One of the main concerns for any man undergoing treatment for prostate cancer is whether he would be able to have a healthy sex life after treatment. Even if many men are usually past their prime when they are diagnosed with prostate cancer, the possibility of continuing to have a healthy sex life after surgery can significantly improve their confidence in going under the knife.
While new methods have made it possible for men to retain sexual function even after treatment for prostate cancer, in many cases, doctors continue to go for treatment options which impact their future sex life. “And this happens more often than it should,” says Dr Thirumalai Ganesan, Consultant Urologist at Apollo Hospitals in Chennai. For instance, even if it may not be absolutely necessary, many doctors continue to remove the testicles of a patient by default to treat prostate cancer, thereby rendering them with lifelong sexual dysfunction.
Hormone therapy to the rescue
The case of 45-year-old Aravind (name changed) in Chennai is a ready example. “He came to me recently, after his surgery. The previous doctor had spotted the tumour and immediately removed his testicles. Now he has lost sexual function, when it could have been entirely avoided in his case,” Dr Ganesan explains. And it isn’t just about sexual function. The removal of testicles, which provide the body with testosterone, can lead to osteoporosis. “Aravind's bones have started to weaken, and he has a lot of body pain. All this could have been avoided in his case," the doctor says.
So, why are testicles removed to deal with prostate cancer?
“It is an old practice which we do not take to unless very necessary,” Dr Ganesan says, “I remember when I was a trainee doctor, if someone had prostate cancer, we would simply remove the testicles. This was done because prostate cancer thrives on the male hormone, which is testosterone. Once you remove the testicles, the cancer stops getting its fuel,” Dr Ganesan explains, adding that drug-induced hormone therapy can instead be given to some of the patients. With intermittent hormone therapy, it is still possible for the patient to have a sex life.
There are, however, at least two reasons why doctors still recommend that testicles are removed. One, if the cancer is in very advanced stages and it has spread to other parts of the body, and two, if the patient can’t afford hormone treatment. “Injections cost at least Rs 1 lakh a year, and they have to be taken indefinitely. But removing testicles will cost only about Rs. 40,000, and it is a one-time cost,” Dr Ganesan says, “But when a doctor suggests removing your testicles, always go for a second opinion.”
Robotic wonder
The other problem which can be caused due to prostate surgery, when the prostate has to be removed to cure the cancer, is erectile dysfunction. Since the prostate is surrounded by nerves, some degree of erectile dysfunction usually occurs after surgery, be it open surgery or laparoscopy.
However, there have been significant advancements in technology with robotic surgery. “For removal of the prostate, robotic surgery is now ruling the roost,” Dr Ganesan says.
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Dr. Thirumalai Ganesan
“The advantage in robotic surgery lies in precision. In the pelvis, the prostate is far below. So, in an open surgery, it is very difficult for the surgeon to reach below,” Dr Ganesan points out, “But when we use the robotic arms inside the pelvis, we will just be operating on the console. It is easy to guide the robotic arms to go down and remove the prostate. Blood loss is very minimal, patient can leave the very next day, return to work is much faster.”
He adds, “After open or laparoscopic prostate surgery, usually the patient encounters leakage of urine, but with robotic surgery, it is significantly reduced.” Another advanced procedure called Nerve-sparing Radical Proctectomy is also available now, where surgeons try to spare the nerves around the prostate with minimal damage. “At the same time, we will not compromise on cancer clearance and if required the nerves will be sacrificed,” he adds.
“But as a thumb rule, we choose treatment based on the age. Treatment should not harm the patient, if they are too old,” he says.
The article was produced by TNM Marquee in association with Apollo Hospitals.