FRIDAY, Aug. 12 (HealthDay News) -- New research finds that men
who undergo prostate removal often suffer more from incontinence
and impotence than they expected, even when counseled beforehand
about possible aftereffects.
The findings suggest there's a wide gap between what men with
prostate cancer expect post-surgery and what actually happens --
and that many are shocked by the level of dysfunction after the
After the surgeries, "we find that men are very disappointed and
very sad. It's as if they really didn't hear what was being told to
them," said study lead author Daniela Wittmann, a sexual health
coordinator at the University of Michigan's prostate cancer
Removal of the prostate, a treatment for prostate cancer, is
especially common among younger men, while older men often turn to
radiation, said Dr. Stephen Freedland, an associate professor of
urology and pathology at Duke University in Durham, N.C. The
procedure can lead to urinary incontinence, sometimes to the point
where men need to wear padding, as well as difficulty attaining and
maintaining an erection.
Prostate cancer is also sometimes treated with hormonal therapy,
which can also lead to impotence and other serious side effects, or
by "watchful waiting," which means having regular exams while
doctors keep an eye on the tumor to see if it grows or spreads. The
latter is usually recommended when physicians feel someone's age
will allow them to outlive the generally slow-moving cancer.
The study appears in the August issue of the
Journal of Urology.
The problem is that the prostate is located right next to the
urinary sphincter and nerves that contribute to erections,
Freedland said. The operation to remove the prostate can disrupt
those other parts of the body.
Competition among doctors may cause them to downplay the risks,
Freedland said. "If one doctor says, 'Look, almost everybody I
operate on leaks a little bit,' and the guy next door says, 'None
of my patients leak,' one of them is telling the truth and the
Compassion can be another factor preventing physicians from
telling the entire story about risks. And patients themselves may
be overly hopeful due to human nature, he said. "You're going to
always have a mismatch between realities and expectations."
The new study tries to measure that gap. A total of 152 men
undergoing radical prostatectomy (prostate removal) took part in
the study. They received counseling about the surgery and were
questioned before the operation and a year later.
The counselors talked to the patients for about 20 to 45 minutes
with a focus on side effects, said study lead author Wittmann.
That's more time than patients typically get with a urologist, she
A year after the surgery, 46 percent reported that urinary
incontinence was worse than expected, while 44 percent said the
same about sexual function. Most of the rest said their experiences
in those areas were what they expected.
The researchers concluded that patients had "unrealistic
expectations" despite the extensive counseling about side effects.
They also discovered that a minority of the men (12 to 17 percent)
expected to have
better bladder control and improved erections after the
surgery, which is the opposite of what usually occurs. Many more
had thought that their bladder and sexual functioning post-surgery
would at least remain the same, they noted.
Wittmann said the researchers plan to test another approach --
two-hour seminars for the patients and their partners about side
effects, including tips men can use to try to alleviate them. "It
includes the kinds of things that men can do to help themselves
afterward," she said. "It's not just information on what you can
expect, but what you can do."
For more about
prostate cancer, see the U.S. National Library of Medicine.
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