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The Local Counselling Centre based in Letchworth ran a post in their blog for mens health week asking readers to ask questions for Professor mcNicholas to answer. We thought it may be helpful to see the results.

Q.
I have been told I will not need surgery and will have hormone injections and radiotherapy. The Doctor mentioned side effects like the menopause but I am not sure I understand what is meant. Can you clarify?

A.
When you were offered hormone therapy somebody should have explained to you the side effects to expect.  Usually, a specialist nurse will go through the pros and cons of the treatment so you know what to expect.  A detailed information sheet is usually given as well.  If you did not have any of these then you should ask why not?  However, the hormone therapy causes a reduction in the male hormone and as a result men often have “menopausal-like symptoms” such as hot flushes, weight gain and sometimes breast swelling.  If the breast swelling is painful or unsightly then treatment can be given and it needs to be given very early on so this is something to ask your radiotherapist about as soon as possible before you begin treatment.  Most men develop thinning of the bones as well, ie all the symptoms that women are familiar with after the menopause.  There are treatments available for each of these side effects if they occur.

Q.
I am having a radical prostatectomy and am concerned about impotence. I am also embarrassed to discuss with my doctor. Is this always a problem and what can I do about it?


A.
If you are having a radical prostatectomy the doctor should have taken the opportunity of going through the issue of sexual side effects with you.  I am surprised if they did not because nearly everybody is embarrassed and it is the doctor’s role (or the specialist nurse if you saw one as well) to go through these issues with you and to describe the treatments that are available to reduce the risk of impotence. A lot depends on just how the surgery is to be done and therefore you do have to discuss it with your doctors performing the treatment and as soon as possible so that they know that this is an issue for you and they can discuss with you whether or not it is possible to preserve the special nerves that help with erections. That is not always possible, but that should be made clear to you up front and then you can discuss what can be done afterwards to regain sexual function. 

Q.
I am having a prostatectomy and have not long been married. My wife is younger than me and was hoping to have children. Is this possible?


A.
It depends what form of prostatectomy you are having.  If it is a “radical prostatectomy” for prostate cancer then the whole prostate and various associated tubes are removed and even though you may regain sexual function you will not be fertile.  If you are having a “TURP”, ie a telescopic operation for benign prostatic obstruction where a cancer is not the issue then the operation may affect how you ejaculate and that can affect the ability to get sperms into the right place to get your partner pregnant.  There are arrangements that can be made such as harvesting sperms and storing them before any operation, so you need to immediately discuss this with your doctors and especially the specialists who are planning your prostatectomy.  Usually, there will be a specialist nurse who has been assigned to discuss matters with you and he or she is usually the best first option to approach.


Q.
Can I pass on the disease through my semen?


A.
It depends what disease you mean.  It is actually very difficult to pass on any significant disease through your semen.  However, drugs can be transmitted e.g. Finasteride and some infections can be transmitted, e.g. sexually transmitted diseases, but there is no risk of passing on either prostate cancer or benign prostatic enlargement.


Q.
Is treatment always a prostatectomy? 


A.
No, treatment is not always a prostatectomy.  “Prostatectomy” is an unfortunate phrase that now covers a wide range of different operations.  It is necessary for you to know exactly what form of prostatectomy is being suggested and for what purpose.   The treatment has to be more carefully customised for your particular needs and may mean one form of prostatectomy, but not another and may still mean an entirely different treatment such as a bladder neck incision or the UroLift device for benign prostatic conditions (see www.urolift.uk).  If treatment is for prostate cancer then radiotherapy in different forms may be just as effective as total removal of the prostate by "radical prostatectomy”.


Q.
My brother and father have had prostate cancer should I be monitored at regular intervals. I am 43?


A.
I think with a family history such as yours you should have a PSA in the next year or so.  If your PSA is below 0.5 then your risks of a prostate cancer are very low for the foreseeable future and another PSA could be deferred for 3-4 years.  If your PSA is above 0.5 then you should be having a PSA annually in order to give you the opportunity of catching any prostate cancer that develops early when it can be more successfully treated and when men usually get over the treatment more easily.


Q.
Should every man over 50 be monitored like with women and breast cancer? If not why not?



A.
Unfortunately, screening the whole population for either prostate cancer or breast cancer has been shown to be counter productive and to turn up too many people who have disease that may never cause them a problem.  Unfortunately finding that sort of "insignificant" or low risk cancer may lead to painful and expensive biopsies and indeed the effects of major treatment that MIGHT be unnecessary.  However, men with a family history of prostate cancer i.e. father and uncles or with cousins who have had very early prostate cancers (below the age of 60) should be screened with an early PSA blood test.  


Q.
My sex life is very important to me. I do not want to be impotent even if my survival is compromised, is there any treatment that will not affect potency?

A.
This depends on whether your treatment is for benign prostatic disease or for prostate cancer. Sexual function is more likely to be preserved, indeed erections can improve after treatment for benign conditions.  Most prostate cancer treatments will significantly affect sexual function.  that is why it is vital to discuss your particular needs with an expert before you go too far with treatment.  There is always room for adjustment and compromise in how treatment is delivered.

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