TREATMENT OPTIONS FOR PATIENTS WITH PROSTATE CANCER INCLUDE SURGERY, RADIOTHERAPY AND CHEMOTHERAPY.

UNFORTUNATELY, SOME PATIENTS MAY HAVE GENITOURINARY COMPLICATIONS WHICH COULD BE DEBILITATING.

JOIN US AS WE TALK WITH UZOMA ANELE ABOUT TREATING COMPLICATIONS FOLLOWING THE TREATMENT OF PROSTATE CANCER NEXT ON KENTUCKY HEALTH.

PROSTATE CANCER IS THE SECOND MOST COMMON CANCER OCCURRING IN MEN.

THE TREATMENT OPTION INCLUDE HORMONAL THERAPY, CHEMOTHERAPY, RADIOTHERAPY AND SURGERY ALONE OR IN COMBINATION.

EVEN THOUGH THE NUMBER OF PATIENTS WHO EXPERIENCE COMPLICATIONS FOLLOWING TREATMENT FOR PROSTATE CANCER IS LOW, BY VIRTUE OF THE LARGE NUMBER OF PATIENTS BEING TREATED, THE NUMBER OF PATIENTS WITH COMPLICATIONS CAN BE LARGE.

MOST COMPLICATIONS ARE FAIRLY BENIGN AND DON'T REQUIRE EXTENSIVE TREATMENT.

HOWEVER, OTHER PATIENTS MAY HAVE SIGNIFICANT MORBIDITY SUCH AS FISTULAS, STRICTURES, INCONTINENCE, AND INFECTIONS WHICH WILL REQUIRE SURGICAL TREATMENTS TO DISCUSS THE COMPLICATIONS ASSOCIATED WITH PROSTATE CANCER AND TECHNIQUES TO PREVENT, MINIMIZE AND TREAT THEM, WE HAVE AS OUR GUEST TODAY Dr. UZOMA ANELE.

HE IS A GRADUATE OF THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

HE COMPLETED A RESIDENCY IN UROLOGY AT THE VIRGINIA COMMONWEALTH UNIVERSITY HEALTHCARE SYSTEM FOLLOWED BY A FELLOWSHIP IN MALE GENITAL URINARY RECONSTRUCTION AND PROSTHETIC SURGERY AT THE CLEVELAND CLINIC FOUNDATION.

Dr. UZOMA ANELE IS CURRENTLY THE DIRECTOR OF GENITOURINARY RECONSTRUCTIVE SURGERY AT THE UNIVERSITY OF LOUISVILLE.

THANKS FOR BEING WITH US THED.

>> THANKS FOR HAVING ME.

>> YOURS IS A VERY SPECIALIZED SPECIALTY.

IN TERMS OF WHAT YOU ARE LOOKING AT NOWADAYS.

I REMEMBER ONE OF THE PROBLEMS FOR ME AS A COLORECTAL SURGEON AND PATIENTS HAVING CANCER OF THE RECTUM OR COLON, THEY WERE AFRAID THEY WOULD HAVE A COLOSTOMY OR SOMETHING.

IS THIS SOMETHING THAT, FEARING COMPLICATIONS, PATIENTS SOMETIMES PUT OFF HAVING TREATMENT FOR THEIR PROSTATE CANCER?

>> IT IS.

AND IT'S SOMETHING THAT, YOU KNOW, WE REALLY TRY TO PLACE AN EMPHASIS ON PATIENT EDUCATION FROM THE OUTSET.

I THINK MAKING PATIENTS NOT JUST AWARE OF THESE THINGS, BUT REALLY UNDERSTANDING THAT THESE ARE NOT NECESSARILY COMPLICATIONS PER SE, BUT CAN BE SIDE EFFECTS OF TREATMENT.

SO THE NUMBER-- I THINK PART OF IT IS IN THE WAY THAT THIS IS PRESENTED TO A PATIENT.

NOT THAT THIS IS SOME THING THAT IS UNFORESEEN BUT SOMETHING THAT CAN COMMONLY HAPPEN.

REALLY VALIDATING A PATIENT IN HIS EXPERIENCE IN THIS CASE, AND THAT REALLY REASSURING HIM THAT HE IS NOT ALONE WHEN THESE SIDE EFFECTS HAPPEN.

SO I THINK IT'S REALLY THE WAY THAT THESE THINGS ARE PRESENTED AND THE WAY THAT THEY'RE REALLY DISCUSSED WITH PATIENTS THAT CAN KIND OF SORT OF CHANGE THE MIND SET AND REALLY ALLAY SOME OF THE FEARS THAT OFTEN TIMES WE MAY SEE ON MEN THAT CAN HAVE SOME SIGNIFICANT HESITATION IN PURSUING TREATMENT, SURGICAL TREATMENT FOR PROSTATE CANCER.

