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CAN I STILL HAVE SEX AFTER PROSTATE TROUBLE?

This probably will be the most read chapter in the book, and rightly. The prostate is tightly bound up with a male’s manhood, and how he thinks of himself as a man. That’s why even the mention, let alone the discussion, of the prostate and its troubles, make most men uneasy, nervous and embarrassed. We’ll look at all problems with the prostate and how they may or may not affect a man’s libido, his attitude, his sexual performance and his sexual desires.

PROSTATITIS AND SEX

The first problem many men have with their prostate is prostatitis. Symptoms of this involve lower back pain, pelvic discomfort, a burning in the penis when urinating, urinary frequency and sometimes a slight pain after ejaculation. This form of noninfectious prostatitis may be caused by some infectious agent we know nothing about, or by some noninfectious form of inflammation. On the other hand, it also can be caused by a man’s sexual habits — too much sex or too little. During arousal, a man produces four times the prostatic fluid he usually does. If this fluid is not discharged by ejaculation, it remains in the prostate. If this happens often, the prostate can become seriously congested.
To prevent this problem, a normal, healthy sex life is the best course of action. If this is not possible, a massage of the prostate by a urologist will relieve the congested prostate and eliminate the pain. If that’s not desired, masturbation is a quick solution suggested by many urologists. Too much sex, too quickly, say eight or ten ejaculations in a two day period, can overwork the prostate and again cause problems. On the other hand, abstinence may cause a build up of prostatic fluids and lead to congestion so a massage is needed. Coitus interruptus, simply the removal of the penis before ejaculation, is a method of birth control once practiced by millions. If done often enough, and if it stops the man’s climax, this too, can lead to an oversupply of fluid in the prostate and bring about congestion and its symptoms. If coitus interruptus is used frequently by a couple, the man or woman should continue to excite the penis to a normal ejaculation to prevent buildup problems in the prostate. So for prostatitis, which can strike men of any age, sexual intercourse may be both the cause and the solution.

INFECTIOUS PROSTATITIS

This inflammation of the prostate is caused by some type of infection and can cause fever, chills, nausea and vomiting as well as an urgency to urinate, burning, pain and blood and pus in the urine. It’s more serious than the non-infectious type. There may be serious congestion of the prostate and urologists sometimes use a prostate massage to relieve it. Most urologists feel that sexual activity of any type that leads to ejaculation is the ideal way to empty the prostate and relieve the congestion.

BENIGN PROSTATIC HYPERPLASIA

With the enlargement of the prostate there will be some sexual changes, particularly if there is surgery involved. As you may remember, a man will have a normally enlarging prostate for ten to fifteen years, maybe more, before he notices it. The enlargement itself does little to sexual performance with the exception of a seriously pinched urethra that could reduce the amount and force of an ejaculation. When it comes to needed surgery for BPH, the question of sex becomes more important.
First, there should be no sexual intercourse for six weeks after a normal TURP surgery. This is to allow time for the “canal” dug through the enlarged prostate tissue to heal.
On a standard TU RP operation to remove enlarged prostate tissue, about six percent of all men operated on will become impotent. That means they will not be able to have a normal erection. There are bundles of nerves on each side of the prostate, and some of these control the impulses and nerve responses that combine to produce an erection. If these nerve bundles are damaged in any way, impotence can follow. Remember, this six percent figure may not be totally accurate. The figure is based on subjective information supplied by the patient. It wouldn’t be unusual for a man 68 or 70 or older to claim that he could have an erection before the operation, when in reality he had lost that ability due to natural aging or some other problem. It is a factor to consider. The other change in a man who has had a TURP operation is that the bladder neck may have been damaged or removed during the TURP. The bladder neck is like a “valve” that automatically closes when a man is ejaculating. It prevents the fluids from going upward into the bladder. The urethra muscles then force the fluid out the end of the penis. After a TURP operation, the bladder neck may no longer be there or it may be enlarged to such an extent that the fluids of the ejaculation take the path of least resistance, and flow upward a half inch or so and empty into the bladder. When this happens the man has exactly the same physical sensations that he had when the ejaculate emptied out the end of his penis. The feeling, the motion, the thrill is the same, only the path the fluid takes is different. This retrograde ejaculation is almost a one hundred percent probability in a TURP or open surgery for BPH. It’s simply a fact of life. However, with men who usually are in the operative stage, their age is often in the early to late sixties or later, and the lack of a penile ejaculation does not present much of a problem. This is especially true if the situation is carefully explained to the patient and his wife before the operation.

