Prostate Cancer: The Low Down and Secret to Getting the Best Recovery

Once you reach the age of 40, worrying about your thickening midriff isn’t the only thing that should be on your radar. There is also the taboo issue regarding your prostate and symptoms affecting you peeing.

Whether it’s having to get up more at night to pee, a slowing in flow, some leaking at random times or dribbling after you’ve already been, it’s time to pay attention and get checked.

Prostate cancer is the most common cancer affecting people who have a prostate. In England alone there are 40 thousand cases diagnosed each year. It will affect 1 in 8 of you in your lifetime. The main time to start getting checked is from 50 onwards, however, if you have family history of prostate cancer, you need to start checking for it from 40 onwards.

Prostate cancer isn’t the only thing you need to be aware of, however. Benign prostatic hyperplasia or BPH as it’s often referred, is another diagnosis many of you will have and been ignoring. This is where the prostate becomes enlarged, which most of you will get as you age. It shouldn’t be ignored however as it can successfully be treated with medication or surgery.

Why is a Physio telling you about this?

So I’m writing this bit early so you can start understanding what prostates and physio have in common…. No this isn’t a joke! A good Pelvic Health Physiotherapist is one of the key people you need to see if you have problems with your prostate, of any kind. That’s because they have the skills that will help you with the specific symptoms I’m about to tell you. They are also pivotal in getting your pelvic floor muscles working properly again. The sooner you start this in your journey the better.

What should you look out for?

The prostate is part of the male reproductive system. It is the size of a walnut and sits just below the bladder, wrapping around the tube that carries your pee (urethra). Now you can see given its location, why it causes the following symptoms.

· Getting up a lot more at night to empty your bladder

· Finding the flow is slower

· Dribbling after you’ve had a wee

· Painful peeing

· Leaking at random times

· Low back or hip pain

I’ve often seen people raising their eyes at having to get up more at night for a pee, underplaying it’s significance. Ultimately ANY changes to your ability to wee need to be investigated, or at least flagged with your GP. You are not wasting their time. It could ultimately save your life.

What should you do if I have any of these symptoms?

As tempting as it is to ignore these symptoms and not wanting to deal with the embarrassment of discussing stuff going on “down below”, taking action can save your life or at the least radically improve it. Ignoring it isn’t ever going to improve it! Your body is trying to tell you something so please, please listen to it!

The first thing you need to do is to see your GP. They will commonly do an internal examination to feel your prostates size and any irregularities (it should be smooth not bumpy) and will also organise a PSA test.

What does a PSA test diagnose?

The PSA test is a blood test that measures your levels of Prostate Specific Antigens. PSA is a protein produced by the cells in your prostate. Cells normally produce a very small amount but inflamed, infected or sinister prostate cells produce a lot more hence why the PSA levels go up. This test can help diagnose more aggressive cancers, earlier, which can be lifesaving.

A “normal” PSA level is 0-4, however as you get older this upper range will increase slightly. Either way, you need to know what you are dealing with and get on the right treatment path ASAP.

By doing the PSA test your GP will then be able to decide what’s next. If there are concerns about your raised PSA level you will then referred to have an MRI and biopsy so you get a diagnosis.

What if you are diagnosed with prostate cancer?

If you are one of the one in eight who are diagnosed with prostate cancer, there are different treatments depending on the type and stage of the cancer. Some people are put on ‘watch and wait’ strategy in the short term whereas others are offered surgery, hormone therapy or radiotherapy straight away to target their specific cancer.

What if you need surgery?

Surgery is always a scary option for any problem. This is worsened when it involves a cancer diagnosis and involves your nether regions. Understandably there are many fears and concerns people have regarding the risks of surgery down there. So here is the low down on down low and prostate surgery.

The type of surgery will depend on the extent of the diagnosis and symptoms. A TURP or transurethral resection of your prostate involves taking away a part of the prostate. This is helpful in restoring better flow when you pee. This can be used for both BPH and malignant cancer diagnosis, depending on size and spread.

A radical prostatectomy is the surgery performed for some prostate cancer sufferers and involves taking the whole of the prostate away.

What are the common problems after prostate surgery?

There is no dressing this up, unfortunately, most people experience incontinence and erectile dysfunction (ED) after prostate cancer surgery.

This happens because when the prostate is removed, the ring of muscle around the neck of the bladder (sphincter) and the nerves to that region might be damaged. You can imagine there is lots of complicated anatomy in a very small space down there and sparing all these structures during surgery is very tricky, sometimes impossible to avoid.

The prostate normally provides support to the bladder so when it is removed your bladder it can cause problems with leaking of your pee. This is called incontinence.

There are 2 types of incontinence you may suffer from;

1) Stress urinary incontinence or SUI which is when you leak when moving, coughing, sneezing or laughing.

2) Urge urinary incontinence or UUI when you leak whilst rushing to the toilet or a constant leak or dribble after going to the toilet to empty the bladder.

Medication can be given to help for incontinence so it’s worth a try. It’s really common immediately after surgery due to the trauma or the operation and use of a catheter however, 10% of people are still incontinent at 24 months after their prostate surgery. If this occurs they are usually offered surgery to have an artificial sphincter to help control flow.

If you are one of those who suffers from ED after surgery, it can be helped with a penile pump, intra-penile injections, and medication. As you can imagine, this can have a huge impact on how you feel, and many get great benefit from talking therapy. So please don’t knock this until you’ve tried it.

What should you do before or after surgery?

If you get the chance to start physiotherapy before surgery grab it with both hands and say halleluiah! It is invaluable to learn and practice the specific pelvic floor muscle exercises you need to be doing, before your op. Your brain gets the right feeling of doing them and you start the learning before any tinkering occurs. If you don’t get to see a physio before your surgery, please don’t worry. You can still get a good outcome.

You need to be doing your pelvic floor exercises (these aren't just for people who've given birth). This may come as a surprise, but your outcome will greatly depend on you doing them. As with any exercise, to get the benefit, you need to be doing them properly. Hence why appointments with your pelvic health physio need to be in your diary! These exercises start as soon as the catheter has been removed after your op and you have the “thumbs up” from the hospital team to start them.

Why is it useful to have physiotherapy?

For many, a cancer diagnosis signals the start of a slow decline in function and ability to enjoy life on your terms. This makes us sad at the HealthHub as this absolutely doesn’t need to be the case. We get it can feel embarrassing and something you’d rather keep private, but that doesn’t mean you can’t get the help you need from the expert professionals that will help you get your quality of life back. It is the very least you deserve.

A pelvic health physiotherapist will be able to give you advice, treatment and a personalised exercise programme to help you with any bladder and bowel issues, pelvic pain and chronic fatigue that occurs.

Because everyone is so different and the surgery can affect folk differently, getting a personalised approach to your recovery will make a huge difference to your life. Like strengthening any weak muscle, exercises need to be progressed. When you start you do them with no load and staying still. But to get the best outcome, you need to progress these exercises adding more load and movement. After all, you don’t just want to sit in a chair all day you want to get out there and do stuff!

Time frames vary too. By getting personalised physiotherapy you ensure you are doing the right thing at the right time, in the right way! And, we are sure you will have lots of questions you need to ask someone who knows what they are talking about!

Getting yourself fit again after surgery or radiotherapy is vital for the future you. This needs to be a gradual and planned thing, that’s if you want the best outcome! Many either push too hard and end up going backwards or give up altogether. Either way, you’ve got choices with how you recover. You can either face it head on and be proactive or try to avoid it and suffer more. Either way, you only get one life. After a diagnosis like this, perhaps it’s time to get some help and really take care of yourself, so you get the best opportunity for the best outcome. Who doesn’t want the freedom to move, live and love their life?.....

Next Steps

If this blog touched a nerve with you and you’d like to find out more, we offer a FREE Discovery visit or phone call with our Pelvic Health therapist, Wendy. This is your opportunity to find out if we can help you with your particular problem and a bit more about the process. If this sounds interesting or you have any other questions, please don’t hesitate to call or email on 01548 852355 or [email protected].

Finally some other resources that could help you are: https://prostatecanceruk.org https://thepogp.co.uk/patient_information/mens_health/prostate.aspx