>> TELL ME, IF YOU WOULD, WHAT ARE SOME OF THE NON-SURGICALLY REQUIRED SIDE EFFECTS VERSUS SOME OF THE SIDE EFFECTS AND/OR COMPLICATIONS THAT COULD REQUIRE SURGICAL TREATMENT?

>> SURE.

AND JUST TO CLARIFY, YOU MEAN AFTER PROSTATE CANCER TREATMENT, SURGICAL TREATMENT FOR PROSTATE CANCER, WHAT SIDE EFFECTS MIGHT... >> LET'S LOOK AT IT IN TERMS OF SOME PATIENTS COULD HAVE PROBLEMS WITH RADIATION AND/OR SURGERY.

I ASSUME MOST OF THE MEDICAL TREATMENTS ARE NOT ASSOCIATED WITH BIG PROBLEMS OR MAYBE THEY ARE.

>> SO THE MAIN KIND OF TREATMENTS, MAINSTAYS OF TREATMENT FOR PROSTATE CANCER, AS YOU STATED, ARE EITHER SURGICAL, REMOVING THE PROSTATE OR RADIOTHERAPEUTIC SO RADIATION TO THE PROSTATE.

AND BOTH OF THOSE ARE NOT WITHOUT THESE POTENTIAL SIDE EFFECTS.

SO OFTEN TIMES WITH SURGERY, WE THINK OF ISSUES WITH ERECTIONS AFTERWARDS AS BEING A THING THAT CAN BE EXPERIENCED.

OR ISSUES WITH CONTINENCE, BEING ABLE TO HOLD URINE AFTERWARDS.

AND IN SOME PATIENTS, THEY'RE VERY LEERY OF JUST UNDERGOING ANY SORT OF SURGICAL INTERVENTION BECAUSE THEY DON'T WANT TO BE CUT ON, ESSENTIALLY IS WHAT IT COMES DOWN TO.

I'VE HAD MANY PATIENTS EXPRESS THAT TO ME.

BUT AT THE SAME TIME, RADIATION IS NOT WITHOUT POTENTIAL COMPLICATIONS AS WELL.

SO RADIATION-- FOLKS THAT UNDERGO RADIATION CAN HAVE ISSUES WITH STRICTURES, THEY CAN HAVE ISSUE-- THAT'S NARROWING OF THE URINE CHANNEL.

THEY CAN HAVE ISSUES WITH ERECTIONS AS WELL.

THEY CAN HAVE ISSUES WITH URGENCY AND FREQUENCY OF YOUR NATION.

THEY CAN HAVE ISSUES WITH BLOOD IN THE URINE AND THEY CAN HAVE ISSUES WITH PAINFUL OR DIFFICULT BOWEL MOVEMENTS AND PART OF THESE SORTS OF COMPLICATIONS OR SIDE EFFECTS OF RADIATION, CAN COME ABOUT BECAUSE THE RADIATION CAN AFFECT OTHER TISSUES AROUND THE PROSTATE, NOT JUST THE PROSTATE ITSELF.

AND THE INTERESTING THING ABOUT RADIATION THERAPY IS THAT THESE SIDE EFFECTS, OR IN SOME CASES, COMPLICATIONS, MAY NOT COME ABOUT UNTIL YEARS DOWN THE LINE.

SO IT'S-- I'VE SEEN A NUMBER OF PATIENTS WHERE THEY WILL COME TO ME AND SAY WELL, DOC, I HAD MY PROSTATE TREATED FIVE, 10 YEARS AGO, WHY AM I HAVING BLOOD IN MY URINE NOW?

OR YOU KNOW, WHATEVER THE POTENTIAL ISSUE AT THAT POINT IS?

AND THEN I HAVE TO EXPLAIN THE EFFECTS OF RADIATION CAN BE LONG LASTING, YOU KNOW, AND IT AFFECTS THESE TISSUES FOR A LONG PERIOD OF TIME AND IT'S DIFFICULT TO KNOW WHICH PATIENTS MAY EXPERIENCE THESE POTENTIAL ISSUES DOWN THE LINE.

BUT, YOU KNOW, RADIATION ITSELF CAN BE A VERY EFFECTIVE EQUALLY EFFECTIVE TREATMENT FOR PROSTATE CANCER.

>> WHAT ARE SOME OF THE MORE COMMON PROBLEMS THAT OCCUR WITH SURGERY?

