YANA
- YOU ARE NOT ALONE NOW
PROSTATE CANCER SUPPORT SITE
AN
INFORMATION GUIDE
TO
PROSTATE CANCER
This is part 4 of a 5 part Information Guide. Introduction: Index
BEYOND
TREATMENT - THE PLAINS OF RECOVERY
For many men, particularly those who have not had enough input from their medical
advisors, the promise of a 'cure' is misleading. They think the surgery or radiation
will have dealt with the disease, they will be cured and they will be able to
get on with their life as it was before the start of this journey to a Strange
Place. But this simply isn't so. As all travellers know, life is never quite
the same when you have been exposed to experiences beyond your previous knowledge.
Prostate cancer is no different and, in addition, there is usually a good deal
to be done in the aftermath of a treatment choice.
One thing common to all treatment choices is the need for continual monitoring
of PSA levels to ensure there is no progression of the disease. Men who have
had surgery are often somewhat shocked to find this is a requirement, despite
having been assured the removal of the gland will cure the disease. But all
treatments have recurrence rates, some of which are quite high, so lifelong
monitoring is therefore essential. PSA tests will usually start three months
after treatment is completed and will follow at similar intervals for the first
twelve months. Thereafter they will usually go to half yearly and finally annual
tests. Significant rises in PSA levels will trigger further investigations and,
in some cases, additional secondary treatment.
Although much of the focus at this stage of the journey is on morbidity or side
effects, which vary depending on treatment chosen, perhaps it is a good idea
to contemplate those factors all men should be taking into account, irrespective
of their treatment choice. The journey from Treatment to Remission is a long
one and it is as well to ensure that there are sufficient resources to keep
on going. So the first step on the long trek across the Plains of Recovery is
to optimise wellness and the immune system, which is going to have a good deal
of work, particularly in the early stages. For those choosing conventional treatment,
scar tissue has to be formed, infections fought off, toxic substances removed,
damaged tissue replaced. For those choosing Conservative Management, the tumour
itself has to be dealt with.
Changes in Lifestyle
Most people will have to consider substantial modifications to their lifestyles
to achieve this optimal state of wellness and to avoid further illness. These
are some of the suggested steps:
· Avoid Exposure to Damaging Substances: Smoking has been demonstrated to cause immense damage to the immune system and has been linked to virtually every fatal illness. No one should continue smoking, least of all those diagnosed with a potentially terminal illness. Alcohol is also a poisonous substance and creates a great deal of additional work for the immune system. Some studies show a moderate amount of wine, particularly red wine, may have some beneficial effects. No studies demonstrate any value in drinking spirits. Coffee is another drink with a large question mark over it. Although evidence of damage is not as clear as for alcohol, coffee drinking should be kept to a minimum.
· Reducing Stress: Many studies show the linkage between stress and illness. Despite this, there has been a general denial that reducing stress can reverse the progress of an illness. This is beginning to change. More and more of the major medical institutions in the US are beginning to take this issue more seriously and are starting to study the effect of stress reduction on recovery rates following diagnoses of life-threatening illness. There are many ways this important facet of recovery can be initiated. These methods may be as drastic as considering a change in workload by changing jobs to being as simple as learning breathing and relaxation techniques. Whatever the choice, the benefits of stress reduction will become obvious.
· Positive Attitudes: Studies show those who have a determination to reach and achieve remission are more likely to attain their goal than those who have a negative view of their prospects. Although many consider only the negative aspect of the term "self-fulfilling prophecies", these are just as likely to occur with positive beliefs. Joining support groups, either in real time or in cyberspace on the Internet, can help in developing this positive attitude because there are so many affirmative role models; so many who are further down the path; so many who have achieved Remission. Visualisation and affirmation are two useful tools to gain and use in the process of making positive attitudes work.
· Diet and Supplements: This is an area where confusion reigns supreme, with views and counter-views being expressed vociferously. Claims of snake oil salesmen compete with those supported by well-designed studies. Everyone ultimately has to make their own decision, as with many other aspects of prostate cancer, but there is a degree of consensus on some of the issues such as:
o Meat, dairy products, fat, sugar, fried foods: All should be avoided or reduced to a bare minimum. Red meat in particular is considered as a negative food. Most fish are a good substitute for meat products, although some farmed fish may have been given unhealthy feed and pharmaceutical products to get them to market quicker - as indeed is often the case with chicken. Because we eat so much sugar in the Western world it is often difficult to give up sugar and the temptation is to substitute sugar with artificial sweeteners, some of which have severe health issues attached to them and therefore, they should also be avoided. Aspartame has been identified as being particularly dangerous.
