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Bladder and Bowel Q2 2024

Why prostate cancer aftercare should not be an afterthought

Arun Sahai PhD FRCS (Urol)

Consultant Urological Surgeon & Reader in Urology, The British Association of Urological Surgeons (BAUS)

Improved prostate cancer diagnosis and treatment have tripled survivor rates since the 1970s. However, treatments may affect sexual and urinary health, so aftercare options are crucial for quality of life.

The two main choices to treat organ-confined prostate cancer are surgery and radiotherapy. Patients often select their treatment based on side effects and the treatment’s impact on their quality of life.

Side effects of prostate cancer treatments

Modern-day treatments are excellent at successfully treating prostate cancer, but they come with well-documented consequences, including sexual dysfunction and urinary leakage. One of the largest surveys in the UK on ‘Life after Prostate Cancer Diagnosis’ found 81% of men to have poor or very poor sexual function.

Moreover, 54.5% of men still had some degree of problematic urinary function 18–24 months after treatment. The negative effect of these on quality of life can lead to treatment regret, and they impact patients’ confidence in social situations and relationships.

Prostate cancer treatment aftercare

There are a multitude of options to treat both sexual dysfunction and urinary leakage. The earlier intervention is started, the less the impact on quality of life. Treatments are multifaceted and include psychotherapy, physiotherapy, medications and surgery and can improve physical and mental wellbeing.  

There are a multitude of options to treat both
sexual dysfunction and urinary leakage.

Increasing awareness of survivorship experience

Prostate cancer awareness has increased. Significant focus has been on improving the diagnosis and initial treatment. However, given the importance of side effects on treatment decisions and quality of life, aftercare should not be an afterthought.

Patients should be provided with a realistic roadmap for life after cancer treatment from the first diagnosis, empowering them to take ownership of their survivorship experience. Specialist experts in sexual dysfunction and urinary leakage offer proactive, timely and specific management.

Enhanced patient monitoring post-surgery

With the work of Consultant Urological Surgeon Majed Shabbir and Arun Sahai, alongside Research Fellow Findlay MacAskill at Guy’s and St Thomas’ NHS Foundation Trust Urology Centre, our understanding of patient needs following radical prostatectomy have shifted. We have improved education and communication, adopting a proactive approach to managing treatment impact holistically. Patients now see specialists in sexual dysfunction and bladder problems at every visit following surgery.

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