>> WITH SURGERY, PRIMARILY THE TWO MAIN ISSUES THAT WE SEE ARE ISSUES WITH ERECTIONS AFTERWARDS AND ISSUES OF BEING ABLE TO CONTROL URINE AFTERWARDS, SO STRESS INCONTINUE INCONTINENCE.

>> I WOULD IMAGINE THAT IN YOUR SPECIALTY, WHEN YOU ARE SEEING PATIENTS WITH THIS, THAT-- SEXUAL FUNCTION IS A BIG DEAL FOR MOST OF US AND SO I IMAGINE WITH MEN WHO ARE COMING IN, THAT HAS GOT TO BE ONE OF THE BIGGEST CONCERNS, THIS THING ABOUT IMPOTENCY.

WHAT IS IT THAT CAUSES THE PROBLEM WITH IMPOTENCY FOLLOWING SURGERY OR SOMETIMES RADIATION BUT PARTICULARLY SURGERY?

>> THAT'S AN EXCELLENT QUESTION.

THE PROSTATE HAS A SYSTEM OF NERVES THAT RUN ALONG THE OUTSIDE OF IT AND THE NERVES ARE INVOLVED IN THE ABILITY TO GENERATE AND MAINTAIN AN ERECTION.

AND EVEN THERE IS PROBABLY SOME CONNECTION AS WELL TO THE ABILITY TO MAINTAIN CONTINENCE MECHANISMS.

BUT PRIMARILY ERECTIONS.

AND SO IN REMOVING THE PROSTATE, THERE INHERENTLY CAN BE AN INTERRUPTION IN THESE OR IN THIS NETWORK OF NERVES THAT RUN ALONG THE PERIPHERY OF THE PROSTATE.

AND THERE ARE TECHNIQUES THAT ARE AVAILABLE NOW TO WHERE SURGEONS CAN TRY TO SPARE THE NERVES.

BUT AT THE END OF THE DAY, THE MAIN GOAL IS TO TREAT THE PROSTATE CANCER.

SO IF THERE IS A CANCER THAT IS PARTICULARLY AGGRESSIVE OR INVOLVED IN MULTIPLE AREAS OF THE PROSTATE, THE SURGEON'S GOAL IS TO REMOVE THE PROSTATE IN AND OF ITSELF WITHOUT AS MUCH DEFERENCE TO TRYING TO SPARE THE NERVES.

EVEN THOUGH THERE ARE TECHNIQUES TO TRY TO SPARE THE NERVES IN HOPES OF PRESERVING ERECTILE ABILITY, IT DOESN'T ALWAYS PAN OUT.

MEN CAN STILL HAVE SIGNIFICANT RISK OF ERECTILE ISSUES DESPITE NERVE SPARING.

SO AT THE END OF THE DAY THOUGH, ANY SORT OF SURGERY TO REMOVE THE PROSTATE CAUSES THE DISRUPTION TO THESE NERVES OR THESE IMPULSES AND SO IT'S VERY COMMON FOR MEN TO NOT BE ABLE TO HAVE ERECTIONS IMMEDIATELY FOLLOWING SURGERY.

AND THEN IT'S A MATTER OF JUST WAITING AND SEEING HOW EACH PERSON SORT OF RECOVERS, WHERE SOME MAY HAVE FUNCTIONAL RECOVERY SHORTLY THEREOF THEREAFTER OR SOME PEOPLE HAVE A LONGER TIME PERIOD.

>> HOW COMMON ARE THE URINARY FUNCTIONS AND/OR SEXUAL FUNCTION DISRUPTIONS?

FOLLOWING SURGICAL TREATMENT OR RADIATION TREATMENT?

>> FOLLOWING SURGICAL TREATMENT, THEY CAN BE VERY COMMON.

SO AS FAR AS ERECTILE DYSFUNCTION, THE RATES OF ERECTION DIFFICULTIES OR DYSFUNCTION VARY WIDELY AND IT VARIES-- A LOT OF THE LITERATURE THAT IS AVAILABLE IS NOT VERY HOMOGENEOUS IN THE WAY THAT IT IS STUDIED AND THE WAY THAT IT IS ASSESSED.

AND SO SOME PEOPLE MAY JUST LOOK AT, OKAY, IF YOU ARE ABLE TO GENERATE ANY SORT OF ERECTION, THAT COUNTS AS YOUR ERECTIONS ARE BACK VERSUS THE QUALITY OR THE CHARACTERISTIC OR CHARACTERIZATION OF THE ERECTION PLAYS A ROLE AS WELL.

