Prostate News

Prostate cancer surgery is leading to issues of self-esteem, an expert says

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Men who undergo lifesaving surgery to treat prostate cancer are experiencing depression and self-esteem issues which are adversely affecting their quality of life, a leading WA health professional says.

Perth physiotherapist Jo Milios is among those spearheading a push for greater support for men with the disease, while at the same time working on new therapies to treat those affected.

At her busy physiotherapy practice in Perth’s northern suburbs, Ms Milios treats hundreds of patients a year suffering what she terms the triple-C — (prostate) cancer, which leads to continence and copulation issues post-surgery.

“Incontinence and erectile dysfunction hit hard and I’m yet to meet a bloke keen to accept those two as rewards for a cancer cure,” she said.

She said while surgery was considered the gold standard treatment for prostate cancer, the side effects could be devastating for men.

Though doctors were good at treating incontinence, many were reluctant to tackle sexual dysfunction.

I’ve learnt that as long as a man is alive his sexual desire is high and if he loses that – and at the moment we’ve got very poor recovery rates – it can be devastating for his self-esteem

Jo Milios, physiotherapist

 “Men often recover their continence by about three months post-operation and their cancer is gone, but then they say ‘what about my sexual function?'” she said.

“I realised that doctors were not talking to their patients about sexual function, and I’ve realised I have an opportunity to educate them.

“I’ve learnt that as long as a man is alive, his sexual desire is high and if he loses that — and at the moment we’ve got very poor recovery rates — it can be devastating for his self-esteem.”

Prostate cancer is more prevalent than breast cancer and is the most common cancer in men in Australia after skin cancer.

It will strike one in five men up to the age of 84.

Every year about 22,000 Australian men are diagnosed and more than 3,000 die from the disease.

Yet medical professionals say many men are more fearful of the side effects of treating the cancer — most notably loss of sexual function and incontinence — than the disease itself.

Ms Milios said the rate of diagnosis was increasing, yet many men were not aware they needed annual testing after the age of 40.

She said funding for men’s health issues was significantly below that of women’s issues — about four times less — although men lived more than four years less than women on average.

“It’s those kinds of statistics that really make you think this issue deserves to be addressed,” she said.

Exercise could hold the key to recovery

Presently, about 98 per cent of men regain their continence but just 30 per cent recover sexually.

But Ms Milios is confident those figures can be vastly improved using a combination of drugs and exercise therapy.

She is currently undertaking a PhD to explore the effectiveness of exercise on the health of men with prostate cancer — both pelvic floor exercises and gym-based exercise.

She believes the results will mirror those she is already seeing in her physiotherapy practice — that exercise makes a significant difference to the continence, sexual function and mental health of those diagnosed.

“One of the things I’ve found is that starting exercises before surgery makes a real difference. The earlier we start, the better the results we are seeing,” she said.

“When I first started it took 6-12 months for a man to regain his continence, now it’s more like 6-12 weeks, and I think a similar thing can happen with sexual function.

“I believe the results will be more like 50-70 per cent of recovery of sexual function.”

Diagnosis numbing, says cancer survivor

Ross Campbell was diagnosed with prostate cancer last year and underwent surgery in July 2013.

The retired electrical contractor had led a relatively healthy life and the diagnosis was “numbing”, he said.

I’d gone through life with that immortality armour that one wears, and that was certainly penetrated when I realised that this is cancer and it’s something that I need to deal with, and death is real

Ross Campbell, retired electrical contractor

“I’d gone through life with that immortality armour that one wears, and that was certainly penetrated when I realised that this is cancer and it’s something that I need to deal with, and death is real,” he said.

“It was quite a shock.”

Diagnosed early, Mr Campbell began pelvic floor exercises several weeks before having surgery to remove his prostate, and was able to rapidly regain his health post-operation.

He has now become a group leader at a men’s gym session Ms Milios set up to help those in recovery from prostate cancer.

“We have a fabulous time there — we work hard, we compete against each other and we develop our muscle strength, pilates for pelvic floor improvement, balance, flexibility, stretching,” he said

“And the support that we give each other is really wonderful, it just happens of its own accord, it’s not a forced or a formal thing.

“There’s a great sense of empathy there.”

Ms Milios said the twice-weekly gym sessions, held at Subiaco Football Club in Leederville, aimed to improve mood as much muscle.

“You’ve got to give men the tools to deal with their health, and they need to be action oriented,” she said.

“Men need to be able to help themselves physically to move forward mentally.”

Holistic approach to support needed

She said a collaborative approach to prostate cancer was needed, that would see GPs refer men onto a range of services.

“At the moment a lot of men don’t get information from their GP – despite the fact that most of the GPs are male,” she said.

Photo of prostate cells

“There needs to be better awareness of early screening, so you can avoid advanced prostate cancer, then if you need treatment, it’s making sure you have a health team working together – that is your GP, urologist, radiologist, oncologist, continence nurse and physiotherapist, combined with an exercise program and psychological support and community support.”

Prostate Cancer Foundation of Australia state manager Cate Harman also believes awareness and a coordination of services are key to effective support of men with prostate cancer.

“We’ve become aware of certain areas where they’re just not getting the information about the support they need, even though that support is out there,” she said.

Funding for nurses specialising in prostate cancer was recently made available nationally, with one nurse now funded in Perth and one in Bunbury.

Ms Harman said they have made a huge difference in helping men understand the treatment and support options available to them, but psychological support was also vital.

She said mental health issues could be significant for prostate cancer sufferers, because of the dramatic physical impact the cancer often had.

“A very significant number experience depression, and often they’re unaware that they’re depressed, which is why having the right support around is so important,” she said.

Updated Sun at 2:34pm