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If you are experiencing symptoms suggesting a prostate problem, or you and your partner are having problems conceiving, you need the support of an internationally respected expert. Schedule a consultation at The Turek Clinic today to discuss your options with Dr. Paul Turek.
Award-winning urologist and mens health pioneer Dr. Paul Turek authors Turek on Mens Health, named one of Healthlines top mens health blogs and one of the Top 30 Mens Health Blogs . The blog covers the gamut of mens health issues, from infertility to hormones to vasectomy reversal.
What Are The Symptomatic Effects Of Enlarged Prostate
An enlarged prostate pushes against both the bladder and urethra. This complication often might precipitate several urinary tract symptoms such as frequent urination, an uneasy feeling of always having to urinate, an inconsistent, unsteady stream of urine flow, urination difficulties, a painful or burning sensation while urinating, blood in the urine and frequent nighttime urination. In addition, men stricken with BPH may be at greater risk of developing urinary tract infections, urinary incontinence and bladder or kidney damage. Arguably the most uncomfortable and potentially life-altering problems associated with BPH are the sexual side effects. Such manifestations include:
Can Masturbation Cut Prostate Cancer Risk
In this area of interest, a study that took information from 32,000 men looked at whether regular ejaculation helps to prevent prostate cancer.
The researchers published their work in the journal European Urology and reported that more frequent ejaculation might lead to a lower risk of prostate cancer.
Among men aged 2029 years old who had 21 or more ejaculations a month, there were 2.39 fewer in every 1,000 who developed prostate cancer when the researchers compared them to those ejaculating 47 times a month.
Among men who were aged 4049 years old, there were 3.89 fewer people per 1,000 who developed prostate cancer.
The reasons for these results are unclear, but one theory refers to prostate stagnation. This means that less frequent ejaculation allows prostate secretions to build up, possibly contributing to cancer.
An earlier study threw light on other potential aspects of prostate cancer, indicating that frequent sexual activity in younger life increased the risk of prostate cancer. However, the study also indicated that this activity seemed to give protection against the disease when people were older.
Recommended Reading: Expressed Prostatic Secretion
Radiation Therapy And Fertility
Radiation therapy is the use of high-energy x-rays to kill cancer cells and can affect your fertility. Radiation to the testicles, or body parts near the testicles, can damage the cells that make sperm. The chance of infertility after radiation depends on the dose to the testes, shielding, and fractionation . Smaller doses can lead to a temporary inability to make sperm. Higher doses can lead to permanent infertility. Leydig cells are less sensitive to the effects of radiation, but damage can still happen.
There are two ways to try to prevent fertility issues from radiation treatment. If the testicles are not the target, shielding can be used. This protects the testicle from being exposed to radiation. Fractionation divides the total dose of radiation into many smaller doses. Fractionation is used to lessen most side effects. In the case of fertility, fractionation causes more damage to sperm than a larger, single radiation dose.
Total body irradiation is used before stem cell and bone marrow transplants. As the name suggests, it is radiation of the whole body. About 80% of men who have TBI will have permanent azoospermia. Shielding is not a choice in this type of radiation.
For those with temporary azoospermia after radiation, sperm counts are at their lowest 4-6 months after treatment. Counts often return to their pretreatment levels 10-24 months after treatment. This can take longer in those who got higher doses of radiation.
Diagnosing Benign Prostate Enlargement
To find out whether your prostate gland is enlarged, youâll need to have a few tests.
Some tests will be carried out by your GP and others will be carried out by a urologist .
First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement, the next stage is to calculate your International Prostate Symptom Score .
Read Also: Chemotherapy For Prostate Cancer Side Effects
Also Check: Prostate Cancer Perineural Invasion
For Gay And Bisexual Men
A partner who is usually insertive, or top, during sex may want to consider changing to receive anal penetration, as sex may be difficult without a full erection.
In the case of a prostatectomy, a partner who usually receives penetration may find that sex is less pleasurable, as the prostate gland usually contributes to the sensation.
What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
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Targeted Therapy And Immunotherapy
Targeted therapy and immunotherapy drugs attack cancer cells differently from standard chemo drugs. Little is known about their effects on fertility or problems during pregnancy.
Males taking thalidomide or lenalidomide have a high risk of causing birth defects in a fetus exposed to these drugs, which can stay in semen for a few months after treatment ends. Oncologists recommend that males and any sexual partner who is able to get pregnant use extremely effective forms of birth control, for example a condom for the man and a long-acting hormone contraceptive or IUD for the woman.
See Targeted Therapy and Immunotherapy to learn more about these cancer treatments.
Causes Of Sexual Problems
While many men experience sexual issues following prostate cancer treatment, these issues are not often due to prostate cancer itself.
Most prostate cancer symptoms involve problems with expelling urine due to enlargement of the prostate gland. This enlargement begins to inhibit the urethra carrying urine out of the body. Urinary symptoms should not affect a persons sex life, however.
More active treatments for cancer, such as surgery, radiation therapy, or hormone therapy, may lead to sexual dysfunction.
Nerves that run close to the prostate gland control erections. Surgery that completely removes the prostate gland carries a risk of erectile dysfunction for this reason.
This type of surgery is usually only suitable for men with aggressive prostate cancer that is likely to grow or spread. Younger men with prostate cancer might also choose it, however.
In these surgical cases, a nerve-sparing prostatectomy aims to avoid damage to the erection-controlling nerves. Nevertheless, nerve-sparing operations are not always possible.
While reducing the risk of erectile dysfunction, this type of treatment may not deal with the cancer fully and may leave behind some cancerous tissue.
Surgery carries the greatest risk, but other treatment methods for prostate cancer can also affect sexual activity.
Treatment options with a risk of erectile dysfunction include:
Brachytherapy has a lower risk of erectile dysfunction than other types of radiation therapy.
Read Also: What Color Ribbon Is Testicular Cancer
How Does The Prostate Work
The prostate is a gland about the size of a chestnut and weighs about 30 grams . It is part of the male reproductive system and is located inside the body. The prostates most important function is the production of a fluid that, together with sperm cells from the testicles and fluids from other glands, makes up semen. The muscles of the prostate also ensure that the semen is forcefully pressed into the urethra and then expelled outwards during ejaculation.
The prostate is located directly below the bladder and above the muscles of the pelvic floor. The rectum is behind the prostate, making it possible to feel the gland from the rectum using the finger. The ducts in the prostate gland flow into the urethra, which passes through the prostate. The word prostate is taken from the Greek expression meaning one who stands before, which describes the position of the prostate gland. Viewed from below, where the urethra leaves the gland, the prostate stands before the bladder.
The tissue of the prostate gland can be divided into three different zones, listed here from innermost to outermost, which encircle the urethra like layers of an onion:
The prostate has various functions:
Production of fluid for semen:
Hormone metabolism: In the prostate the male sex hormone testosterone is transformed to a biologically active form, DHT .
How Will I Know If Im Fertile After Treatment
You can have a semen analysis done at a sperm bank to see if youre producing sperm and to analyze your sperm count and motility . Wait at least 1 year after completing treatment before having a semen analysis so that your testes have time to recover. If they dont find sperm in the specimen, remember that it can take a number of years for some men to start producing sperm again. You can repeat the semen analysis 6 to 12 months later. If you want a more in-depth evaluation, ask your doctor to refer you to a reproductive urologist.
Read Also: Prostate Fiducial Marker Placement
Surgery Effect On Ejaculation
Surgery can affect ejaculation in different ways. For example, if surgery removes the prostate and seminal vesicles, a man can no longer make semen. Surgery might also damage the nerves that come from the spine and control emission . Note that these are not the same nerve bundles that pass next to the prostate and control erections . The surgeries that cause ejaculation problems are discussed in more detail here.
Men Cancer And Fertility: Overcoming Challenges Of Starting Families After Treatment
This post is available in: Spanish
The most common cancers that affect men primarily testicular and prostate cancers can cause significant fertility problems that affect their ability to father biologic children, including the production of sperm.
Cancer treatments including surgery, chemotherapy and radiation can also diminish sperm counts and damage nerves needed for erection and ejaculation. Nonetheless, there are methods and procedures that can overcome these hurdles for men, many of whom recover their ability to father biologic children following surgery or extensive treatments, explains Ahmed Eldefrawy, M.D., urologic oncologist at Miami Cancer Institute, part of Baptist Health.
Testicular Cancer
Ahmed Eldefrawy, M.D., urologic oncologist at Miami Cancer Institute, part of Baptist Health.
Testicular cancer primarily strikes young men between the ages of 15 and 40, with the average age at the time of diagnosis at 33, says the American Cancer Society. Many of these men may be starting families. If the cancer is caught early, orchiectomy or the removable of the cancerous testicle is a very viable option with a very good outcome. If cancer is localized, chemotherapy or radiation may not be needed, says Dr. Eldefrawy.
Trying to conceive naturally may take a while following successful testicular cancer treatment.
Factors That Affect Fertility
Prostate Cancer and Sperm Banking
Bladder and Kidney Cancers
Don’t Miss: Find Prostate Externally
Understanding The Anatomy Of The Prostate
Despite its importance, the prostate gland in an adult man is only about the size and shape of a walnut and weighs less than 1 ounce .
It is located below the bladder, above the pelvic floor muscles, and in front of the rectum.
The prostate reaches its mature size during puberty and will keep its walnut size until the man is in his late forties or early fifties. After this age, it slowly begins to enlarge.
