There are many treatment options available for persons with prostate cancer. One of the most common treatments for localized prostate cancer is a surgical procedure, called a radical prostatectomy. Researchers have been comparing the different treatment options for prostate cancer to determine which is the most effective and which is associated with the fewest side effects. Researchers from the Prostate Cancer Outcomes Study now report that many men who receive a radical prostatectomy subsequently have difficulty with sexual and urinary function.
Cancer of the prostate, a male sex gland located near the bladder and rectum, is a type of cancer that occurs commonly in older men. Treatment for prostate cancer depends on the stage of disease (extent of disease at the time of diagnosis). Treatment approaches may include delaying treatment until the cancer progresses, or surgery, radiation therapy, brachytherapy (use of radiation placed in the prostate), hormone therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. A radical prostatectomy is a surgical procedure to remove the prostate gland and some of the surrounding tissue, for persons in whom prostate cancer is localized, or has not spread outside the prostate gland. A pelvic lymph node dissection, meaning the removal of the lymph nodes around the prostate, may be done before the radical prostatectomy to determine whether these lymph nodes contain cancer cells.
The researchers from the Prostate Cancer Outcomes Study evaluated the status of urinary and sexual function in 1291 men who had a radical prostatectomy for localized prostate cancer. Some of the men received a nerve-sparing surgery, a new procedure designed to prevent permanent injury to the nerves that control urinary and sexual function. The researchers found that, overall, 8.4% of men were incontinent and 60% were impotent 18 months after the surgery. In those who did not receive the nerve-sparing surgery, 65.6% were impotent. In those who received the nerve-sparing surgery on 1 side of the prostate, 58.6% were impotent, and in those who received the nerve-sparing surgery on both sides of the prostate, 56% were impotent. Before the surgery, 18% of the men reported sexual function to be a moderate to big problem; 2 years after the surgery, this number had increased to 42%.
These findings suggest that radical prostatectomy is associated with significant problems with urinary and sexual function. This may be a consideration for some men who are evaluating their options for the treatment of localized prostate cancer. Men considering a “nerve-sparing prostatectomy” should inquire about the actual risk of impotence at the treating institution. (Journal of the American Medical Association, Vol 283, No 3, 2000)
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