cancer?

Patients and survivors need to know there are services out there to help them with these problems. One of the things we found in our review was the utility of the sexual health services was quite high. On the other hand, there are not enough sexual health clinicians out there to help patients. However, there are now many programs in process to help patients with online services. Many physicians think that’s not the most ideal because we think there is something beneficial to the human touch, but these online tutorials are better than no services at all.

Do patients find it difficult to discuss the problems they're experiencing?

Yes, though the worst thing is that physicians are not comfortable bringing it up, which creates a barrier. On the patient’s side, they’re not comfortable bringing up their problems unless the physician brings it up. We’re trying to get rid of that whole barrier, inform patients there are services to help and open up a better dialogue between the patient and their partner.

This program, in some ways, unburdens the physicians because it allows the different aspects of the program to address these problems of the patients. Both oncologists and urologists can point their patients in the right direction.

How can doctors be encouraged to talk about these specific side effects from cancer and cancer treatment?

Physicians need to be taught in medical school about how to discuss difficult topics with patients. Medical students need to get comfortable talking about sexual health issues. It’s a really important part of every person’s quality of life. It shouldn’t be something we’re afraid to talk about. I think there’s a lot of cultural stigma, even in 2016.

In terms of cancer, how to discuss these difficult topics should be part of training for cancer specialists. I’m not saying they need to become sexual health clinicians, but they need to have the sensitivity and realize that sexual health issues are very important to patients and their partners. They have to understand how devastating it can be when all of a sudden your sex life is not what it used to be.

There seems to be more attention and knowledge surrounding sexual dysfunction among female patients and survivors of cancer. Why is that?

As someone who treats prostate cancer patients, I can say definitively that there’s a huge difference between men and women. Men don’t really like to bring up problems they’re having with their surgeon because they’re worried about offending them. Additionally, urologists don’t always have time to delve into sexual dysfunction problems or they offer surface solutions, such as Viagra. They don’t go into detail. We’re left with a sort of void.

Women with breast cancer are very vocal about their sexual dysfunction problems and men with prostate cancer are not. Services tend to go towards the population outwardly seeking them and wanting them. These women need help and they’re getting it, but because the men are not so communicative, no one knows they need help.

What are your hopes for the future of this area?

I really hope insurers and institutions look at this kind of data we’re revealing. Currently, our data set is small, but over time physicians need to better understand the impacts these kinds of problems have on patients, particularly sexual health. Not all cancers cause problems of incontinence, but many cause problems with sexual health. It’s not just prostate cancer or gynecologic cancers.

On the education side, I hope there’s more emphasis put on sexual health and medical education and I hope there are more trained sexual health clinicians in the future.