Side effects of surgery among patients diagnosed in the Göteborg screening trial

In July this year, we commented on the 14-year mortality data published by Hugosson et al. from the randomized, population-based, prostate cancer screening trial initiated in Göteborg, Sweden, in 1995.  Newly published data now provide us with insight into the treatment-related morbidity following radical prostatectomy in men participating in this trial.

In this new paper, Carlsson et al. report data from a subset of prostate cancer patients diagnosed during the Göteborg screening trial who were treated by radical prostatectomy between 2001 and 2008 and who participated in questionnaire-based surveys before their surgery and at 18 months post-surgery. The two primary endpoints assessed by the researchers were patient-reported frequencies of erectile dysfunction and urinary incontinence, broken down by whether the patients were in the screened or the non-screened (control) groups in the initial screening trial.

The original screening trial enrolled 20,000 men, all aged between 55 and 64 years, who were randomized either to receive a PSA test every 2 years or to receive no PSA tests. At 14 years of follow-up, 1,849 men had been diagnosed with prostate cancer (1,138 in the screening group and 711 in the control group). Of these 1,849 patients, 829 received radical prostatectomy.

The results of the current study are as follows:

  • 294/829 men who received a radical prostatectomy participated in the surveys.
    • 205/294 were in the screening arm of the original study.
    • 89/294 were in the control arm of the original study.
  • 169/294 men claimed to be sexually potent prior to surgery.
  • 140/169 men (82.8 percent) who claimed to be potent before surgery stated that they were either impotent or sexually inactive at 18 months post-surgery.
    • 91/115 of these men (79.1 percent) were in the screening arm of the original trial.
    • 49/54 of these men (90.7 percent) were in the control arm.
  • 47/291 men stated that they were incontinent (i.e., required regular use of pads) at 18 months post-surgery.
    • 29/203 of these men (14.3 percent) were in the screening arm of the original trial.
    • 18/88 of these men (20.5 percent) were ion the control arm.

The authors use these data to estimate that the “cost” of the side effects of surgery per life saved from prostate cancer-specific mortality in the screening trial is that four more men become impotent and < 1 more man has the need of pads among men invited to regular PSA screening as compared to the unscreened men. They conclude that while the risk for erectile dysfunction and incontinence following radical prostatectomy for prostate cancer is high, “the excess burden of permanent side effects after population-based screening can be regarded as relatively low, when related to the number of men saved from prostate cancer death.” They do add, however, that “the outcome on a population-level may differ from the benefit for the individual.”

What is of interest to The “New” Prostate Cancer InfoLink is that this is the second, recent, European, study to suggest a very high rate of erectile dysfunction at a significant period post-surgery among men claiming to have been potent pre-surgery. We commented only a few days ago on the other (Spanish) study, by Pardo et al. The Spanish study gave data about whether patients received nerve-sparing or non-nerve-sparing surgery which does not appear to be available for this more recent paper by Carlsson et al.

Data from the only comparable study in the USA (the “Quality of Life and Satisfaction with Outcomes” study published by Sanda et al. in 2008) seem to suggest that patients treated with radical prostatectomy have a somewhat higher ability to recover erectile function post-surgery. However, it is not possible to make a direct comparison of data from these three studies and draw any really meaningful conclusions. The “New” Prostate Cancer InfoLink would simply point out that patients should be cautious about their expectations for return of erectile function after radical surgery — especially if they are over 55 years of age and the information being given to them suggests that the likelihood of full recovery of sexual function is “high.”

2 Responses

  1. I want to ask about the new HISTOSCAN methodic to check the prostate. Is it helpful to find out cancer or not if the PSA is high?

    Thanks for your answer

    gottfried hofmann

  2. Dear Mr. Hoffman:

    I think that all we can say at present is that the HistoScanning process (as described in this study) may, at some point in the future, be able to act as an option prior to the need for a biopsy and in conjunction with PSA tsting. However, I am not aware of any large, prospective study that has demonstrated the diagnostic accuracy of this technique.

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