THERE HAVE BEEN STUDIES THAT HAVE SUGGESTED AS MANY AS ONE IN FOUR TO MAYBE HALF OF PEOPLE, MAYBE SLIGHTLY MORE, UP TO 60% OF PEOPLE OF MEN MAY HAVE ISSUES WITH ERECTIONS AFTER SURGERY FOR PROSTATE CANCER.

AND THEN WHEN IT COMES TO INCONTINENCE, THAT NUMBER IS A LITTLE BIT MORE FAVORABLE, SO IT CAN BE ABOUT 10% OF MEN MAY HAVE ISSUES WITH CONTINENCE AFTER PROSTATE CANCER SURGERY BUT IT CAN BE AS HIGH AS 30% DEPENDING ON THE EXPERTISE AND EXPERIENCE OF THE SURGEON.

>> NOW YOU PARTICIPATE IN SOME THING CALLED THE GROW PROGRAM.

THIS SEEMS RATHER INTERESTING IN THAT IT IS A PROACTIVE THING OPPOSED TO BEING ON THE DEFENSIVE AFTERWARDS.

>> YES.

>> DESCRIBE THIS TO ME.

WHAT GOES ON?

>> SO THE GROW PROGRAM KIND OF CAME ABOUT AS AN AFTER A NEED ASSESSMENT IN THE COMMUNITY, REALLY REALIZING THAT THE EXCELLENT SURGEONS AT THE BROWN CANCER CENTER ARE ABLE TO PROVIDE HIGH LEVELS OF CARE IN TREATING DIFFERENT CANCERS, SPECIFICALLY PROSTATE CANCER AND ALSO BLADDER CANCER.

BUT I THINK THERE WAS AN AREA OF NEED IN REALLY ADDRESSING SOME OF THE SIDE EFFECTS THAT CAN COME ABOUT FROM THAT.

AND ONE OF THE COMOB COMMON SORT OF CONCERNS RAISED WITH ME WHEN IN MY INTERACTIONS WITH PATIENTS OVER THE YEARS HAS BEEN NO ONE TOLD ME ABOUT THAT.

NO ONE TOLD ME THAT COULD HAPPEN.

AND SO EVEN THOUGH THESE THINGS ARE PROBABLY DISCUSSED, PERHAPS THEY WEREN'T DISCUSSED TO THE LEVEL OF DETAIL OR ON THE LEVEL OF UNDERSTANDING WITH THE PATIENT.

SO REALLY TRYING TO CREATE A COMPREHENSIVE PROGRAM THAT COULD 1: EDUCATE AND INFORM PATIENTS.

AND MAKE SURE THAT THEY WERE REALLY ABLE TO UNDERSTAND WHAT THEY WERE GETTING THEMSELVES INTO.

AND THEN 2: I THINK ASSEMBLE A TEAM THAT COULD ADDRESS ALL OF THESE DIFFERENT POTENTIAL THINGS THAT COULD COME ABOUT FROM THE SURGICAL THERAPY.

>> OKAY, SO GROW IS GUARD, RESTORE, OVERCOME AND WELLNESS.

>> YES.

>> TAKE ME THROUGH THIS BECAUSE YOU ARE RIGHT.

I THINK WHEN WE ARE TALKING, IT'S ALMOST LIKE THE CARTOON OF MAN TALKING TO A DOG.

WE ARE TELLING THE DOG THESE GREAT INSTRUCTIONS AND ALL THE DOG HEARS IS BLAH BLAH BLAH BLAH BLAH.

PATIENTS DON'T ALWAYS HEAR WHAT WE ARE TELLING THEM.

>> EXACTLY.

>> WORK US THROUGH THIS IF YOU WOULD.

>> PATIENT COMES IN TO SEE ME-- LET ME REWIND.

A PATIENT WILL SEE ONE OF MY PARTNERS, ONE OF THE YOUR LOGIC ONCOLOGISTS AND HE IS SCHEDULED FOR A SURGERY TO REMOVE HIS PROSTATE.

THEN AND THEN HE COMES TO ME TO TALK ABOUT THE POTENTIAL SIDE EFFECTS THAT WE KNOW CAN POTENTIALLY HAPPEN BEFORE THEY UNDERGO THE SURGERY BECAUSE THE WHOLE GOAL AS YOU MENTION FROM THE OUTSIDE IS TO BE PROACTIVE, TO REALLY BET IN FRONT OF THINGS , SO A PATIENT COMES IN TO SEE ME AND I SIT THEM DOWN AND BASICALLY I GO THROUGH THE DIFFERENT STEPS IN THE PROGRAM.

SO THE OVERALL GOAL IS TO GET THEM IN TO BE ABLE TO HAVE HIS PREOPERATIVE, PRESURGERY LEVEL OF FUNCTIONALITY, WHETHER IT COMES TO HIS ERECTIONS OR HIS URINARY FUNCTION.

