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| |  Radical Prostatectomy Often Results In Impotence And Urinary Incontinence CHICAGO, IL -- January 18, 2000 -- A large-scale study of men who underwent radical prostatectomy for localized prostate cancer shows that at least 18 months following surgery, 59.9 percent were impotent and 8.4 percent were incontinent, according to an article in the January 19 issue of The Journal of the American Medical Association (JAMA).
Despite the level of urinary incontinence and sexual dysfunction reported on this new survey, most men (71.5 percent) reported they would choose radical prostatectomy again. Janet L. Stanford, Ph.D., from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues conducted a study of men diagnosed with primary prostate cancer between October 1, 1994 and October 31, 1995 who were residents of six areas around the country and who were included in cancer registries in those areas: Connecticut, New Mexico, Utah, the Atlanta metro area, the Los Angeles County metro area and King County in Washington. There were 1291 patients in the analysis, 1042 of whom completed a six- and/or 12- month survey and a 24-month survey (where patients had undergone prostatectomy at least 18 months previously when the 24-month survey was completed). In addition, the researchers reviewed medical record abstracts. At 24 months, 59.9 percent of men reported that erections were not firm enough for sexual intercourse, and 44.2 percent were unable to have any erections. Among men who were not impotent before surgery, the proportion of men who reported being impotent 18 or more months after surgery varied according to whether a nerve-sparing procedure was attempted: 65.6 percent of non-nerve-sparing, 58.6 percent of unilateral nerve-sparing, and 56.0 percent of bilateral nerve-sparing procedures produced impotence. (Nerve-sparing procedure attempts to leave intact one or both of the "neurovascular bundles" which pass close to the prostate capsule. In most cases, the "bundles" are essential for achieving and maintaining an erection). The authors report that before the diagnosis of prostate cancer, 17.9 percent of patients felt that sexual function was a moderate-to-big problem. On the 24-month survey, 41.9 percent reported that sexual functioning was a moderate-to-big problem. The study also shows that sexual function varied by race and age. At the 24 month survey, 38.4 percent of African-American men reported erections firm enough for intercourse compared with 25.9 percent of Hispanic men and 21.3 percent of white men. The proportion of men who were able to have erections at 24 months was higher in those younger than 60 years (39 percent) compared with the older age groups. (15.3 to 21.7 percent). Compared to younger men, those aged 75 to 79 years experienced the highest level of urinary incontinence at 24 months (13.8 percent vs. 0.7 percent to 3.6 percent). According to the researchers, the oldest age group also had more frequent incontinence (40.8 percent vs. 10.0 to 15.9 percent). Overall, 16.1 percent of the men reported surgery for treatment of strictures (narrowing of the urethra) and 15.8 percent used medication to treat incontinence during the 24-month follow-up period. "These results provide the first description, to our knowledge, of outcomes experienced by a cohort of unselected, population-based patients who have undergone radical prostatectomy," the authors explain. "Our findings are likely to be more representative of the occurrence of urinary and sexual dysfunction following surgery for localized prostate cancer in men in the community compared with earlier studies, which were limited to single or multiple institutional-based patient series." They write: "To make informed choices about treatment alternatives, patients with prostate cancer and their physicians need accurate information to assess the potential and pattern of complications associated with each option." According to information in the article, prostate cancer is the most frequently diagnosed solid tumor in U.S. men, and an estimated 179,300 men will be diagnosed as having the disease in 1999.
Related Link: The Journal of the American Medical Association.
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