Common prostate conditions such as benign prostatic hyperplasia (BPH) or prostate cancer can cause pelvic symptoms such as voiding dysfunction, nighttime and daytime frequency of urination, urinary urgency and urinary incontinence (UI).
Despite the importance of the prostate and the prevalence of prostate symptoms, many men are unaware of the anatomy of their pelvis and do not know how they can improve their pelvic health to conservatively manage pelvic symptoms secondary to prostate changes.
In 2022, an estimated 24,217 men were diagnosed with prostate cancer in Australia. Prostate cancer has a five-year survival rate of 96%. It is an age-related condition and men with a male primary relative with prostate cancer have an increased risk of diagnosis.
Treatment of prostate cancer, including radical prostatectomy (RP), radiation therapy and hormone therapy can have both short-term and long-term side effects. Side effects of prostate cancer treatment significantly impact the physical, mental and emotional health of men and their families.
Common RP side effects include UI and erectile dysfunction (ED). Over 90% of men will experience UI following RP. Approximately 5-10% of these men will have UI that will persist beyond 12 months post-operatively. ED persists beyond two years in approximately 40% of men.
Radiation therapy has an increased risk of bowel dysfunction in the short term, and though side effects of UI and ED are less common in the short term they can occur up to 1-2 years following radiation treatment. Side effects of hormone therapy can include fatigue, sexual dysfunction, weight gain and mood changes.
Active surveillance is an option that is given to some men who have a low-grade, localised prostate cancer diagnosis. This involves monitoring changes in the prostate but not having active cancer treatment. These men avoid the side effects of treatments and may potentially be able to avoid treatment long term.
Pelvic health physiotherapists have an important role to play in supporting men on their prostate cancer journey. This includes education on the anatomy of the pelvis, the role of the prostate and the pelvic floor muscles (PFM) and the side effects of chosen treatments.
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Pelvic health physiotherapists provide individual PFM assessment and training using a variety of biofeedback techniques including real-time ultrasound and manual feedback. Studies have shown better outcomes for men post RP if they have done pre-operative PFM training.
Physiotherapy education includes fluid optimisation, bladder retraining strategies and bowel education. Physiotherapy management also includes support and advice for ED and continence products. Pelvic health physiotherapists can prescribe strength exercises, advise on physical activity and provide lifestyle advice to help men to improve their overall health.
Pelvic health physiotherapists have a significant role in supporting men with prostate issues. The combination of postgraduate expertise and time spent with patients, allows physiotherapists to effectively support men to process their diagnosis, treatment and symptoms.
Through ongoing care and problem-solving, physiotherapists help men to connect to their bodies, improve their pelvic health and optimise their outcomes. A prostate cancer diagnosis is often the first-time a man has focused on pelvic health. This may also be the first time a man has seriously considered improving his health. Pelvic health physiotherapists are vital in supporting men as they navigate this journey.
Author competing interests – nil
KEY MESSAGES
- Prostate cancer treatment impacts a man’s quality of life
- Pelvic health physiotherapy can improve outcomes following surgery
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