>> GOT YOU.

>> SO GROW.

SO GUARD.

SO WE WANT TO MAINTAIN WHAT ABILITY HE HAS GOING INTO SURGERY.

AND SO WHAT DOES THAT INVOLVE?

SO THAT INVOLVES WHEN IT COMES TO ERECTIONS, TEACHING THEM CERTAIN EXERCISES IN TERMS OF TRYING TO PRESERVE THE HEALTH OF THE TISSUES IN THE PENIS.

SO THROUGH-- WE USE MEDICATIONS LIKE CIALIS SURPRISINGLY.

THAT HELPS IMPROVE THE BLOOD FLOW AND OXYGENATION TO THE TISSUES IN THE PENIS.

THERE IS ANOTHER OVER THE COUNTER MEDICATION L-SITROLY NE.

AND VACUUM ERECTION DEVICE THAT GOES INTO THE EXERCISE PART THAT I MENTIONED WHERE STRETCHING THE TISSUES, TRYING TO MAINTAIN OR SIMULATE THE NATURAL PHYSIOLOGICAL NIGHT TIME ERECTIONS.

SPONTANEOUS ERECTIONS THAT REALLY PRESERVE THE LENGTH AND THE SIZE OF THE PENIS.

AND SO THE PATIENT IS INSTRUCTED TO BEGIN THESE EXERCISES A COUPLE OF WEEKS BEFORE THEIR SURGERY AND THEN JUST FOLLOWING THEIR SURGERY, RESUME THEM AND CONTINUE THEM.

AND THE GOAL BEING TO, AS THINGS HEAL AND RECOVER AND POSSIBLY IF THESE NERVES THAT WERE CUT DURING THE SURGERY, AS THEY RECOVER, THEY MIGHT HAVE THE BEST POSSIBLE ENVIRONMENT TO RECOVER IN.

SO THERE IS A SIMILAR COROLLARY WHEN WE TALK ABOUT URINARY FUNCTION.

SO SORT OF THE SAME THING, TEACHING THEM CERTAIN PELVIC FLOOR EXERCISE, KEYING WILL EXERCISE KIEGLE EXERCISES AND THEN AFTER SURGERY THEY CAN CONTINUE WITH THEM TO PUT THEM IN THE BEST POSSIBLE POSITION TO HAVE A SIMILAR LEVEL OR THE SAME LEVEL OF FUNCTIONALITY THAT THEY HAD BEFORE HAD.

>> WHAT ABOUT R, RESTORE.

>> RESTORE.

SO THESE INITIAL-- THIS INITIAL STEP IS MOSTLY PRE-HABILITATION.

PROACTIVE, TRYING TO ENCOURAGE OR CREATE A GREAT ENVIRONMENT FOR THINGS TO EVENTUALLY, HOPEFULLY NATURALLY RETURN BACK TO WHERE THEY WERE.

SO RESTORE IS IN THE SENSE THAT NOT EVERYONE IS GOING TO NECESSARILY GET BACK TO THAT LEVEL OF FUNCTIONALITY QUICKLY, AND SO IT'S SORT OF A STOP GAP TO BE ABLE TO REACH THAT POINT.

SO FOR MEN WITH ISSUES NOT BEING ABLE TO ACHIEVE ERECTIONS YET, IN THE TIMEFRAME THAT WE WOULD HOPE, THEN WE HAVE DIFFERENT THINGS LIKE HIGHER DOSES OF THE MEDICATIONS LIKE CIALIS OR UTILIZING THE VACUUM ERECTION DEVICES IN DIFFERENT MODIFIED WAYS OR EVEN INJECTION THERAPY, SO DIFFERENT MEDICATIONS THAT CAN HELP, PRETTY RELIABLY, ACHIEVE AN ERECTION IN THAT CASE.

AND WHEN IT COMES TO URINARY FUNCTION, GETTING THEM PLUGGED IN WITH THE PELVIC FLOOR PHYSICAL THERAPIST WHO CAN SHOW THEM AND TEACH THEM AND GUIDE THEM IF THE WAYS OF HAVING VERY STRUCTURED PELVIC FLOOR EXERCISES BEYOND THE LEVEL OF JUST KIEGLE EXERCISES AND TRYING TO HAVEN THE RETURN TO FUNCTION M.T.A.

>> WHAT ARE YOU TRYING TO DO?

STRENGTHEN UP THE MUSCLES AROUND THE BLADDER IN THIS CASE?

>> YES.

