Prostate Cancer: Managing Incontinence and Hormone Therapy Options - Urology

More Info

---

Managing prostate cancer, particularly after surgical interventions like laser prostatectomy, can be challenging, especially when dealing with complications such as incontinence and considering further treatment options like hormone therapy. Your father's situation, with a PSA level of 32.5 and a diagnosis of stage II prostate cancer, requires careful consideration of both his physical health and his quality of life.


Incontinence Post-Surgery
1. Duration and Management of Incontinence:
After prostate surgery, it is common for patients to experience some degree of urinary incontinence. This can vary widely among individuals, but many find that their symptoms improve significantly within a few months. In your father's case, since it has been only a month since the laser procedure, it is not unusual for him to still be experiencing incontinence. The healing process can take time, and factors such as the extent of the surgery and individual recovery rates play a significant role.

To manage incontinence, pelvic floor exercises, commonly known as Kegel exercises, are often recommended. These exercises strengthen the pelvic muscles, which can help improve bladder control. Additionally, biofeedback and pelvic floor physical therapy may provide further benefits. If these conservative measures do not yield satisfactory results, medications or other interventions may be considered. It is essential to maintain open communication with his healthcare provider about the severity of his symptoms and any changes he experiences.

2. Expected Improvement:
While some patients see improvement in a few weeks, others may take several months to notice significant changes. If your father’s incontinence persists beyond three to six months, it may be worth discussing further options with his doctor, including potential surgical interventions specifically aimed at addressing incontinence.


Hormone Therapy Considerations
1. Hormone Therapy as a Treatment Option:
Hormone therapy, also known as androgen deprivation therapy (ADT), is a common treatment for prostate cancer, particularly in cases where the cancer is at risk of recurrence or progression. Given that your father is hesitant about undergoing further surgery, hormone therapy could be a viable option. It works by reducing levels of male hormones, such as testosterone, which can fuel the growth of prostate cancer cells.

The combination of hormone therapy with radiation therapy is often recommended for patients with higher-risk prostate cancer. However, as you noted, radiation can exacerbate urinary incontinence, particularly in patients who have already undergone surgical procedures. This is a valid concern and should be thoroughly discussed with his healthcare team.

2. Sequential Treatment Approach:
If your father prefers to avoid radiation therapy at this stage, starting with hormone therapy alone is a reasonable approach. This can help control the cancer and potentially reduce the risk of progression while allowing time to assess the impact of his current incontinence issues. The decision to add radiation therapy later can be revisited based on his response to hormone therapy and any changes in his condition.


Conclusion
In summary, your father's experience with incontinence post-laser surgery is not uncommon and may improve over time with appropriate management strategies. Hormone therapy presents a viable option for managing his prostate cancer, especially if he is apprehensive about further surgical interventions. It is crucial for him to have ongoing discussions with his healthcare providers to tailor a treatment plan that addresses both his cancer and his quality of life concerns. Regular follow-ups and adjustments to his treatment plan will be essential as he navigates this journey.