Most Who Had Surgery or Radiation Were Impotent 5 Years Later

By Salynn Boyles

WebMD Medical News  Reviewed By Brunilda Nazario, MD
on Tuesday, September 14, 2004
 
Sept. 14, 2004 -- Most men treated for prostate cancer with surgery or
radiation are impotent five years after having surgery or radiation, and
a significant percentage have other health-related quality-of-life
issues, according to a study led by researchers from the National Cancer
Institute.
The findings suggest that the some of the consequences associated with
external radiation or surgery for prostate cancer are longer lasting
than has previously been believed. Both treatments were associated with
similar declines in overall sexual function.
However, erectile dysfunction became more common with time in men who
received external beam radiation, from half of all patients at two years
after treatment to 63% at five years. For comparison, five years after
surgery, four out of five men (80%) had erectile dysfunction.
"We were surprised to find that in terms of overall sexual function
(including impotence, libido, and sexual frequency) there was not much
difference between the surgery and radiation groups at five years," lead
researcher Arnold E. Potosky, PhD, tells WebMD. "Most people thought
that the sexual side effects were worse with surgery because that is
what early reports told us, but long-term the two treatments appear
similar."
Deciding on Treatment
This year, more than 200,000 men in the U.S. will face a diagnosis of
prostate cancer, and each will have to decide on a treatment strategy.
The main choices for men with localized cancer are surgical removal of
the prostate, radiotherapy, radioactive seed implants, or simply doing
nothing, known as watchful waiting.
Prostate cancers tend to be slow growing, with the time from diagnosis
to death from the cancer averaging over a decade.
Frustratingly, patients have had little information on which course of
action offers them the best chance of survival. No studies have directly
compared long-term survival between surgically- and radiation-treated
patients, and few have examined the long-term side effects associated
with the two treatments.
In the newly reported study, published in the Sept. 15 issue of the
Journal of the National Cancer Institute, Potosky and colleagues
followed more than 1,100 localized prostate cancer patients who had
either surgery or radiotherapy for five years following diagnosis.
No significant difference in the rates of erectile dysfunction was seen
in men who received surgery or external beam radiation. At two and five
years after diagnosis, roughly 80% complained of impotence. Impotence
rose from 50% at two years to 63% among men who received external beam
radiation.
The incidence of urinary incontinence at five years -- defined as
frequent leaking urine or no control of bladder function -- was 15% for
men undergoing surgery and 4% in men treated with radiation. However,
almost a third of the men treated with radiotherapy complained of bowel
urgency at five years compared with a fifth of the men who had surgery.

The finding of lasting compromises in quality of life is sure to add to
the already heated debate about the merits of aggressively diagnosing
and treating localized prostate cancer.

SOURCES: Potosky, A. Journal of the National Cancer Institute, Sept. 15,
2004; vol 96: pp 1358-1367. Arnold L. Potosky, PhD, epidemiologist,
Division of Cancer Control and Population Sciences, National Cancer
Institute, Bethesda, Md. Alan R. Kristal, PhD, associate head, cancer
prevention program. Steven B. Zeliadt, PhD, health services researcher,
Fred Hutchinson Cancer Center, Seattle.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."