WHEN YOU THINK OF THE PROSTATE AS ANOTHER SPEENG SPHINCTER AND YOU ARE RELYING ON THE KIE GL LE MUSCLE.

IT'S A NEW THING FOR THE BODY SO REALLY TRYING TO STRENGTHEN THE PELVIC FLOOR I THINK IS PART OF THAT GOAL OF TRYING TO RETURN BACK TO CONTINENCE.

>> OVERCOME.

>> OVERCOME, SO NOT EVERYBODY IS GOING TO RESPOND EVEN TO THESE INTERVENTIONS.

AND SO THAT'S WHEN WE START TALKING ABOUT WHAT IS THE NEXT STEP?

WHAT CAN WE DO?

AND I TRIED, IN DEVELOPING THIS PROGRAM, WE TRIED TO THINK OF IT FROM THE LEAST INVASIVE TO THE MORE INVASIVE THINGS, RIGHT?

THAT'S WHEN WE START GETTING INTO SURGICAL OPTIONS BASICALLY.

SO WHEN IT COMES TO ERECTION ISSUES PENILE IMPLANT IS ONE POTENTIAL OPTION.

THERE ARE DIFFERENT VARIETIES.

THERE IS AN INFLATABLE IMPLANT AND NON-INFLATABLE OR SEMIRIGID OR MALLEABLE IMPLANT.

IT'S REPLACINGS THE IMPLANT IN THE BODIES NATURAL SPACES IN THE PENIS.

ESSENTIALLY TO ENSURE THAT A MAN WILL BE ABLE TO HAVE AN ERECTION, SENSATION STAYS THE SAME, ABILITY TO CLIMAX AND ALL THOSE THINGS ARE STILL MAINTAINED BUT BASICALLY IT GUARANTEES THAT A MAN WILL BE ABLE TO HAVE AN ERECTION.

THAT'S ONE OPTION THERE.

FOR URINARY INCONTINENCE, FOR MEN WHO ARE STILL PERSIST TINGE WITH THE INABILITY TO HOLD THEIR URINE, THERE ARE OPTIONS SUCH AS A SLING THAT HELPS SUPPORT THE URETHRA AND THERE IS ALSO AN ARTIFICIAL URINARY SPOONING TER, A TUBE THAT SITS AROUND THE CHANNEL AND CONSTANTLY INFLATED AND A MAN SIMPLY TO PRESS A BUTTON IN THE VOTE UM SCROTUM AND THAT ENABLES HIM TO EMPTY HIS GLAD-- HIS BLADDER.

>> THAT MAKES IT EASY.

>> IT DOES.

AND WE FELT THE TERM OVERCOME WAS VERY SUGGESTIVE TO AND REALLY CHARACTERISTIC OF WHAT WE WERE TRYING TO GET ACROSS THERE ARE SOLUTIONS AND WAYS TO TRULY OVERCOME THE ISSUES THAT ARE STILL GOING ON.

>> OKAY, WELLNESS.

>> YES.

SO I LIKE TO SAY THAT WELLNESS, YES, IT'S THE FOURTH STEP, BUT REALLY IT'S ONGOING THROUGHOUT THE ENTIRE PROCESS.

SO PART OF THIS COLLABORATION, WHICH IS THIS GROW PROGRAM REALLY IS, IT'S A COLLABORATION BETWEEN DIFFERENT MULTIDISCIPLINARY TEAM, SO THE BROWN CANCER CENTER HAS A PROGRAM CALLED THE SOAR ON PROGRAM.

SO THEY HAVE A MULTITUDE OF RESOURCES WHETHER IT BE DIETICIANS, CHAPLAINS, MASSAGE THERAPY, COUNCILORS, SEXUAL HEALTH THERAPIES AND COUNSELORS, ALL THESE DIFFERENT RESOURCES THAT I THINK ARE IMPORTANT IN THE JOURNEY OF RECOVERING FROM PROSTATE CANCER TREATMENT.

AND SO, YOU KNOW, THERE IS ALWAYS AN EMPHASIS ON TREATING THE PHYSICAL THINGS, THE BODY, BUT I THINK THERE NEEDS TO BE REALLY AN EQUAL EMPHASIS ON TREATING THE MIND AND THE SPIRIT IN ADDITION TO THE BODY.

>> BECAUSE ESPECIALLY WHEN YOU ARE TALKING ABOUT SOMETHING LIKE INCONTINENCE, THAT'S, AS AN ADULT, THAT'S THE LAST THING ANY OF US EVER WANTS TO HAVE.

WHERE WE CAN'T CONTROL THE PASSAGE OF OUR URINE.

>> YEAH.

