1. Side effects following radical treatments for prostate cancer Mary Symons Helen Worth Worcestershire Acute Hospitals NHS Trust

2. Radical Prostatectomy The most common side effects are:- Impotence Urinary incontinence Urinary tract infections

3. Radical Prostatectomy Long term side effects are most likely to be:-- Impotence Urinary Incontinence

4. Radical prostatectomy Urinary problems Urinary incontinence could be just the occasional leakage or severe leakage There is a definite reduction if the patient is taught pelvic floor exercises to do before surgery as well as post-operatively Not advised to do while the catheter is in situ

5. Radical prostatectomy Urinary problems Advise reduction in alcohol and caffeine and encourage extra fluids in the form of water, squash or milk Medication may be required Less than 5% may have long term urinary problems which may require further surgery

6. Radiotherapy Long term side effects Bowel problems Bladder problems Erectile dysfunction Infertility

7. Radiotherapy Long term side effects Bowel problems:- Rectal bleeding my occur and require referral to a colo-rectal surgeon Bowel motions may be more frequent and the stools may be loose

8. Radiotherapy Long term side effects Bladder problems Radiation cystitis, same advice on fluids Haematuria (blood in urine) will require further investigation Frequency & urgency – medication 1% may have urinary leakage – greater risk if patient has had previous turp

9. Hormones Side effects Hormones are given for a short term with radiotherapy and most side effects abate over time Erectile Dysfunction Hot flushes Gynaecomastia (breast swelling) Tiredness

10. Hormones Side effects Hot flushes affect 50-80% of men Stop smoking Advice on fluids Reduce spicy food Keep room cool – use a fan Light cotton bedding Wear cotton clothing

11. Hormones Side effects Hot flushes:- Drug treatments progestogens e.g. megestrol acetate Anti androgen e.g. cyproterone Alternative therapies Eat soy Sage Tea Evening primrose oil

12. Hormones Side effects Gynaecomastia, this is very rare for short term users Tamoxifen – cannot be used with oestrogens One treatment of radiotherapy Surgery

13. Brachytherapy Long term side effects Erectile dysfunction Uretheral narrowing – patient may need a catheter for a while or to do self catheterisation Less than 1% suffer urinary leakage

14. Erectile dysfunction Helen Worth

15. Erectile Dysfunction Following Radical Prostatectomy Following Radical Radiotherapy and hormone therapy

16. Erectile Dysfunction TREATMENT OPTIONS PDE5 inhibitors Viagra Cialis Levetra

17. Erectile Dysfunction TREATMENT OPTIONS Vacuum pump devices Intracavernosal Injections Urethral Pelletts

18. Erectile Dysfunction TREATMENT OPTIONS Penile Implants

19. Erectile Dysfunction TREATMENT OPTIONS Penile Rehabilitation

20. Erectile Dysfunction Is there a place for testosterone replacement?

21. Leaflets and booklets expanding on this information are available Any questions? 27 th April 2010 Worcester Sixways Rugby club

22. Radical Prostatectomy The most common side effects are:- Impotence Urinary incontinence Urinary tract infections

23. Radical Prostatectomy Long term side effects are most likely to be:-- Impotence Urinary Incontinence

24. Radical prostatectomy Urinary problems Urinary incontinence could be just the occasional leakage or severe leakage There is a definite reduction if the patient is taught pelvic floor exercises to do before surgery as well as post-operatively Not advised to do while the catheter is in situ

25. Radical prostatectomy Urinary problems Advise reduction in alcohol and caffeine and encourage extra fluids in the form of water, squash or milk Medication may be required Less than 5% may have long term urinary problems which may require further surgery

26. Radiotherapy Long term side effects Bowel problems Bladder problems Erectile dysfunction Infertility

27. Radiotherapy Long term side effects Bowel problems:- Rectal bleeding my occur and require referral to a colo-rectal surgeon Bowel motions may be more frequent and the stools may be loose

28. Radiotherapy Long term side effects Bladder problems Radiation cystitis, same advice on fluids Haematuria (blood in urine) will require further investigation Frequency & urgency – medication 1% may have urinary leakage – greater risk if patient has had previous turp

29. Hormones Side effects Hormones are given for a short term with radiotherapy and most side effects abate over time Erectile Dysfunction Hot flushes Gynaecomastia (breast swelling) Tiredness

30. Hormones Side effects Hot flushes affect 50-80% of men Stop smoking Advice on fluids Reduce spicy food Keep room cool – use a fan Light cotton bedding Wear cotton clothing

31. Hormones Side effects Hot flushes:- Drug treatments progestogens e.g. megestrol acetate Anti androgen e.g. cyproterone Alternative therapies Eat soy Sage Tea Evening primrose oil

32. Hormones Side effects Gynaecomastia, this is very rare for short term users Tamoxifen – cannot be used with oestrogens One treatment of radiotherapy Surgery

33. Brachytherapy Long term side effects Erectile dysfunction Uretheral narrowing – patient may need a catheter for a while or to do self catheterisation Less than 1% suffer urinary leakage

34. Erectile dysfunction Helen Worth

35. Erectile Dysfunction Following Radical Prostatectomy Following Radical Radiotherapy and hormone therapy

36. Erectile Dysfunction TREATMENT OPTIONS PDE5 inhibitors Viagra Cialis Levetra

37. Erectile Dysfunction TREATMENT OPTIONS Vacuum pump devices Intracavernosal Injections Urethral Pelletts

38. Erectile Dysfunction TREATMENT OPTIONS Penile Implants

39. Erectile Dysfunction TREATMENT OPTIONS Penile Rehabilitation

40. Erectile Dysfunction Is there a place for testosterone replacement?

41. Leaflets and booklets expanding on this information are available Any questions? 27 th April 2010 Worcester Sixways Rugby club