o Refined products: The more foodstuffs are processed before reaching the table, the more the natural values are damaged or destroyed. The closer that food is to its natural state, the better. So many 'fast foods', many of which are fried, have very little value.
o Fresh fruit and vegetables: Regular and substantial helpings of fruit and vegetables are essential for good health. Canned fruit often has sugar or additives; stored fruit loses some of its value, so fresh fruit in season is a better bet. Fruit juices often have added sugar, but in any event are too concentrated and even if unsweetened will deliver a massive dose of natural sugar. Vegetables in salad form are ideal, but otherwise, to extract the most value, they should be lightly steamed and not overcooked. Cruciferous vegetables such as broccoli, cabbage and Brussels sprouts are particularly valuable in the fight against prostate cancer (so your parents were quite right to tell you to eat them all up!!).
o Vitamins and other supplements: Those opposed to taking supplements make the good point that people eating a well-balanced diet should not need anything more. The problem with this argument is two-fold. Firstly, with modern methods of growing, storing and distributing food, much of the natural value of food is lost. Secondly, the area or conditions in which the food grows may be poor. For example, selenium has been shown to be beneficial in the prevention of prostate cancer and it may also have some curative effect. Foodstuffs grown in selenium-rich areas of the country will supply sufficient selenium for these purposes, but if grown hydroponically, for example, they will not. For most men eating a healthy diet, a general, good quality multi-vitamin will be the main supplement, with the use of garlic, Vitamins C & E and selenium in support. This regimen should prove a sound basis to proceed from. Although excess quantities of Vitamin C are excreted, it is possible to overdose with Vitamin E and Selenium, so recommended doses should not be exceeded.
· Exercise: Appropriate amounts of suitable exercise are essential for wellness. Exercise induces a feeling of well-being through the release of endorphins, improves circulation of essential elements throughout the body and assists in the removal of waste through the lymph system. Just how much exercise is acceptable depends on the individual and any other health issues, but as a general rule it is considered raising the pulse rate and a sweat three times a week is a good minimum to aim for. Walking in the fresh air at a brisk pace is a good way to start an exercise program.
· Body Mass Index: Obesity is linked to many illnesses and every effort should be made to achieve the lean body mass considered correct for age and height. Following a good diet and exercise program should result in a gradual and healthy reduction of body fat and mass.
As has been said, these are general guidelines for the journey through the Plains
of Recovery. One area here - The Swamp of Depression
- traps a substantial number of men and their partners to a greater or lesser
degree, following diagnosis. A leading medical oncologist in the US has said
that depression is the single biggest hurdle faced by most of the men he sees.
Yet it is something rarely discussed, seemingly because of a complete misunderstanding
of the nature of depression and mental health.
Most men seem to regard an inability to cope with mental stress as a shameful
weakness. They feel that they should be able to 'snap out of it' - advice which
is often given by those who should be providing support. People suffering from
depression would like nothing more than to be able to do just this, but they
can no more 'snap out of it' than a drowning person can save themselves by heeding
the advice to 'start swimming'. Anyone suffering from depression should seek
professional help. This debilitating condition can be overcome - sometimes in
a remarkably short time - with help.
Any of the conventional treatments will have side effects. Some of these are
of short duration; others are not. At the back of this booklet is a questionnaire,
developed by a leading US treatment centre, used to monitor the side effects
of treatment for men who have undergone therapy at their facility. It gives
a good indication of the range and type of morbidity associated with conventional
treatments.
Unfortunately it is not possible to establish the degree of morbidity any individual
will experience with any degree of accuracy. There is little doubt that the
experience of the medical people carrying out the procedure is the greatest
predictive factor in the degree of side effects experienced after treatment.
Quite simply stated, men have less severe side effects when treated by an experienced
practitioner or medical team. This may seem obvious, but the embarrassment of
seeking evidence of expertise has led to severe consequences for many men. This
awkwardness must be overcome for the best outcome.
Following the questionnaire is a summary of the potential
side effects of Hormone Therapy. As is the case with side effects from other
treatments, the number of men who experience these side effects and the severity
of the morbidity is widely variable. Many men have reported having no significant
problems with hormone treatment, while for others it is barely tolerable.
Erectile Dysfunction: This is the morbidity or side
effect upon which the majority of men focus. The ability to achieve or maintain
an erection is, for most men, an important part of their life and their view
of manhood. Loss of this ability can be devastating and, for some men, literally
make life not worth living. It is probably the greatest source of the depression
already discussed. In many cases it also creates an enormous amount of stress
for the partners of men in this position, with both parties mourning the loss
of the physical aspect of their relationship.
