HALIFAX -- Five men with prostate cancer sit in a tight circle, speaking of the sadness that overcame them when treatments led to impotency, a lack of bladder control and bouts of anxiety.

They're sharing their experiences at the end of an innovative 28-day program that has dealt with some very sensitive issues.

"I was depressed before ... and this program brought me out of it," Dane Berringer says during a recent gathering at Dalhousie University in Halifax.

The new Patient Empowerment Program (PEP) is part of a broader effort by the health system to help the roughly 23,000 men diagnosed annually with prostate cancer.

Developed by Dalhousie University researcher Gabriela Ilie and radiation oncologist Dr. Rob Rutledge, the program includes, among other things, pelvic exercises to reduce incontinence and counselling that teaches men how intimacy goes deeper than sex.

While surgery, radiation and hormone treatments can lead to a cure, those treatments can leave wounds.

For Berringer, the surgery caused nerve damage near his prostate, a walnut-sized gland above the genitals. The injury has limited the 60-year-old educator's ability to have erections -- a common side effect that often leads to feelings of guilt, loss and inadequacy.

However, time spent with his wife in couples' therapy has helped him accept "there's more to life than penetrational sex."

When men lose sexual and urinary functions, many are left to cope on their own, according to Prostate Cancer Canada.

"There is currently an unmet need in our health care system to identify and understand sexuality issues related to prostate cancer ... both for heterosexual men and the LGBTQ community," Stuart Edmonds, director of research at the non-profit group, said an email.

   Rutledge, who practises at the Nova Scotia Cancer Centre in Halifax, says it's a "silent epidemic."

   He says too many men turn inward and develop mental illnesses related to their distress.

   A recent survey of more that 400 prostate cancer patients in the Maritimes found 19 per cent suffered from depression and anxiety. Over 70 per cent reported challenges with sex and intimacy.

   Ilie says many men associate intercourse with how they connect to their partners. When impotency sets in, they lose "a navigation system."

   "Men aren't like women," says Ilie. "They don't go outward and seek advice. They go inward ... It becomes crucial therefore to find tools that ... bring their feelings to the surface."

   Aside from couples counselling, the PEP program also teaches men how to find alternative forms of intimacy.

   "There's 65 different ways they can connect (with their partners)," says Rutledge. "Go on a date with your partners, plan something. ... Ask for a hug sometimes."

   As well, a buddy system encourages the men in the group to keep in touch on a weekly basis.

   Mel Bartlett, 61, says daily exercises and better eating habits helped him lose ten pounds, and special pelvic exercises helped end urinary incontinence.

   "My prostate cancer is gone, but I'm not cured of the consequences ... and the treatment of it," says the retired actuary.

   "What this has done has treated the patient wholistically. It's tied all the pieces together."

   Meditation is also part of the program.

   When the men gathered at the beginning and end of the program, they were given small monitors to measure their progress in learning to quiet their minds.

   Ross MacDonald, a pastor at Grace Chapel, says the program has helped him cope with the emotional pain that comes with erectile dysfunction and the "hot flashes" caused by hormone therapy.

   "There's a grieving that comes in terms of losing that aspect of our relationship," he says.

   "(However), the fact that I'm exercising, I'm eating well, I'm meditating and practising quiet ... It's all been very helpful for me, but I know the depression is there."

   Preliminary results from PEP program have been encouraging.

   After four weeks, the average weight and blood pressure readings for the men went down. Strength levels -- measured by hand grips -- "significantly improved," Ilie says.

   "On average, our men reported fewer concerns about feeling a burden to others, feeling alone, having relationship difficulties, feeling sad (and) feeling angry."

   Concerns about intimacy and bodily changes caused by medication were also reduced.

   The key to the program, says Berringer, is the close contact of the group.

   "If you just say, 'Here's an exercise system, go do it,' you won't recreate this," he says. "The human aspect is what they're seeing here."