CANCER OF THE PROSTATE

Stage A and B cancer of the prostate will usually involve a radical prostatectomy, the complete removal of the prostate. This almost always harms the nerve bundles on both sides of the prostate and results in a man being impotent. However new techniques have now been developed to preserve these nerves. Some urologists say that in so doing, they may leave some cancer cells behind after the operation. At this point the cancer is the main concern, the life of the patient, and not his sexual function. The surgeon will try his best to get all of the cancerous growth. The nerve bundles are not a high priority. For the man who might be in his fifties, and is cured of a stage A cancer of the prostate, there are drugs and devices that can help him achieve an erection for satisfying intercourse. The cancer patient who is treated with radiation, internal or external, can usually continue his sex life without any problems. His sexual ability would be the same before or after the radiation with the exception of the normal radiation caused fatigue problems. When used in certain areas, radiation can also cause impotence. For the cancer patient with stage D cancer of the prostate, which is usually not operable, the man’s sex life would be in direct relation to where the cancer was situated and how it affected his ability to perform. At this point the patient is much more interested in extending his life, and not worried about his sexual function.

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PROSTATE CANCER

Cancer is the word that has brought agonizing pain and terror to the last half of the twentieth century. To most people cancer means death. Many still think that a man with cancer has a death sentence. Not true. Increasingly in this last decade of the century it is proving not necessarily so. There are hundreds of different kinds and types of cancers, the medical experts tell us, and some can and are being cured. One of those types of cancer strikes men in their prostate. Cancer is described as being an uncontrolled growth of abnormal cells. Cancer cells can spread quickly throughout the body through the blood stream and the lymph system. Wherever they lite they create new tumors that begin replacing the normal tissue.
Some types don’t move at all, some are aggressive and attack different parts of the body quickly first. Cancer can develop in the lymphatic system, in bones, a man’s lungs, chest, throat, colon, stomach, even his brain. One of the areas cancer hits in a man is his prostate. When cancer strikes a man’s prostate it is usually what doctors call a primary cancer. This simply means the cancer begins, originates, in the prostate and has not been transported there from some other cancer in another part of the body.

WHAT CAUSES PROSTATE CANCER?

Scientists say there are hundreds of different kinds of cancer and they undoubtedly are caused by hundreds of different inciters. A few of the cancers have been researched enough so the medical people have the beginnings of the causes of them and can then go ahead and utilize some kind of anti-body to stop or kill the cancer. Massive research is going on for many forms of cancer, but less than one percent of that work is being done on prostate cancer. What this says is that there probably won’t be a miracle cure for prostate cancer within the lifetimes of most of us. That, like some of the preventive inoculation vaccines we have, will have to be applied to our children or our grandchildren. So who can develop prostate cancer? Unlike smoking and lung cancer, there isn’t even a hint of what might cause prostate cancer. Most researchers have ruled out any of the usual work and behavior activities such as alcohol, diet, work place, smoking, venereal diseases, too much sex or too little, or any other currently defined lifestyle.
There is one exception: men who work in nearly constant exhaust fumes from cars and those exposed to cadmium in the work place, are found to be at slightly higher risks of prostate cancer than the rest of us.
The one constant in prostate cancer and man seems to be age. As with the enlargement of the prostate, cancer seems to strike older men. Yes, some men die of prostate cancer in their forties, but most of the confrontations with the disease comes when men are over sixty. One researcher reports that the average age of men who are diagnosed as having cancer is seventy-two. Slightly over eighty percent of all prostate cancers reported come in men who are over the age of sixty-five.
Most doctors understand that by the age of eighty, nearly eighty percent of men have cancer of the prostate to some degree too. It may have been dormant for years, or it may just be starting and of a type that will grow slowly. Most of these men will never develop any symptoms of prostate cancer and will die of some cause not related to their prostate.
Most of our readers probably know someone who either has prostate cancer or has died of it. The American Cancer Society says that one out of eleven Americans will develop cancer of the prostate during his lifetime. Nearly 100,000 prostate cancer cases are reported by doctors each year. With men living longer now each year, there is expected to be an increasing number of prostate cancers. Men are simply living longer now and that’s when the disease develops. The American Cancer Society reports that nearly 28,000 men died of prostate cancer last year.

