Life after prostate surgery can be hard

Nearly half of men who undergo surgery to treat prostate cancer find themselves with greater incontinence problems and less sexual function than they had anticipated, according to a new poll.

Before the surgery, some men in the study had expected to get better urinary and sexual function a year after the procedure - a misbelief that the researchers say is out of step with the reality of prostate cancer surgery.

"Those results were surprising," said Dr Tracey Krupski, an assistant professor of urology at the University of Virginia, and who was not involved in this study.

"Any intervention that you do to a patient, whether it be surgical or radiation, is never going to make the person (function) better than they are at the present time," Krupski said.

Prostate cancer and incontinence

While there is controversy over how to treat low-risk tumours, some of which may never cause any harm if left untreated, surgery and radiation are common options when the disease is more advanced. Every year, tens of thousands of men select surgery for their treatment.

As part of the new survey, 152 men who had part or all of their prostate removed for cancer treatment filled out a questionnaire before surgery. They first had counseling to educate them about the risks of the procedure, which include erectile dysfunction and incontinence.

The questions asked about their expectations of urinary, bowel and sexual function a year after the surgery.

About half of men expected that they would have the same function after surgery as before, and 17% of men anticipated better sexual function after the surgery.

One year later, the researchers followed up with the patients and found that just 36% of men's expectations for urinary function matched the true outcomes, and 40% of the expectations for sexual function matched reality.

Sex after prostate surgery

Daniela Wittmann, the sexual health coordinator in the urology department at the University of Michigan and a researcher on the study, said doctors are unable to tell patients specifically how well they are likely to recover their urinary and sexual functions.

"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 his ability to have intercourse. In May, another research team found that some degree of incontinence was common, too, although men tended not to be significantly bothered by it.

Krupski said men's unrealistic expectations can be a double-edged sword. On the one side, 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."

The inability to get an erection is one of the more common side effects from prostate cancer surgery, though some men are eligible for a "nerve sparing" procedure, which leaves intact the nerves that control erections.

A different study, published in the same issue of the Journal of Urology as Wittmann's, found that when patients were educated about the risks and benefits of nerve sparing, and then given the power to choose the type of procedure, they were likely to make choices similar to their surgeons'.

In this case, the men participated in both a routine, pre-operative counseling session as well as a separate appointment with a surgeon to discuss the risks and benefits of each procedure.

Krupski said additional pre-operative visits would be beneficial, but are generally not covered by insurance plans.

Support networks for men

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 said.

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.  - (Reuters Health, July 2011)

Read more:

Life after prostate cancer
Quiz: How healthy is your prostate?

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