The reality: Drugs and surgery can kill libido for life
By Larissa Cahute
When diagnosed with cancer, you may find treatment is not your best option.
"Most people when they hear the word cancer want to get it treated and in many cases that can be a mistake because the impact of the treatments on the quality of life can be serious," said Richard Wassersug, prostate cancer survivor and urology professor at the University of B.C.
According to Wassersug, prostate cancer patients are "appallingly" uninformed about the treatment side effects and doctors need to start discussing the "brutal realities."
"This is where we're way behind - patients don't know what hormonal therapy means, doctors don't want to tell patients they're going to be chemically castrated," said Wassersug.
"When we put patients on these drugs, these produce not just loss of erections, but loss of libido."
And the same side effects occur with surgery - there's no escaping it.
"The majority of patients who go for surgery ... will have sexual problems that will persist for at least a year and in most cases for life," said Wassersug.
"Urinary incontinence or loss of erectile function not only affects the individual patient, but any partnership that they have is going to be challenged by those types of side effects."
Because of this, the patient may not even think to touch his partner anymore.
"If the patient is no longer interested in their partner, the partner can feel abandoned," said Wassersug.
"The psychological burden of prostate cancer treatments is often more severe on the partners than the patients themselves."
He says a number of experts are beginning to realize they've been over-treating some patients. "They're realizing now we've got to cut back," he said.
While prostate cancer research has improved with PSA testing, which has led to earlier diagnoses, there's still a downside.
"What's happening is people are getting tested early, diagnosis is treated early, their cancer is gone, but now they're going to live with impotence for the rest of their lives," Wassersug said. "[It's when they're as] young as in their 40s or 50s or 60s - when they would still be sexually active."
"We're ... trying to convince patients to recognize that we don't necessarily need to treat it - we can save the lives of prostate cancer patients, but ruin the quality of their life by over treating," he said.
"It's what a patient is willing to accept as alternative to treatment, because we know we're over-treating, but we also know that patients freak if we tell them they don't need treatment."
He said it's a matter of changing the mindset from "having cancer" to "having a chronic disease" that needs to be watched.
For young men diagnosed early - and who are still sexually active - Wassersug suggests "active surveillance."
"In the active surveillance program what we look for is their quality of life, life expectancy," he said.
"We should be asking, 'Are they sexually active?' The average age for prostate cancer is about 65 - many men are still sexually active."
Active surveillance merely monitors the cancer's growth and rate of change and a patient will usually get tested each year.
Some patients are better candidates for active surveillance than others - it depends on the stage of cancer and their age.
"It's a matter of what would the patient wish to do with the information once they get it," said Wassersug. "We're encouraging a greater number of patients to consider - who are diagnosed early - not getting treatment."
These are the topics and issues that men and their families need to familiarize themselves with.
"The reality of prostate cancer is that most guys are going to get it if they live long enough."
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