Prostate Cancer

Any surgical intervention of the prostate will have adverse impact on continence, sexual and reproductive health.

I don’t keep it a secret that I admire Mick Jagger. Most of my friends find it strange that I know very little about the Rolling Stones, but yet completely mesmerised by Jagger.

This 71-year-old great grand daddy should be a typical male patient who turns up to the urology clinic complaining of nighttime urinations, slow urinary flow, terminal dribbling and possibly even erection difficulties.

On the contrary, Jagger seems to be devoid of any prostatic complaints at his age. Instead, this legendary Rock and Roll front man is still hopping from strength to strength at this grand vintage. I often wonder if this has something to do with his “Jagger-edge” philosophy of life with “no regrets”:

“The past is a great place and I don’t want to erase it or to regret it. But I don’t want to be its prisoner either.”

This week, I would like to share an email from a reader who may have regrets following a prostate cancer treatment.

Dear Dr G,

Thank you so much for responding to my email.

My name is Leonard. I am 62 years old.

I suffered from prostate cancer.

In 2010, I went for medical check up and had elevated prostate cancer marker PSA.

The reading was 8.2ng/L and the doctor recommended a prostate biopsy.

Unfortunately, the results turned out to be positive.

The doctor said it is malignant with moderate aggression (Gleason 3+3).

Since the cancer was early stage one; my urologist recommended three options, including surgery, radiotherapy and strangely also the option of doing nothing!

Come on! This is cancer! Of course I will not leave it alone.

I went for Robotic Surgery for complete clearance.

It was amazing, the robotic surgery was a success and it cured my cancer. My most recent blood tests revealed no further cancer four years down the line!

The only problem I faced now is urinary incontinence, especially at night. Occasionally, when I cough, I also leak a little bit.

My biggest regret is actually losing my ability to have intimacy naturally. I am now completely impotent with no medication.

What exactly is the prostate and why I am incontinent and impotent after the removal of the organ? Has the Robot made errors in my operation?

Have I made mistake about the operations? Is my erectile dysfunction curable?

Please help.

Leonard

The word prostate is derived from Greek word literally means “The one who stands before” or the “Protector”.

Anatomically, this structure surrounds the urethra below the bladder and just before the penis.

Physiologically, the organ contribute around 70% of seminal secretions that makes up the semen with the role of protecting the sperms and prolonging their lifespan in the hostility of the acidic vaginal tract.

In view of the close proximity of the prostate to the sphincter of the bladder and the neurovascular bundle that supplies the erectile tissue in the penis, any surgical intervention of the prostate will have adverse impact on continence, sexual and reproductive health.

Prostate cancer has become increasingly more common among men as the life expectancy advances in the 21st century.

Although a substantial research has been carried out in the field of prostate cancers, the true natural history of this condition is largely unknown.

A considerable number of men may be diagnosed with the cancer; however, the Big C (cancer) may not necessary progress to the Big D (death).

Having said that, most urologists and oncologists would encourage younger men in Leonard’s predicament to opt for surgical intervention in order to ensure complete and long-term eradication.

Robotic Radical prostatectomy is the state-of-the-art treatment for stage one prostate cancers. Although this sounds far-fetch like a scene from the movie Terminator, the surgeons have absolute control of the operation via a console.

Therefore, the thought of a Robot going haywire making surgical errors is imaginable but impossible. This technological advancement ensures that patients recover faster and better cancer clearance with minimal adversity.

The harsh reality in life is the complete cancer clearance in some men may be compromised with some long-term complications such as incontinence and erectile dysfunction. However, both problems are treatable.

Although Leonard’s difficulties have a significant negative impact on his quality of life, I still don’t consider it to be serious enough to warrant artificial sphincters or penile prosthesis. Perhaps these may be future options if the conditions worsen.

Retrospective reflections of life can be cruel and full of regrets. The iconic poet and novelist of the Chronicle of Narnia once asked: “Has this world been so kind to you that you should leave with regrets? There are better things ahead than any we leave behind!”