Prostate Surgery

Maria Dalamagka 

Nearly half of men who undergo surgery for prostate cancer find themselves with greater incontinence problems and less sexual function than they anticipated, according to a new poll. Before the surgery, some men in the study had expected to have better urinary and sexual function a year after the procedure than before it -- a misbelief the researchers say is out of step with reality. As part of the new survey, 152 men undergoing radical prostatectomy filled out a questionnaire before they had surgery but after they had received counseling on the risks of the procedure. The questions asked about their expectations of urinary, bowel and sexual function a year after the surgery. About half of men expected the same function after surgery as before, but 17% anticipated better sexual function after the surgery. On a follow-up survey one year later, just 36% of the men said their expectations for urinary function matched the true outcomes, and 40% said their expectations for sexual function matched reality. Daniela Wittmann, the sexual health coordinator in the urology department at the University of Michigan and the lead author on the study, noted it's hard to predict how likely a patient is to recover his urinary and sexual function. "We can only (inform them) in terms of overall statistics, we can't predict for the individual man" how well he will recover, Wittmann said, "which means that, if in doubt, people tend towards being hopeful and optimistic." One recent study showed that, one year after surgery, only one out of four men recovered the ability to have intercourse. (See Reuters Health report, April 21, 2011.) Another research team recently found that some degree of incontinence was common, too, although men tended not to be significantly bothered by it. (See Reuters Health report, June 3, 2011.) Dr. Tracey Krupski of the University of Virginia, who wrote an editorial published along with the study online June 15th in the Journal of Urology, said men's unrealistic expectations can be a double-edged sword. On the one side, she told Reuters Health, optimism is known to help people heal, but on the other side, "it may ultimately lead to disappointment when adjusting to a long term disability." A different study, published along with Wittman's, found that when men were educated about the risks and benefits of nerve sparing prostatectomy, and then given the power to choose the type of procedure, they were likely to make choices similar to their surgeons'. In this study, by Dr. Hugh Lavery and colleagues at Ohio State University, the men had both a routine pre-operative counseling session and a separate appointment with a surgeon to discuss the risks and benefits of each procedure. Dr. Krupski said additional pre-operative visits would be beneficial, but are generally not covered by insurance plans. She said that a network of men who have been through the experience and can support new cancer patients might help them understand the realities of life after surgery. Wittmann said that involving patients' partners is also vital to successfully regaining sexual relationships. "Sex is a partnered activity for most people. The partner can be very effective as part of an intimate team recovering from the side effects of this surgery," she told Reuters Health. The study did not examine whether men would make a different treatment decision given their hindsight after the surgery. Wittmann said she thinks only a small proportion of men would choose not to have surgery if they fully understood the potential for erectile dysfunction, because there are other cancer-related reasons that drive their decision.