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What happens after prostate cancer surgery?


Results
Comment

Prostate cancer is the commonest cancer in men, and in the majority the cancer will be clinically localised at diagnosis. There are various treatment options, including radical prostatectomy, radiotherapy, and watchful waiting. To make informed choice, one of the most important pieces of information is what happens after each of these choices. A new US study gives good information about urinary and sexual function in a large population-based cohort of men [1].

Study


The prostate cancer outcomes study was conducted in five major centres in the US. Men diagnosed with primary prostate cancer in the 13 months up to November 1995 were eligible cases. There were over 11,000 eligible cases, and 5700 were randomly sampled. For the analysis of surgery, 1291 men aged 39 to 79 with histologically confirmed, clinically localised prostate cancer undergoing radical prostatectomy as primary treatment were selected because they had survey data and medical records available.

They were surveyed by postal questionnaire at six, 12 and 24 months to collect detailed information on urinary and sexual function. The response was high. The men who had answered both a 6 or 12 month questionnaire, plus a 24 month questionnaire, comprised 81% of the total sent.

Results


About half the men were younger than 65 years at diagnosis. The Gleason score (how advanced the tumour was) was 6 or above in about 70%. Arthritis and hypertension each affected about a third of the men, and diabetes and depression a further 10% each.

Information on urinary problems included results on urinary control and leakage, frequency of incontinence, use of incontinence pads and frequent need to urinate. Perhaps the best summary was whether the men considered the totality of these items to constitute no problem, a small problem, or a moderate to big problem. Figure 1 shows these results over 24 months. Clearly the proportion of men who considered urinary incontinence to be a problem surged in the 6-12 month period after surgery, and then settled somewhat. This was not just that they were getting used to having a problem, as the same pattern was seen in control of urination, frequency of incontinence and need for incontinence pads.

Figure 1: Effect of prostate cancer surgery on problems men had with urinary incontinence


Information on sexual function included the level of interest in and frequency of sexual activity, and whether erections were firm enough for sexual intercourse and problems in keeping an erection. Again there was a summary of whether problems with sexual function were none, small, or moderate to big. Figure 2 shows the results over 24 months. The proportion of men with no problem dipped dramatically after surgery and remained low thereafter. It is a moderate to big problem for 61% of men six months after surgery, and remained a big problem for 42% at 24 months. The problem was in getting and maintaining erections firm enough for sexual activity.

Figure 2: Effect of prostate cancer surgery on problems men had with sexual function


For both urinary and sexual function men aged 75 to 79 years had worse outcomes, and outcomes for white men were worse than those for black men.

Comment


Eighteen months after surgery 72% of the men said they would make the same treatment choice and only 7% said they would not choose radical prostatectomy again. Choice is a funny sort of word in this context. Most men would not choose to have prostate cancer, but if it does strike, a man wants to know what is the best treatment option for him. This gives real-world outcomes from a large group of men, from several centres, at different ages, and over two years following surgery. It warns of major problems immediately afterwards, but that some of these problems wane with time.

Reference:

  1. JL Stanford et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer. The prostate cancer outcomes study. JAMA 2000 283: 354-360.
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