Survey Emphasizes Prostatectomy Side Effects

One of the largest surveys of men who had their cancerous prostates removed found that nearly 60% were impotent and more than 8% lacked bladder control more than a year and a half later.

Although such side effects of the surgery are well known, the figures could help patients make the difficult decision of whether to have their prostates removed.

“It’s clearly a large effect on men’s quality of life, and I think it’s important they go into the surgery knowing that,” said Janet Stanford, a researcher at the Fred Hutchinson Cancer Research Center in Seattle who led the study.

The study appeared in Wednesday’s Journal of the American Medical Assn.

The researchers are still following the men who answered the survey and are trying to determine whether their impotence remained five years after surgery and whether Viagra worked for them.

Cancer of the prostate, a gland involved in semen production, is the second most common type of cancer found in American men, behind skin cancer. A total of 179,300 were diagnosed with the disease in 1999.

Treatments include what is known as a radical prostatectomy--the removal of the prostate--and radiation. Doctors also often recommend “watchful waiting,” or leaving the cancer untreated, in elderly men who are more likely to die first from other ailments.

For the study, researchers surveyed 1,291 men beginning in 1994 who had undergone a radical prostatectomy within six months of being diagnosed with prostate cancer.

The study is considered to be one of the most comprehensive because participants were from six states and were black, Latino and white. The patients also ranged in age from 39 to 79.

Previous studies found a wide range of difficulties with incontinence and impotence a year or more after patients’ prostates were removed--4% to 40% reported problems holding their bladders and 29% to 75% reported trouble achieving and maintaining erections.

In this study, researchers found that patients who had surgery that spared one or two bundles of nerves in the area were less likely to be impotent.

About 59% of those who had unilateral nerve-sparing procedures (in which one of two nerve bundles can be saved) and 56% of those who underwent bilateral nerve sparing (both nerve bundles remain) said they were impotent 18 months or more after the surgery.

Nearly 66% of those whose nerves were not spared said they could not keep or sustain an erection. Doctors say the nerves can regenerate, but that can take up to two years.

Surgeons at two major research institutions said they have had even better results.

Dr. William Catalona, who performs about eight radical prostatectomies a week at the Washington University School of Medicine in St. Louis, said he has found that 86% of men under 50 are able to regain sexual function after surgery in which the fewest number of nerves are damaged or disturbed. The percentage lessens with age all the way to 42% for those older than 70, he said.

“If the patients are young and have good erections before surgery--and if they are treated by a surgeon who specializes in this sort of surgery--then the results are excellent,” said Catalona, the school’s chief of urological surgery.

Dr. Charles Brendler, head of urological surgery at the University of Chicago Medical Center, said he has also found that younger men are more likely to retain sexual function. But he said even doctors who specialize in the surgery must learn new techniques to prevent post-surgery impotence.

“We’re doing well getting rid of the cancer and with urinary control,” he said. But, he added, where sexual function is concerned, “we’re a long way from perfect.”