WHAT CAN THE AVERAGE MAN DO?

The problem is far from hopeless. They key to any cancer, and especially prostate cancer, is to catch the problem as early as possible. Some urologists suggest that all men over forty should have a digital rectal examination once a year.
Most of these examinations will be negative, which is good news to the man examined. We do dozens of examinations each year on people and expect negative results. Cholesterol testing is done routinely on people in their twenties and thirties, but the problem usually isn’t critical until much later in life. Chest X-rays are done routinely with usually a 99% negative result.
Testing for prostate cancer should be as routine for all men over forty. Yes, it’s a bit uncomfortable, but not painful. It takes about three minutes in a doctor’s office. Some urologists say the digital exam of the upper two lobes of the prostate will reveal ninety percent of prostate cancer. Other urologists think this is a bit high, but the exam should be made.
If such exams could catch 50% of starting prostate cancers in an early stage, most of those could be cured completely.
The big problem with prostate cancer is that it is a silent killer. It can show no symptoms at first. By the tune it starts hurting, the cancer usually has spread into other parts of the body and it’s often a matter of time until it kills the patient.

SCARE TACTICS?

If your reading this book does nothing more than makes you decide to have a yearly physical examination including a digital rectal exam of the prostate, that will be reward enough. You could be saving your life with a digital examination by discovering a cancer early enough to cure it.
Right now, about sixty-four percent of prostate cancers are discovered while they are small. Of these men, almost eighty-four percent are still alive five years after their surgery. Doctors compile statistics on cancer patients and most consider a man cured after a 15 year free period. The secret is catching it early so all of the cancerous tissue can be removed so it can’t spread or grow again. Ann Landers in her syndicated column has repeatedly pushed for greater awareness of testing to catch early cancer development. In one recent column she urged women to do the job this way. Whenever they go in for a mammogram, usually once a year, they should make an appointment for their husband to have his prostate checked by a digital exam or by the more expensive ultrasound probe. She urges women to do this so they won’t become premature widows. The lady has a good idea.
The American Cancer Society reports that currently seventy-one percent of all patients with cancer of the prostate live for five years or more after treatment. That’s for all cases whether diagnosed early or late. The later the diagnosis, the worse the chance for a cure.

HOW DOES YOUR DOCTOR KNOW IT’S CANCER?

More and more these days there is a push to try to catch prostate cancer in its earliest stages. This is a difficult job because very small cancers in the prostate traditionally have been from hard to impossible to detect by the traditional digital exam.
Now there are new tools to use to find these cancers. One of the best may be a simple blood test called the PSA. That stands for Prostate Specific Antigen. Prostate antigen is a protein found only in the prostate tissue. It has long been known that when the prostate is cancerous, the antigen level is elevated. The problem has been in finding how much this elevation may be made when the cancers are small and can’t be felt digitally.Now with the PSA there has been enough research to make some general pointings.
The tests showed that in the BPH men when the level of antigen had risen to 4 units, BPH was likely by a ratio of 4 to 1. But when the antigen level lifted to 10 or more units, the likelihood of cancer was more likely by a ratio of 33 to 1. Cooner also suggests the use of prostate ultrasonography as another diagnostic tool for screening patients who fall in the over 50 year category. This is done with a probe in the rectum and the use of ultrasound to reveal the tissue and mass in the prostate area.
Cooner concludes in his paper that we need to employ these two tools in a try to improve the ability to find curable cancers before they cause pain. He suggests that all men over 50 years should have a digital rectal elimination, then a PSA blood test, and a prostate ultrasound sonogram done as a baseline for future comparisons.
At this time PSA looks like a tool that the urologists need to make more use of. What if it only catches two or three percent of early cancer cases. Those men, cured of their cancer, are going to be wildly enthusiastic about the benefits of the test. As a parallel, how many positive readings do physical exams get these days from a routine chest X-ray? A dramatically low percentage.

