January 5, 2000
Many men with prostate cancer may endanger their lives by avoiding prostate removal, unwilling to deal with the surgery's reported side effects. Now, in a study reported in the January issue of Urology, Johns Hopkins researchers conclude that when patients seek out a surgeon highly experienced in the procedure, they are far more likely to remain continent and potent than if their operations were done by a less experienced doctor. In addition, the study's potency and continency rates are the highest ever reported after prostate removal.
"There is no better way to cure cancer that is confined to the prostate than total surgical removal of the prostate," says Patrick Walsh, M.D., director of the Brady Urological Institute and lead author of the study. "And at a high-volume center of excellence, the side effects of radical prostatectomy are minimal and the outcome is quite good."
In the early 1980s, Walsh discovered that the nerves that run to the corpora cavernosa, the spongy, erectile bodies in the penis, sit outside the capsule of the prostate. This led Walsh to develop nerve-sparing radical prostatectomy.
Many men, however, still decline to have the surgery because of high rates of reported side effects in the bedroom and bathroom arena. Doctors at several centers, Walsh notes, report that one year after the surgery, only 50 percent of their patients are continent and between 10 and 30 percent are potent. These figures disagree with findings from several centers of excellence, where up to 93 percent of patients report continency and 65 percent report potency.
Until now, these discrepancies have been attributed to different methods of data collection. It appeared that patients reported worse side effects when they answered via an anonymous patient questionnaire than when they reported directly to the doctor. When asked directly, some doctors hypothesized, patients may not be as forthcoming with the truth because they don't want to disappoint their doctors or, perhaps, surgeons have an unconscious bias toward minimizing adverse outcomes.
To more accurately identify side effect rates, anonymous patient questionnaires were distributed by an independent third party to 64 men with prostate cancer before radical prostatectomy as well as three, six, 12 and 18 months after the surgery. The researchers found that when patients were asked at 12 months whether they had a problem with urinary control, 98 percent said they did not have a problem or, if they had a problem, it was small. At 18 months, 86 percent of the men reported being potent. The recovery of sexual function varied with age: 100 percent in men 30 to 39 years of age; 88 percent in men 40 to 49; 90 percent in men 50 to 59; and 75 percent in men 60 to 67.
"This is a demanding operation," says Walsh. "Patients who feel that radical prostatectomy is the best treatment for their condition should seek out physicians who do a lot of them, if not exclusively."
The prostate is a muscular, walnut-shaped gland about an inch and a half long that sits directly under the bladder. Its main function is to produce part of the fluid for semen. Prostate cancer is the most common male cancer, striking more than 175,000 men in the United States each year. For more information about nerve-sparing radical prostatectomy, visit http://urology.jhu.edu/surgical_techniques/radical_prostatectomy/index.html.
Other authors of the study include Penny Marschke, Deborah Ricker and Arthur L. Burnett.