Jan 18, 2000. Men diagnosed with localized prostate cancer and their physicians need clear information about probable side-effects before choosing any treatment. So far, not enough information about treatment complications has been available. Results from large population-based studies has been limited.

In a new study following 1291 men from 6 geographic regions with clinically localized prostate cancer treated with radical prostatectomy, Janet L. Stanford, PhD, of Fred Hutchinson Cancer Research Center, found that 8.4% of men were incontinent and 59.9% were impotent at 18 months or more following surgery.

Among men who were potent before surgery, impotency at 18 months was less likely for those who had nerve-sparing surgery (56.0% to 58.6%) compared with non–nerve-sparing surgery (65.6%). Rates of erectile dysfunction and urinary incontinence after radical prostatectomy varied by age and sexual function also varied by race.

Dr. Stanford and her team set out to to measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer. Anyone in the USA who is found to have cancer is entered into a cancer registery. Dr. Stanford used the cancer registeries to identify a cohort, or a group of patients with comparable disease and treatment. At the time of diagnosis, the patients selected lived in Connecticut, New Mexico, Utah, the Atlanta, Ga, metropolitan area, Los Angeles County, California, or King County, Washington, which includes Seattle.

She focused on a total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease.

The study looked for patterns in change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis.

At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after surgery varied according to whether the procedure was nerve sparing (65.6% of non–nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve–sparing).

At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age:

• Thirty-nine per cent of men younger than 60 years vs 15.3%-21.7% of older men were potent at 18 months.
• Almost fourteen percent of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at 18 months.

Sexual function also varied by race:

• 38.4% of black men reported firm erections at 18 months vs 25.9% of Hispanic and 21.3% of white men

According to leading urologist Patrick Walsh M.D., there is "no better way to cure cancer that is confined to the prostate than total surgical removal of the prostate." Walsh, director of the Brady Urological Institute, says that at a high-volume "center of excellence, the side effects of radical prostatectomy are minimal and the outcome is quite good."

But outside of state-of-the-art prostate surgery centers and among patients who have not been hand-picked for this surgery, effects on sexual and urinary functions may be more disappointing.

Dr. Stanford says, "Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions."

The study did not focus on success rate of radical surgery on eliminating cancer in these patients or others.

Urinary and Sexual Function After Radical Prostatectomy for Clinically Localized Prostate Cancer The Prostate Cancer Outcomes Study

Janet L. Stanford, PhD, et al., Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, MW-814, Seattle, WA 98109-1024 (e-mail: [email protected]). The authors "thank the men who, by their participation in the PCOS, have contributed to a better understanding of the effects of prostate cancer on men's lives."