"While we're able to cure a lot of men with early prostate cancer, it comes at a price," says doctor Phillip Katelaris, a consultant urologist and director of the Prostate Cancer Rehabilitation Centre in Sydney.
That cost comes in the form of anxiety and depression, incontinence or lack of bladder control, and sexual problems, especially erectile dysfunction.
Problems with incontinence and sexual function can lead to embarrassment, social isolation and relationship problems, which in turn feed into depression and anxiety.
But as delegates to this month's Prostate Cancer Foundation of Australia International Conference heard, clinicians are getting the message that rehabilitation is possible.
And it's about time, says Katelaris
, a conference speaker.
argues the focus has been on treating the cancer while ignoring a man's quality of life: "This is unusual in medicine"
According to Katelaris
, patients undergoing, say, total knee replacement or a heart bypass are routinely sent to a physiotherapist for an extensive rehabilitation program to get them back to a normal lifestyle.
To some degree sexual function after prostate cancer treatment is determined by factors beyond control, according to Katelaris
: "It depends on a lot of things such as age, whether the person had problems achieving erections before and how extensive the cancer was".
The men most likely to report good outcomes are young men with no history of erectile dysfunction and who are otherwise healthy and not taking medications.
But as papers presented at the Gold Coast conference reveal, there's growing evidence that proactive rehabilitation can make a real difference, both in the bedroom and the bathroom.
As Katelaris told delegates, poor bladder control is caused by the weakening of a small muscle under the prostate that's part of the pelvic floor group of muscles.