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Effects of prostatectomy can be devastating

SEATTLE, WASHINGTON. It is estimated that almost 180,000 American men will be diagnosed with prostate cancer in 1999. More than 70 per cent of these cancers will be localized and will be treated with radical prostatectomy (removal of the prostate gland) or radiation or in some cases will be left alone and watched carefully for further growth (expectant management). The most commonly chosen option is radical prostatectomy. It has long been known that this surgery can have serious after effects specifically impotence and incontinence. However, what has been less clear is just how frequent these complications are.

Researchers at the Fred Hutchinson Cancer Research Center have just released the results of a major study which paints a grim picture of the seriousness and frequency of the after effects of radical prostatectomy. The study involved 1291 black, white, and Hispanic men between the ages of 39 and 79 years who had been diagnosed with localized prostate cancer between October 1, 1994 and October 31, 1995. All the men had undergone radical prostatectomy within six months of diagnosis. The men completed questionnaires or had personal interviews about their urinary and sexual functions at baseline and 6, 12 and 24 months after diagnosis.

At 18 or more months following surgery 59.9 per cent of the men were impotent and 38.9 per cent reported involuntary urination (incontinence) at least once a day. Only 37.8 per cent of the men reported no problems with incontinence and only 14 per cent reported no problem with sexual function. Prior to surgery 77.8 per cent reported no problem with incontinence and 50.3 per cent reported no problem with sexual function. The after effects of prostatectomy were less pronounced among younger men and among men with higher education and higher income. The decline in sexual function was most pronounced among white men and least pronounced among black men. Nerve-sparing surgery improved the outcome somewhat with 65.6 per cent of men having non-nerve-sparing surgery being impotent after 18 months as compared to 56 per cent among men having had bilateral nerve-sparing surgery. Surprisingly, 75.5 per cent of the men were satisfied with their surgery and 71.5 per cent said that they would choose radical prostatectomy again.
Stanford, Janet L., et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer. Journal of the American Medical Association, Vol. 283, January 19, 2000, pp. 354-60

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