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The treatment of cancer is difficult because cancer cells are cells that have escaped from the controls that govern normal cell growth and differentiation of function. As a result, uncoordinated growth may develop rapidly, and cancer cells may migrate and invade other tissues. Any anti-cancer drug is therefore likely to damage normal cells, particularly actively growing cells such as those of the bone marrow, and the dose of a cytotoxic agent is often a compromise between that having the desired anti-cancer action and that causing toxicity.
The drugs used in the treatment of cancer can be divided into four main groups, which attack the cells at different points. The alkylating agents interfere with the replication and function of DNA, modify protein synthesis, and have correspondingly wide effects. The antimetabolites interfere with cell metabolism by combining with cell enzymes, or by forming abnormal proteins, or otherwise inhibiting normal development. The cytotoxic antibiotics have an action similar to that of the antimetabolites, but they also have radiomimetic properties, and combined radiotherapy may increase the risks of damage to normal cells. These antibiotics, with the exceptions of dactinomycin and bleomycin, also have undesirable cardiotoxic properties, and dosage requires careful control. Amsacrine is a synthetic cytotoxic agent with some of the properties of the antibiotic group. Some recently introduced drugs include docetaxel, gemcitabine, letrozole, paclitaxel, raltitrexed and topotecan.
The vinca alkaloids are a class apart, as they are plant substances, and act at the metaphase stage of cell division. They are used mainly in acute leukaemias and some lymphomas. Vincristine is almost free from any depressive effects on bone marrow function, vinblastine has some degree of myelosuppressive activity but is less neurotoxic. Vindesine occupies an intermediate position. Etoposide is a synthetic drug with some of the properties of the vinca alkaloids. Other and unclassified cytotoxic agents include the platinum complexes carboplatin and cisplatin, used mainly in ovarian cancer, and the enzyme crisantaspase used in acute lymphoblastic leukaemia. Some cancers are hormone dependent, and the symptoms may be controlled by suitable hormone antagonists. Breast cancer for example may respond to aminoglutethimide, anastrozole, formestane, letrozole and toremifene. Prostatic cancer can be treated with anti-androgens such as fosfesterol, bicalutamidc, cyproterone and flutamide. Certain hormone analogues such as buserelin, goserelin, leuprorelin and triptorelin are also used in cancer of the prostate. A distressing side-effect of high-dose cytotoxic chemotherapy was severe and intractable nausea and vomiting, which could be so intense that patients have been known to refuse further anti-cancer treatment. The problem has since been resolved by the introduction of potent antierneties of the ondansetron type.

Myleran
carmustine    BiCNU
chlorambucil    Leukeran
cyclophosphamide    Endoxana
estramustine    Estracyt
ifosfamide    Mitoxana
lomustine    CCNU
melphalan    Alkeran
mustine    Mustine
thiotepa    Thiotepa
treosulphan    Treosulfan
cladribine    Leustat
gemcitabine mercaptopurine methotrexate
thioguanine    Lanvis
cytarabine    Alexan, Cytosar
fludarabine    Fludara
fluorouracil    Fluoro-Uracil, Efudix
Gemzar Puri-Nethol
Maxtrex

raltitrexed    Tomudex
bleomycin    Bleomycin
dactinomycin    Cosmegen
daunorubicin    DaunoXome
doxorubicin    Doxorubicin
epirubicin    Pharmarubicin
idarubicin    Zavedos
mitomycin    Mitomycin C
mitozantrone    Novantrone
vinblastine    Velbe
vincristine    Oncovin
vindesine    Eldesine
vinorelbine    Navelbine
aldesleukin
amsacrine
bicalutamide
carboplatin
dacarbazine
Proleukin
Amsidine
Casodex
Paraplatin
DTIC
cisplatin    Cisplatin
docetaxel    Taxotere

etoposide
Vepesid
hydroxyurea
Hydrea
iritotecan
Campto
letrozole
Ferrara
octreotide
Sandostatin
paclitaxel
Taxol
pentostatin
Nipent
procarbazine
Natulan
razoxane
Razoxin
topotecan
Hycamptin
tretinoin
Vesanoid
aminoglutethimide
Orimeten
anastrozole
Armidex
buserelin
Suprefact
Cyprostat
Drogenil
flutamide
Lentaron
formestane
goserelin
Zoladex
tamoxifen
Torero
torasemide
Casodex
Emblon, Nottam, Notwadex, Tamofen
bicalutamide
cyproterone

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