The complex and common series of significant short- and long-term complications of radical prostatectomy (RP) — whether conducted with or without the assistance of a robot — are often not well understood by patients when they elect this form of treatment for localized prostate cancer.
Parker et al. have reported data from a relatively recent series of 434 patients with localized prostate cancer followed post-surgery. They used a survey tool known as the Expanded Prostate cancer Index Composite (EPIC) to obtain their data from men followed prospectively for 5 years after RP. The patients were asked to complete questionnaires before their operation and at 1, 4, 12, 24, 36, 48, and 60 months postoperatively.
The data collected by Parker et al. showed the following:
- The average (mean) age of the patients was 63.4 years.
- The patients’ average (mean) urinary function and incontinence were both worse than the baseline level immediately after RP, with recovery stable at 12 months after surgery.
- The patients’ average (mean) urinary “bother” returned to baseline by 4 months post-surgery.
- 55.8 percent of the patients had recovered their baseline levels of urinary function at 12 months post-RP.
- 77.5 percent of the patients had recovered their baseline levels of urinary “bother” at 12 months post-RP.
- Average (mean) sexual function and sexual “bother” scores both declined after surgery.
- New stable baseline scores for sexual function and sexual “bother” were definable at 24 and 36 months post-RP, respectively.
- Only 24.2 percent of the patients reported a return to their baseline level of sexual function after 24 months.
- There was no reported improvement in average (mean) sexual “bother” until 12 months post-RP.
- 36.8 percent of the patients reported a return to their baseline level of sexual “bother” after 36 months.
- Patients reported only minimal change in the bowel and hormonal domains.
The results above and the conclusions reported by the authors would come as no great surprise to experienced prostate cancer patients, educators, physicians, or advocates. However, one is driven by these data to wonder just how many men are given data this clearly at the time they are electing to be treated by radical prostatectomy or actually “hear” these data even when they are given them.
The loss of sexual functionality (whether whole or partial) is a major issue for most patients post-surgery – and all too often we believe that patients truly do not grasp the probability of this loss or the degree to which it is likely to affect them over time. It would be easy to apportion blame for what is clearly a communication failure pre-surgery but a better response might be to ensure that all patients receive this type of information in writing at their pre-surgical consultations. And that written information should mention risk for reduction in penile length and Peyronie’s disease in addition to effects on urinary and sexual function over time.
In a Reuters report on this article, the research team note that a “structured early and long-term erectile rehabilitation program to augment sexual recovery as early as possible, yet also convince patients to maintain their erectile rehabilitation efforts long-term” has since been put in place at their institution. The “New” Prostate Cancer InfoLink would be interested to know whether patients were also receiving a more thorough education about the complications of surgery prior to making the decision to undergo RP.
As average life expectancy continues to increase, and as we grow our appreciation of the fact that many men diagnosed with localized prostate cancer are going to live with the consequences of their decisions about treatment for 15, 25, or even 35 years in some cases, the importance of making a wise decision at the time of treatment has become a crucial factor in the overall management of localized prostate cancer — ans most particularly for the large percentage of patients diagnosed with low-risk disease.