>> SO YOU ARE ADDRESSING THOSE ISSUES AS A TEAM CONCEPT.

>> EXACTLY.

AND I THINK IT'S REALLY THE PARADIGM OR THE WAY THAT WE THINK ABOUT THESE THINGS IS SORT OF SHIFTING.

YOU KNOW, WE THINK OF, AS UROLOGISTS WE THINK OF INCONTINENCE OF BEING MILD OR MODERATE TO SEVERE.

AND MILD MIGHT BE TYPICALLY THOUGHT OF AS REQUIRING UP TO THREE PADS IN A DAY.

BUT TO A PATIENT-- >> THAT'S A LOT.

>> TO A PATIENT REQUIRING PADS, THAT'S A LOT.

IF EVERYTHING YOU DO REVOLVES AROUND WHERE IS THE NEAREST BATHROOM?

IS ANYONE GOING TO SEE URINE LEAKING FROM ME?

ALL OF THIS, AND IT'S REALLY JUST UNDERSTANDING THE TOLL, THE PSYCHOLOGICAL TOLL IT CAN TAKE ON SOMEBODY.

THAT WAS A MOTIVATING FACTOR FOR ME AND SO TRADITIONALLY, MOST FOLKS WOULD TEND TO WAIT MAYBE A YEAR OR TWO YEARS BEFORE ADDRESSING THESE THINGS BUT WE WANT TO MOVE THAT TIMELINE UP BECAUSE WE KNOW THAT, YOU KNOW, PATIENTS, THESE ARE THEIR LIVES.

>> ONE OF THE THINGS, THE IMPORTANT PART OF COPING THROUGH THIS IS THE PARTNER.

ARE THEY INVOLVED IN THESE STEPS, TOO?

>> I ENCOURAGE EVERY PATIENT THAT I SEE FOR THE GROW PROGRAM, TO BRING THEIR PARTNERS AND SO WE ALWAYS ENCOURAGE THEM TO DO THAT AND SEVERAL OF THEM TAKE US UP ON THAT OFFER.

BECAUSE I THINK IT'S IMPORTANT, YOU KNOW.

WHEN I GO SEE A DOCTOR AND I COME HOME AND MY WIFE ASKS ME, WHAT DID THE DOCTOR TELL YOU?

RHYME KIND OF LIKE, OH YOU KNOW, GIVING THEM LIKE THE CLIFF NOTES BUT I'M NOT REALLY SURE AND IT'S SORT OF EMBARRASSING AND THAT'S ME EVEN THOUGH I'M A PHYSICIAN.

AND SO I TELL EVERY MAN THAT COMES IN, LIKE HEY, I COMPLETELY UNDERSTAND WHEN YOU ARE GOING HOME TO TRY TO GIVE YOUR REPORT TO YOUR WIFE AND YOU ARE TRYING TO PUT THE THINGS TOGETHER.

SO IT'S ALWAYS GREAT TO HAVE YOUR PARTNER COME IN WITH YOU SO YOU HAVE ANOTHER SET OF EYES AND EARS AND ANOTHER MIND THAT CAN BOTH, YOU KNOW, TAKE IN ALL THE INFORMATION AND BE ABLE TO RECALL IT AND I THINK ALSO JUST HAVING THAT SUPPORT, RIGHT?

HAVING THAT HOME SUPPORT, KNOWING THAT WE ARE TRYING TO TELL YOU THAT WE'VE GOT YOU AND WE ARE NOT GOING TO-- WE ARE WITH YOU ALONG THE WAY BUT THEN HAVING YOUR SUPPORT SYSTEM AT HOME THERE, TOO, I THINK IT REALLY RESONATES WITH PATIENTS.

>> I GUESS, TOO, I WANT TO, IN TERMS BECAUSE SEX DOES PLAY A SIGNIFICANT PART IN MOST PEOPLE'S LIVES.

WHEN YOU TALK ABOUT THE IMPLANTS AND THINGS.

IF THE OTHER PERSON IS NOT RECEPTIVE,... DO YOU FIND THE PARTNERS ARE USUALLY OKAY WITH THINGS?

>> SO IT'S KIND OF MIXED.

SO THAT'S PART OF THE REASON WHY I REALLY ENCOURAGE MEN TO BRING THEIR PARTNERS WITH THEM BECAUSE THERE ARE SOME SITUATIONS, UNFORTUNATELY, WHERE MEN DON'T REVEAL IT TO THEIR PARTNER AND THEN THEY MAY COME TO A SUBSEQUENT FOLLOW-UP APPOINTMENT AND THEY'RE SURPRISED THAT THEY HAD THIS THING DONE OR THERE IS NO, YOU KNOW, THEY MAY UNDERUTILIZE THE DEVICE.