The prostate, which surrounds the urethra, is made up of glandular, stromal tissue, and smooth muscles fused within a capsule.
Though the prostate gland is often referenced as a singular entity, it is actually made up of a number of tubular or saclike glands that secrete fluids into the urethra through the ejaculatory ducts.
The prostate is divided into three histologically and anatomically separate glandular areas: The transition zone, the central zone, and the peripheral zone.
Transition Zone This surrounds the part of the urethra that passes through the prostate . This zone only represents about 5 percent of the gland, but is the primary origination of benign prostatic hyperplasia, or enlarged prostate. That is, the transition zone is the region of the prostate that grows as men age.
Central Zone Making up quarter of the prostate, this area surrounds the transition zone, as well as the ejaculatory ducts that stretch from the seminal vesicles which produces the majority of the fluid of semen to the prostatic region of the urethra.
Surgery For Bladder Cancer
Most bladder cancer surgeries are done by placing a tool into the bladder and taking out the tumor. For invasive bladder cancers, the most common treatment choice is to take out the whole bladder, prostate, and seminal vesicles . After that surgery, a man would not be able to naturally father children. Sperm banking before surgery is something to discuss if you would like to have children.
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Sex After Prostatectomy: How To Have A Healthy Sex Life After Surgery
Prostate health issues such as benign prostatic hyperplasia and prostate cancer affect hundreds of thousands of men in the United States every year.
If youve been diagnosed with a serious prostate issue, your healthcare provider may suggest a prostatectomy a surgical procedure in which your part or all of your prostate gland is surgically removed from your body.
Prostate removal surgery is usually highly effective at treating cancer and prostate enlargement , but it can potentially lead to complications.
These include some sexual performance issues, such as erectile dysfunction and difficulty ejaculating normally.
Although these effects can change your sexual experience, many men are still able to enjoy a fulfilling, satisfying sex life after prostate surgery by making certain lifestyle changes and using medication.
Below, weve talked about what to expect if youre scheduled to undergo a prostatectomy and want to maintain an active sex life after surgery.
Weve also explained how you can have a healthy sex life after a partial or complete prostate removal, whether through exercises to improve sexual functioning, medications, devices or a combination of different approaches.
Read Also: How Much Does Prostate Surgery Cost
Cancer Treatments And Erectile Dysfunction
Following surgery, many men experience erectile dysfunction , but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. Another factor is the surgeons skill level for performing the nerve-sparing technique, which if done correctly, may improve patients likelihood of retaining erectile function, says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapybrachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
When you compare surgery with radiation, both may affect erections, says Dr. Shelfo. Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over timemonths or, sometimes, yearssexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.
Recommended Reading: Does Tamsulosin Affect Ejaculation
Achieving Orgasm After Radical Prostatectomy
Men worry about erectile dysfunction after radical prostatectomy, the operation that involves removing the prostate gland as a way to treat prostate cancer. Its a legitimate concern. Men, their spouses and partners, and their surgeons should talk about erectile dysfunction before and after the surgery. Almost all men will experience erectile dysfunction for several months to a year after a radical prostatectomy, although todays nerve-sparing operation has decreased the number of cases when its permanent.
But orgasm after radical prostatectomy? Its often even not on the radar screen. Dr. Ravi Kacker thinks that should change.
Sometimes orgasm gets forgotten because everyone is so focused on erectile dysfunction, says Dr. Kacker, a urologist and fellow in male sexual medicine at Harvard-affiliated BethIsraelDeaconessMedical Center. But for somemaybe mostmen and their partners, achieving orgasm can be as important as erectionsor even more so for having a healthy sex life.
And, says Dr. Kacker, theres good news. Orgasms after radical prostatectomy may feel qualitatively different for most men, but they dont need to be any less pleasurable or satisfying.
Can A Man Father A Child After Prostate Removal
The prostate and seminal vesicles, which produce semen, are removed during surgery. This means you wont ejaculate any semen after surgery, which means you wont be able to father a child. But you might be able to store your sperm before treatment so that you can use it later for fertility treatment.
Recommended Reading: Chemo Pill For Prostate Cancer
Tips For Talking With Your Partner
Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:
- Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
- Listen to your partners concerns, too. Remember that this issue affects both of you.
- See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
- If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.
Evaluating Fertility Preservation Options
These options for protecting fertility are not appropriate for everyone. Consider these factors:
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Health insurance may not cover the cost of fertility-preserving procedures
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Their effectiveness varies
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The added stress of fertility preservation in an already stressful time
You may benefit from counseling for fertility-related decisions. People considering fertility preservation should make the decision that feels right to them based on these and other factors.
Read Also: Side Effects Of Chemotherapy For Prostate Cancer