A 17 percent potency rate post-surgery in one Swedish study

According to another media release issued on Sunday by the European Association of Urology, only 17 percent of a large cohort of Swedish men with prostate cancer who were potent prior to surgery were still potent 18 months post-surgery (whether they had nerve-sparing or non-nerve-sparing surgery).

The media release was designed to address issues related to heterogeneity of functional outcomes among men treated surgically for localized prostate cancer. However, for The “New” Prostate Cancer InfoLink the key finding from the study under discussion was this one:

  • “Of 635 men potent at baseline, 606 provided data at 18 months, of whom 100/606 (17 percent) were potent (nerve-sparing and non-nerve-sparing surgery), suggesting the absence of heterogeneity between surgeons (p = 0.5).

Carlsson et al. report a retrospective analysis of  data from 1,280 men treated by a total of nine surgeons at an academic institution in Sweden between January 2, 2001 and July 16, 2008. Other data reported in the media release indicate that:

  • Biochemical recurrence was defined as a PSA value > 0.2 ng/ml with at least one confirmatory rise.
  • Functional outcomes were assessed pre-operatively and 18 months post-operatively by use of self-administered patient questionnaires.
  • Multivariate random effect models were used to evaluate heterogeneity between surgeons, adjusting for case mix – which included age, PSA, pathological stage and grade, year of surgery, and surgical experience.
  • 85 percent of patients were continent at 18 months post-surgery (although “continent” is not defined in the media release), and there was statistically significant heterogeneity among the nine surgeons with respect to continence rates (p = 0.002).
  • There was a negative correlation between the surgeons’ adjusted probabilities of potency and continence at 18 months.
  • There was no association between surgeons’ adjusted probabilities of functional recovery and 5-year probability of freedom from biochemical recurrence.

The authors apparently have stated that “Surgeon heterogeneity suggests that at least some patients are receiving suboptimal care,” and that “Quality assurance measures should be considered to identify and correct suboptimal treatments to ensure patients receive optimal care.”

That sounds like a significant understatement! One really has to wonder how many of these men would have done just as well on active surveillance or even watchful waiting.

3 Responses

  1. I didn’t see how “potency” was defined in this study, but my guess is, based upon what I have read in other studies, that it is something like “sufficient erection for penetration into the vagina, with or without medication (e.g., sildenafil citrate).” That’s not “potency” in my book. I consider “potency” as the ability to get and keep a firm erection, on demand, without any medication, surgical intervention, or mechanical device (like before the surgery). If the above study were discussed by the doctor with his patient, together with the generally accepted medical definition of “potency”, I believe many more patients would demand AS or WW. However, I can’t see any surgeon showing this study to his patient and telling the patient that there is only a 17% chance he will be potent after surgery (regardless of the definition of “potency”). That’s quite a depressing statistic.

  2. I can vouch for the first two bulleted points. As for a doctor telling his patient that there is a high chance of impotence after treatment, I think it is advisable. I was told worse and appreciated it. If one is not given full information at the start of treatment, the shock, surprise, and dismay caused by not being prepared can easily be worse. This happened to me recently, not by caution on a doctor’s part, and probably not by local or governmental Swedish policy (although the government is not objecting; I am), but because “I have heard” by way of an unwritten understanding amongst at least local oncologists. In my case, that’s far worse; that’s potentially harmful withholding of information.

  3. That’s a depressing number. I have to agree with George on this one, I’d much rather know the risks going into something, so I can really weigh what I want to do, as opposed to just going into it thinking everything’s going to be OK.

    Thyroid specialist, Texas

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: