Common prostate problems:
• Enlarged prostate
• Inflammation or infection of the prostate
• Cancer
Symptoms of prostate problems:
• Increased need to urinate during day or night- increased frequency
• Weak flow of urination
• Urgency
• Hesitancy- difficulty to urinate
Who are at risk for Prostate Cancer?
• 1 in 8 men has a risk to prostate cancer
• Black men have a higher risk for cancer (1 in 4)
• You are 2.5 times more likely to get prostate cancer if your father or brother has it.
• You may have a higher risk of prostate cancer if your mother or sister has had breast cancer
• Prostate cancer mainly affects men over the age of 50 years and your risk increases as you get older.
How to test your prostate health:
• PSA: Prostate specific antigen test is a blood test that measures the amount of specific protein produced by the prostate, Elevated PSA levels may be indicative of prostate cancer or a benign condition of the prostate, such as benign prostatic hyperplasia or prostatitis.
• Digital rectal examination
• Biopsy of the prostate tissue. If the biopsied prostate tissue is found to be cancerous, a Gleason Grade is calculated to determine the cancer’s potential to grow and spread.
• CT scan, MRI or PET scan if the biopsy was positive.
Types of treatment:
• Radiation
• Radical Prostatectomy: surgical removal of the prostate gland and the surrounding lymph nodes.
• Hormone therapy - prostate cancer cells rely on the male hormone testosterone to grow, Removing or blocking testosterone may cause cancer cells to die or grow slowly.
Side effect of the treatment:
• Urinary incontinence – affects 99% of all patients, 98% full recovery (Glina et al 2009)
• Erectile dysfunction -Erectile dysfunction affects 68-99% of all patients>30% recover (Nelson J Sex Med 2014)
• 12 months post op (Frey 2014 JSM 316 participants)
o 5% anorgasmia
o 60% decrease orgasm intensity
o 57% delayed orgasm o 10% pain with orgasm
o 38% PPI o 25% penile sensory changes
o 47% penile length loss>1cm
o 10% Peyronie’s Disease (A blood types) - Peyronie’s disease questionnaire
How physiotherapy can be of benefit to you before surgery:
Common side effects of pelvic floor dysfunction and prostatectomy surgeries can include erectile dysfunction, urinary leakage, urge incontinence and frequency of urination. There can also be a deep ache in the pelvis where the prostate used to be and can be the result of scar adhesion and trigger points in the PFM that are close to the prostate area.
Physiotherapy treatment should be a 4 month plan starting 1 month pre-operatively. Stop with the pelvic floor muscle training while the catheter is in situ. As soon as the catheter is removed start with exercises until continence has recovered.
Your physiotherapist will give you advice for lifestyle changes to assist to continence:
• Bladder irritants
• Better bathroom habits
• Continence pads
• Pelvic floor muscle exercises
- To kegel or not to kegel
• Normalising the internal pelvic floor muscle
• Strengthening of the core muscle
• Penile rehabilitation with vacuum pump
Most men should be dry 6-12 weeks post surgery.