AND FOR SO MEN IT'S MORE SO A FEELING OF MANHOOD IF YOU WILL, WHICH, YOU KNOW, THERE IS SOMETHING TO BE SAID OF THAT, TOO.

BUT I THINK AT THE END OF THE DAY, BOTH PARTNERS SHOULD BE INVOLVED AS MUCH AS THEY'RE COMFORTABLE BEING AND I THINK THAT IS AN IMPORTANT ASPECT.

>> WE HAVE TWO MINUTES.

IF YOU CAN, GIVE ME THE THREE BIG THINGS FROM YOUR EXPERIENCE OF WORKING THROUGH THESE ISSUES YOU WANT US TO KNOW.

>> SO I THINK THE MOST IMPORTANT THING IS YOU ARE NOT ALONE.

FOR MEN THAT ARE UNDERGOING PROSTATE CANCER SURGERY, THESE SIDE EFFECTS THAT CAN HAPPEN ARE NOT UNCOMMON.

AND THERE ARE FOLKS THAT ARE ASSEMBLING TO BE THERE WITH YOU ON THAT JOURNEY.

I THINK THE SECOND THING IS, YOU KNOW, BEING PROACTIVE, YOU KNOW, SO THESE STEPS THAT WE HAVE PUT TOGETHER IN THIS PROGRAM, THE GOAL IS TO TRY TO RESTORE FUNCTIONALITY BACK TO WHAT IT WAS, AND IT INVOLVES A CERTAIN PART ON THE PATIENT TO REALLY PARTICIPATE IN A LOT OF THE DIFFERENT STRATEGIES THAT WE HAVE PUT TOGETHER.

AND THEN I THINK THE LAST PART IS REALLY VALUEING THE JOURNEY AFTER CANCER THERAPY.

I LIKE TO SAY TO PATIENTS IT'S NOT JUST ABOUT SAVING YOUR LIFE IN TERMS OF THE PROSTATE CANCER, BUT WANT TO SAVE YOUR QUALITY OF LIFE AS WELL.

I THINK THAT'S AN IMPORTANT PART, TOO.

>> THAT'S THE GOOD THING, ONE THING TO CURE A PERSON OF CANCER LIKE YOU TALKED ABOUT BUT YOU ALSO MORE TO LIFE.

YOU WANT THEM OUT THERE TO ENJOY THEMSELVES: MUST BE SATISFYING FOR YOU AT THE END OF THE DAY.

>> YEAH, IT IS.

>> CAN PEOPLE CALL YOU UP OR DO THEY HAVE TO GO THROUGH THEIR PHYSICIAN.

>> YOU CAN SELF REFER AND YOU CAN CERTAINLY-- WE ARE WORKING RIGHT NOW TO ESTABLISH THE GROW PROGRAM WITH A WEBSITE AND EVERYTHING.

THAT'S UNDER CONSTRUCTION AT THE MOMENT BUT THEY CAN CERTAINLY CONTACT US THROUGH THE U OF L HEALTH SYSTEM AND WE ARE MOVE THAN HAPPY TO SEE FOLKS.

>> I APPRECIATE YOU TAKING TIME TO BE WITH US TODAY.

IT'S BEEN REALLY INTERESTING, I MUST ADMIT.

THERE ARE A LOT OF MEN WHO WON'T TALK ABOUT THIS SO I'M GLAD WE ARE HAVING THIS CONVERSATION NOW.

HOPEFULLY THEY'LL CONTINUE THIS.

YOU KNOW, THERE ARE MANY COMPLICATIONS THAT CAN OCCUR FOLLOWING TREATMENT FROM PROSTATE CANCER, UNFORTUNATELY BECAUSE THESE AFFECT URINARY AND GENITAL FUNCTION, MANY MEN ARE EMBARRASSED AND RELUCTANT TO TALK ABOUT IT AND/OR SEEK TREATMENT.

THERE IS NO SHAME IN DISCUSSING THESE PROBLEMS WITH YOUR PROVIDER.

AS WE HAVE JUST SEEN, THERE ARE MANY EFFECTIVE TREATMENTS.

IF YOU HAVE ANY QUESTIONS ABOUT TODAY'S DISCUSSION, PLEASE REACH OUT TO YOUR HEALTHCARE PROVIDER AND DON'T BE AFRAID OF THAT DISCUSSION.

HAVE IT.

IF YOU WANT TO WATCH THIS SEGMENT AGAIN OR SEE PAST SHOWS, PLEASE GO TO KET.ORG/KENTUCKYHEALTH.

LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH.