Introductions were made by Dr John D’Arcy in welcoming approximately 170 attendees to "Life after Prostate Cancer Treatment". John highlighted the fact that erectile dysfunction and incontinence are "important issues and couples’ problems". Dr Katelaris began by highlighting the recent controversies raised in the media by opposing medical experts including Professor Alan Coates, who declared he ‘would sue any doctor who wanted to take his PSA’. Such statements have raised the debate in the public arena and brought the issue out in the open. A digital rectal examination together with the PSA test are the two most useful tools available to the medical profession. Dr Katelaris raised the point that many breast cancer doctors often lament the fact that they don’t have such a diagnostic tool as a simple blood test, like the PSA test, to detect breast cancer! This test is often the first indication that men have a prostate problem and when performed each year is the best monitor for early cancerous change. He quoted a US Urologist, Dr Lange - "Know the facts, practice the art" - the art being early detection and treatment. With an indication of abnormality, a biopsy, under ultrasound guidance, can be done to analyse what is found.

Depression affects all parts of a mans life, both physical and emotional.

• annual PSA
• commence at 50 years of age
• family history of prostate cancer - commence at 40 years of age.

The involvement of both the patient and his wife/partner in the decision of the treatment options is paramount. Another critic, Professor Chapman, has queried whether or not treatment saves lives.

Between1991 and 2000 there has been a 21% decrease in deaths …IS THIS PROOF ENOUGH? Often those who are ‘watchful waiting’, without treatment, leave it too long for curative surgery or alternative treatments such as brachytherapy or external beam radiation. As far as quality of life issues are concerned, only 3% of men who had undergone a radical procedure said they would not have the surgery again. Others, however, indicated that with sexual rehabilitation they enjoy a healthy sex life.

Dr Katelaris went on to explain the difference between "seed" and "needle radiation" brachytherapy, available to carefully selected patients, as opposed to external beam radiation. (Results have shown a decrease in urinary and bowel problems with brachytherapy).

Statistics indicate that men undergoing surgery in their 60s are already experiencing some form of erectile dysfunction – being diagnosed with prostate cancer probably highlights this fact.

Prof Nehra began his presentation by indicating that both partners in a relationship are affected by erectile dysfunction. It is necessary, therefore, to define that an erection must be adequate for the satisfaction of both parties during intercourse. Often the factors causing ED can be summarised as ageing; hypertension; smoking; secondary inhalation; heart disease and then add to the list: PROSTATE CANCER. The side effects are the couples’ health, depression and quality of life.

1. Do nothing
2. Use a pill eg: Viagra
3. MUSE (Trans urethral medication)
4. Penile injections
5. Vacuum erection device
6. Penile prosthesis – which is invasive but more suitable with ageing and when large amounts of medication are taken for other problems.

The prostheses available are malleable and inflatable (available in a two or three piece product) and can be implanted in the patient with a simple opening at the top of the scrotum and a day or so in hospital. The prosthesis means an increase in girth, length and rigidity. It requires manual activation and its life expectancy can range from 15 - 20 years. Mechanical failures/repairs are less than 5%, infection less than 1% and they come with a ‘limited lifetime replacement policy’.

With the introduction of the prosthesis a few side effects can occur, namely:

1. stress incontinence
2. the pelvic floor muscles may not be as active and
3. occasionally the bladder becomes less compliant.

However, these are factors and facets that may come into play anyway during the treatment of prostate cancer.

With regard to incontinence, the artificial sphincter is also available in such a simple construction as a cuff, balloon and control pump. A tandem cuff is available for severe cases of incontinence but only one cuff is implanted at a time.

And, as William J. Mayo (1861 – 1939) said "The best interest of the patient is the only interest to be considered".

Our two consumer advocates gave a brief synopsis of their diagnosis, treatment and ‘life after prostate cancer’.

Graham, who had a family history of prostate cancer, had been regularly tested from the age of 45. Having undergone a radical procedure five years ago he tried penile injections but found that over the course of time he could no longer inject himself.

He then decided to have the prosthesis implanted and compared the pain during recovery as similar to having prolonged toothache. Graham has found that he is not conscious of the prosthesis ‘being there’; unclothed there is no evidence; his flaccid penis is probably longer but erect a bit shorter! However, he indicated that this wasn’t a matter of "life or death" and the necessary adjustments and experimenting have occurred in his sexual relationship with his wife.

They have found by having the prosthesis, sex remains spontaneous …. he can ‘perform’ on demand, but so as not to trivialise his situation, he is glad to be rid of the cancer and is prepared to have the procedure performed again when the prosthesis requires replacement.

David then indicated his reasons for not undergoing another surgical procedure and the satisfaction obtained by the use of the vacuum device.

A vigorous question and answer session followed. Time allowed afterwards for personal approaches to be made to the panel.

If you require further detailed information visit: www.erectilerestoration.com.au

The Foundation is very grateful to the Sydney Theatre Company and American Medical Systems for sponsoring the meeting.