A current review of the side effects of radical prostatectomy

A Swedish research team has reviewed recent published data on the side effects of radical prostatectomy. While they suggest that there have been improvements in several areas since the situation in the 1990s, they are very clear that there is still a series of significant risks associated with radical surgery as a treatment for prostate cancer.

Hugosson et al. note that radical prostatectomy (RP) is probably still the the most commonly used procedure for treatment of localized prostate cancer, and that the increasingly widespread use of PSA testing has led to operations being carried out on younger men with a highly likelihood of organ confined disease, thus justifying more preservative types of surgery.

The authors report the following estimates of the risks associated with radical prostatectomy when used today for the first-line treatment of localized disease:

  • Peri-operative mortality is low — at around 0.1 percent.
  • Stricture of the vesico-urethral anastomosis (i.e., constriction of the site of reattachment of the urethra to the bladder) now seems to occur in about 2 to 9 percent of patinets (as compared to the 10 to 20 percent of patients observed in the 1990s).
  • The overall risk of incontinence has declined with improved technique, but …
    • While risk for severe incontinence is now relatively low
    • Up to 30 percent of men report mild incontinence (i.e., use of 1 or 2 pads a day) after long-term follow-up.
  • Erectile dysfunction (ED) remains a common, frequent, and long-term side effect after radical prostatectomy.
    • Risk for ED depends on age, pre-operative sexual function, surgical technique, and other risk factors for ED such as smoking, diabetes, etc.
    • Selected subgroups of patients are at low risk for ED (e.g., younger men with excellent sexual function prior to surgery)
  • Inguinal hernia is a relatively recently described complication after open radical retropubic prostatectomy.
    • Inguinal hernia occurs in 15 to 20 percent of patients within 3 years of surgery.

Hugosson et al. conclude that radical prostatectomy is an effective and relatively safe procedure that can be used to achieve cancer control in appropriately selected patients, and that it coems with a relatively low risk of permanent side effects except for ED.

The “New” Prostate Cancer InfoLink would simply note that while this conclusion is certainly fairer than some of the suggestions we have seen in the past, the single most important factor in the quality of patients’ outcomes after radical prostatectomy is the skill, dedication, technique, and focus of the surgeon who carries out the procedure. There are still plenty of surgeons who are ill-qualified to carry out radical prostatectomies. In particular, it is now generally accepted that until a surgeon has carried out at least a couple hundred procedures, s/he has not achieved the technical skill level to be able to optimize outcomes (and minimize side effects) for her/his patients.

3 Responses

  1. The end of the last sentence in this article should have been/should be that doctors performing this procedure will become good at it only after doing it hundreds of times … and if they are focused on learning how to do it better and pay very serious attention to the side effects and outcomes of the treatments they have done.

    For many doctors radical prostatectomy appears to be a cash-cow they do as routinely as putting gas in the car, with little attention to getting better. Feedback from former patients remains a better guide for new patients than is the number of procedures a doctor has done.

  2. My surgeon said he likes his patients “to be dry” but this was something you couldn’t predict. He didn’t even mention ED. Then he told me there was a 1 in 3 chance of my needing radiotherapy after the surgery. I said I’d go away and think about it. Instead, I went to University College Hospital and had HIFU. Best decision I’ve ever made.

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