Every man considering surgery for treatment of prostate cancer knows he could leave the hospital incontinent and impotent. Some men with prostate cancer fear these complications so much they avoid surgery altogether, even though it's the surest method to rid the body of cancer. But perhaps these men should reconsider their options. According to a new study by researchers at Washington University School of Medicine in St. Louis, today's prostate cancer patients recover remarkably well from surgery, and very few regret having the operation.
The researchers surveyed more than 1,000 prostate cancer patients and found that men who opted for surgery compared favorably to men who underwent other treatments. "The surgery patients fared well emotionally, they adjusted well, and very few reported being dissatisfied with their treatment," says Deborah S. Smith, Ph.D., research assistant professor of urologic surgery and lead researcher for the study, which was funded by the American Cancer Society.
Although surgery did put men at a higher risk for sexual problems, it didn't increase the risk of incontinence. Most importantly, the men who underwent surgery felt healthier than the other patients and were just as content with their lives.
The researchers reported their findings April 16, 1997, at the annual meeting of the American Urological Association in New Orleans. "This is the first modern study to look at outcomes for men whose prostate cancer was detected through screening," says William Catalona, M.D., chief of urologic surgery at the School of Medicine and co-researcher of the study. "The results are far more encouraging than anything else that has been published."
Surveys Yield Surprises
The researchers sent surveys to 1,842 men who had been diagnosed with prostate cancer through screening at the Washington University School of Medicine between 1989 and 1995. They eventually received 1,340 completed surveys. Seventy-six percent of the respondents had undergone radical prostate removals at the School of Medicine and elsewhere; 18 percent had received treatments of hormones, radiation or cryotherapy; and 6 percent had received no treatment.
The questionnaires asked the men if their current urinary or sexual functioning "bothered" them. The men also rated their satisfaction with their treatment, their overall emotional well-being and their general health. About 58 percent of surgery patients reported problems with sexual functioning, compared with 51 percent of the patients who had other therapies and 35 percent who had no treatment. "That's a striking difference, but it's smaller than we expected," Smith says.Surprisingly, the percentage of patients reporting urinary problems was the same for each group -- about 10 percent. "We thought the surgery patients would be most bothered by urinary problems because that is a potential side effect of surgery," Smith says. A recent study of Medicare patients showed that 32 percent of the men had to wear pads after surgery for prostate cancer, Smith says. She notes that those patients hadn't necessarily undergone prostate cancer screening and that the cancers may have been relatively advanced at the time of surgery.
About 90 percent of the men in each Washington University survey group said they were satisfied with their treatment.
Interestingly, the major key to satisfaction turned out to be urinary function, not sexual function. Men with urinary problems were generally dissatisfied with their treatment, but men with sexual problems were as satisfied as everyone else.
The groups also were nearly identical in terms of emotional well-being, and their scores were typical for men their age. The surgical patients felt slightly healthier than the other patients, partly because doctors consider healthy men to be the best candidates for prostate cancer surgery.
Smith points out that the average surgery patient was 65 at the time of diagnosis, about seven years younger than the patients in the other two groups. Doctors generally don't recommend surgery for prostate cancer patients in their mid-70s or older because the operation probably won't add significantly to their life span, Smith says. The age difference in the study partially explains why the surgery patients responded so well to treatment, and Smith plans to adjust the results to account for the age gap. She also plans to send out a new batch of surveys this year.
The current picture for prostate surgery patients may be incomplete, but it's decidedly rosier than it used to be, Catalona says. Previous studies had painted a bleak picture of life after the operation, he explains. "Those studies showed gloom and doom -- almost every patient was impotent, incontinent and unhappy," he says. "But those studies are from years ago, when surgeons weren't using modern techniques and cancers weren't detected early. Today, patients have an excellent chance of leading full lives after prostate surgery."