Health hotline: Prostate cancer Q&A

I would rather be normal again and do not want to jump the gun and have an Artificial Urinary Sphincter installed prematurely, although I hate living with no urinary control and do not want to suffer hopelessly for additional months unless there is a chance correction will take place.

My prostrate was removed four years ago with robotic surgery out of state. The surgery and healing was nearly painless and went well except for the above stated problems.

The exercise to strengthen the muscle never helped and two and a half years after the operation I saw a local urologist and it was decided to have an implant of a AMF-800 artificial urinary sphincter.

This resulted in very little improvement in incontinence. Another surgery was done to check the sphincter and add more fluid to the pump. There is still minimum improvement and after several visits with the urologist it was concluded he could give me no further help.

The only thing my doctors have suggested for the erectile dysfunction was to use Viagra. I tried this several times with no result.

Answer:

Unfortunately, erectile dysfunction and loss of bladder control are the major complications of radical prostatectomy. Usually, the incontinence will gradually improve over time. While most of the improvement will occur during the first year, it may continue to improve after that, but probably not a lot.

There are a lot of things that can be done to decrease incontinence, certainly surgical technique and trying to keep blood loss to a minimum.

After surgery, the patient can do Kegel exercises to improve the function of the sphincter. Often, medication can help, like over-the-counter Sudafed. If surgery is required, sometimes a bulking agent can be injected into the urethra, or a sling-type procedure can be used. As a last resort, an artificial urinary sphincter can be placed. Even with the sphincter, people often will have a small amount of leakage. If it is severe, a second cuff can be placed, which often helps.

Comment:

I am 62 years old. My BPH is about typical for my age, according to my urologist. Over the past few years, my PSA has fluctuated wildly from as low as 1.5 to as high as 13.5. Twice when it was high, I underwent biopsies, which thankfully were negative. Currently my PSA is about 2.0 and I am in good health and exercise daily.

If a benign tumor in the body had a one in six chance of future malignancy, I think most people would want it removed because of those high odds. Why not remove a healthy prostate in a person of my age, rather than to wait and see if I get cancer? This would give me one less thing to worry about in life, and would also eliminate the need for incessant PSAs, rectal exams and biopsies. Not a bad trade-off.

The ED and incontinence risks are not as big as in the past, and besides, they don't scare me like cancer does. As it is, I have some incontinence from the BPH anyway, and am being treated with Avodart.

I know that some women with high cancer risk based on family history elect to have preventive healthy-breast mastectomies, which are much more radical and deforming than a prostatectomy would be. How about adding preventive healthy-prostate removal as a treatment option?