When you are diagnosed with prostate cancer, you join more than 3 million men in the United States who are living with prostate cancer. Your prostate cancer survivorship journey starts at the time of diagnosis. Each man with prostate cancer should have a survivorship care plan. This is a record that summarizes and communicates what happened during active cancer treatment, recommendations for follow-up care and surveillance, and referrals for support services.
The Commission on Cancer had mandated that by 2018 more than 75% of cancer patients who had completed treatment be enrolled in survivorship care plans. Unfortunately, this has not been the case. As a prostate cancer survivor, you have a vested interest in your survivorship care, with a care plan specifically involving a cancer doctor and a urology doctor who specializes in urinary incontinence (urine leakage) and erectile function (difficulty with sexual function) after treatment for prostate cancer.
Importance of Your Cancer Doctor
Whether your prostate cancer is treated with surgery (radical prostatectomy) or radiotherapy, a cancer specialist will be the doctor coordinating your cancer treatment and follow-up. For radiotherapy, this specialist will be a radiation oncologist. For surgery, you will be treated by a urologist who treats prostate cancer or a more specialized urologic oncologist. These doctors are experts in providing the appropriate treatment plan for your cancer. This treatment plan is based on several factors including your age, general health, prostate cancer risk stratification, and your desires. Cancer specialists should provide information regarding prognosis, probability of cure, and risk of recurrence, as well as outline the follow-up treatment schedule that will be in place after treatment is complete. Additionally, they should highlight the side effects of primary therapy, specific to both radiotherapy and radical prostatectomy.
Importance of Your Sexual Medicine Urologist
Many patients will be cured of localized prostate cancer with either surgery or radiotherapy. However, this often comes at a cost of side effects, most commonly erectile dysfunction and urinary incontinence. Urologists that specialize in sexual medicine are doctors who specialize in sexual dysfunction, including erectile dysfunction and male incontinence. Most have completed a fellowship or additional training after residency to become proficient in these areas. These specialists are important for your care for the following reasons:
- Your cancer doctor may not be well-versed in treating erectile dysfunction and/or urinary incontinence after they treat your prostate cancer
- These two side effects can lead to a great deal of anxiety, depression, and treatment regret for prostate cancer survivors, even in situations where they are cured of prostate cancer
Many men (particularly men who are sexually active), who may be good candidates for a radical prostatectomy may be particularly concerned with erectile dysfunction and urinary incontinence side effects. Because of these concerns, they may choose inferior primary therapy based on their age and health to try to reduce these side effects—and risk a poor cancer treatment outcome. Having a sexual medicine urologist involved early in the decision process can help relieve concerns about side effects that may lead a healthy man to decide not to pursue appropriate aggressive primary therapy.
What Does Your Prostate Cancer Survivorship Plan Look Like?
Having a cancer doctor and a sexual medicine urologist as part of your journey has several benefits. First, before deciding on your primary treatment for prostate cancer, you will understand the appropriate treatment options available. Second, by meeting with your sexual medicine urologist prior to treatment, you will have a detailed understanding of the side effects (and degree of side effects) that are likely to result after treatment. Third, following treatment, you will have a specific follow-up with your cancer doctor for PSA blood test checks to ensure there is no recurrence of prostate cancer. You will also have a follow-up with your sexual medicine urologist to immediately begin working on treatment/exercises to help improve erectile dysfunction and urinary incontinence. The following diagram highlights the prostate cancer survivorship journey, and the integration of cancer doctors and sexual medicine urologists.
Conclusion
Many men will be cured of localized prostate cancer with primary treatment, but side effects such as erectile dysfunction and urinary incontinence can have a significant effect on quality of life. By having a cancer doctor and a sexual medicine urologist as part of your prostate cancer survivorship team, you have doctors that are focused on treating your prostate cancer and the side effects that are all too common after treatment.