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‘It’s important to look at the demographic of many men who get prostate cancer.

It is typically a disease of older men and, in these men, erectile function is not always at its best anyway.‘Then there is the tumour itself; your risk of impotence depends on the extent of the disease, which dictates how much treatment you will need.’'Your choice of surgeon is also ‘critically important — more so than the technique you undergo,’ says Professor Neal.

Low-risk, early-stage prostate cancer that is contained within the prostate. This measures the aggressiveness of the cancer from a tissue sample.

A score of six and under is the least aggressive cancer; seven indicates a middle-ranking cancer; eight and above is the most aggressive. These include a prostate specific antigen test to detect a protein linked to prostate cancer (rising levels could indicate the cancer has become more serious), digital rectal examinations, magnetic resonance imaging (MRI) scanning and biopsies.

Pretty much everyone is impotent straight after.’‘It’s fair to say that a man in his 50s has a better chance of retaining function than a man in his 70s,’ adds Professor David Gillatt, director of the Bristol Urological Institute.

Nerve-sparing prostate surgery is where the surgeon tries to avoid damaging the two nearby bundles of nerves that control erections, explains Mr Anderson.

A quarter to a third of men will lose sexual function due to damage to the surrounding nerves and small blood vessels responsible for erections.‘We need to remove the cancer, prevent urinary incontinence and preserve sexual function —– and the majority of patients agree this is the order of importance.‘However, the key indicator of what your sex life will be after the operation is what it was like before.Remember also that sexual function may begin to wane naturally once a man reaches his 50s and 60s.’John Anderson, vice president of the British Association of Urological Surgeons, agrees.High-dose brachytherapy may be offered for higher risk cancers, but this is not widely available.‘Treatment is rapid, taking just two days,’ explains Professor Neal.Because the radiation doesn’t travel very far in the body, the healthy tissue around the prostate gland gets a much smaller dose of radiation and so may cause less damage to bladder and urethra resulting in fewer incontinence problems.The new intensity-modulated radiotherapy can deliver different doses of radiation, meaning less risk to surrounding tissue. ‘There is always the danger with leaving the prostate inside the body that some residual cancer may remain,’ says Professor Kirby.


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