There is no doubt this is a serious issue, but it is also important not to make
it the sole focus of life after treatment, or to link it specifically to the
treatment itself. The majority of men will suffer some form of erectile dysfunction
as they age, a fact often overlooked by men with problems after treatment. Erectile
problems should therefore be considered in this broader view.
Although most men will have some erectile issues to deal with after treatment,
many will recover some or all their erectile function with the help of the numerous
mechanical and chemical aids that are available, the most common of which are
mentioned below:
o Viagra: This pill has without a doubt been hailed as the greatest aid for men with erectile problems after treatment. Some failures are reported and some men cannot tolerate the side effects from the drug, but by and large most reports are positive. A similar drug, Levitra, is now also approved for use in the US. Other drugs are coming on the market with a similar effect.
o Injections: Although for most men the thought of injecting themselves with a drug in this sensitive area is a frightening one, many men report an excellent result from penile injections and that it is a comparatively simple skill to acquire. A number of proprietary preparations is available, with variable results reported.
o (VED)Vacuum Erectile Device: Again there is a variety of these devices on the market. All work on the same principle: they create a flow of blood to the penis, creating an erection and then mechanically maintain the erection. There are many reports of erections satisfactory for intercourse using this method.
o Penile Implant: Reports on the success of this procedure are very mixed. For most men, this is a last resort.
Although the focus is generally on the utmost importance of gaining an erection,
which in itself can be self-defeating because of the anxiety created, many men
are seemingly unaware of the satisfaction that can be gained without penetration.
Techniques taught by sex therapists can result in the sexual fulfilment of both
parties and there are many reports of men admitting to finding the experiences
of these techniques as being even better than their previous sexual encounters.
So there is life after treatment in spite of everything.
Incontinence: There are two types of incontinence
associated with treatment for prostate cancer.
Bowel or faecal incontinence is the more serious of the two and is associated
with radiation treatment rather than surgery, where it is rarely reported. It
occurs in radiation treatment because of the close proximity of the prostate
gland to the bowel and bladder. The occurrence, according to most studies, is
not high and appears to be falling with the introduction of more modern equipment
capable of focussing the radiation beams with a greater degree of accuracy.
It is very rarely reported in conjunction with brachytherapy carried out by
an expert operator. Severe bowel incontinence is very difficult to remedy because
the damage done by radiation makes surgery almost impossible. In some cases
colostomy is an option, to provide a better quality of life.
Bladder or urinary incontinence occurs with both surgery and radiation treatments.
The degree of incontinence can vary from what is termed stress incontinence
- the most commonly reported variety - to complete lack of control. Women who
have had children will relate to stress incontinence, where drops of urine escape
in conjunction with actions such as coughing, sneezing, laughing or lifting.
This is not usually regarded as a serious issue and can often be controlled
by building up the muscle in the area. This is done by practicing what are known
as Kegel Exercises. Essentially these exercises consist of tightly clenching
the muscles, holding the tension, relaxing and repeating. Initially, especially
after surgery, this will be quite tiring, so the exercise should be done in
short sets repeated at intervals many times throughout the day.
If the leakage problem does not respond to these exercises, the usual recommendation
is for the man to wear incontinence pads, especially if a comparatively small
amount escapes. Mechanical devices can be used to stem the flow, medications
may provide some relief, and condom catheters with collection bags to contain
the urine are available. Various degrees of success have been reported with
these means.
For incontinence that cannot be dealt with by any of these methods, an indwelling
catheter will be fitted to drain the bladder into a suitable receptacle or it
may be possible to surgically install an artificial sphincter to regain control
of the bladder. A male sling surgical procedure is sometimes used in the US
but the reported success rate for these operations is not high, particularly
in cases of high-volume incontinence.
Another aspect of bladder incontinence, not often mentioned, occurs during arousal
for sexual intercourse, which can cause leakage of urine. This happens frequently
and is particularly disconcerting.
On the opposite end of the urinary scale from incontinence is stricture, where
it becomes very difficult to urinate, usually because of the build-up of scar
tissue. Although surgery will often alleviate this condition, it is often not
helpful for men with keloid scars. In those cases, a urethral stent may be helpful.
It is important to bear in mind that the definition of incontinence can vary
tremendously. Some studies do not regard a man who uses two pads a day as incontinent.
This may not be the man's view.
GO NOW to Part 5 - Remission
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