Take care of your prostate

Are routine tests for prostate cancer doing more harm than good?

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Are routine tests for prostate cancer doing more harm than good? In New Zealand, test results do not support a national approach to screening.

However, the Urological Society of Australia and New Zealand supports the use of a PSA (prostate specific antigen) test plus rectal exam at an earlier age of 40 rather than 50, which can predict a man's future risk of prostate cancer and enable early monitoring.

What is the purpose of the prostate? Along with other glands in the pelvic area, it contributes a fluid which increases the volume of semen. Problems occur in the prostate when the fluid is inadequately expressed, causing cancer or enlargement of the gland and blocking the passage of urine.

What is necessary for prostate health? Care includes: releasing the build-up of fluid with routine ejaculation; investigating gentle prostate massage; maintaining an appropriate body weight; including blue and red berry fruits in your diet; exercising your PC (pelvic floor) muscles regularly; exercising (walking) for 30 minutes each day.

Will prostate cancer mean the end of our sex life? Not necessarily, is the fairest answer. But you may need to make some changes in the way you express your sexuality.

Choices about treatment include surgery to remove the prostate; radiotherapy; brachytherapy (implanting of radioactive beads into the prostate); and hormone therapy. At some stage, all these treatments will impact on a man's erection and therefore affect intercourse.

Some treatments also affect desire (sex drive) and orgasm. The following consequences usually occur with the treatment chosen.

Radiotherapy affects erections over time, as tissues become less flexible and blood flow to the penis is lessened. Brachytherapy lessens this side effect considerably.

Hormone treatment reduces the levels of male hormones in the body, limiting the growth of prostate cancer cells, but impacting on erections and sexual desire.

Surgical removal of the prostate can damage nerves, but new techniques minimise this damage. Nerves heal slowly and can take up to three years to recover.

If nerves have been spared during surgery, the "exercising" of the penis, along with low but regular medication such as Cialis and Viagra, can limit the deterioration of penile tissues and help the return of erections.

Prostate cancer treatment may be experienced as a loss within the relationship to both partners.

The absence of erections may also have a negative impact on masculine identity, but the cultural myth of an erect, reliable penis as the essence of manliness is just that, a myth  and possibly not a partner's priority for good sex.

If erections are not reliable enough for intercourse, changes will be necessary to the way both partners express their desire for intimacy, masturbation and orgasm.

Help may be needed to work out some new strategies, but the changed relationship will flourish with patience and loving understanding.

Helen Mounsey, Christchurch therapist, is part of the Sex Therapy NZ referral network team. Those seeking professional help with any sexual matter should contact the referral manager Kerryn Findlater on (06) 354 2449 or www.sextherapy.co.nz.

- The Marlborough Express