: : : : : Health Report : : : : :
First, you have some time to do
research, get opinions from different
specialists, and make a carefully con-
sidered choice. Most prostate cancers
grow slowly, and research shows that
delaying treatment for up to three
months does not affect survival rates
or the ability to control the cancer.
complications such as bleeding, blood
clots, and infection, the most common
long-term side effects of radical prostatectomy are urinary incontinence
and impotence.
The more immediate problem will
be incontinence, since most men are
incontinent immediately after surgery.
Nighttime bladder control usually improves before daytime continence, but
within three to six months most men
are back to normal. Only a small percentage of men have serious, long-term
problems with bladder control.
Surgery and radiation
have similar cure rates
but different risks.
Treatment options
Most men diagnosed with prostate
cancer today have two broad options:
cutting the cancer out surgically or
zapping it with radiation. The procedures offer similar cure rates but have
different risks and side effects.
Surgery • Radical prostatectomy is
a major operation that takes two to four
hours and typically requires a hospital
stay of two or three days. Most men
need a catheter for 10 to 21 days after
surgery and return to their usual activities within three to five weeks.
During the operation the prostate
gland is removed, along with some
nearby tissue. Surgeons typically make
a long incision in the lower abdomen
or perineum. Although laparoscop-ic and robotic procedures offer big
advantages—smaller incisions, a shorter
recovery period—they require more
surgical experience to be performed
safely and effectively.
In addition to the risk of surgical
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“In general, the outcomes with re-
gard to bladder function these days are
pretty good,” says Litwin. “It is very
uncommon for somebody to be in dia-
pers for life.”
Impotence is a different matter. Sur-
gery carries a risk of impotence ranging
from 10 to almost 100 percent, depend-
ing on the patient’s age and whether
the surgeon was able to spare one or
both of the cavernosal nerve bundles
that control erections.
“With surgery there are some
complications that are kind
of theoretical, but the potency issue is a very real
one,” says urologist Peter
Albertsen, M.D., chief of
the urology division at the
University of Connecticut
Health Center.
Most men who undergo
surgery experience at least a
temporary loss of erectile function, because the nerves are traumatized by the
surgery. Nerves recover slowly, usually
over the course of 18 to 24 months.
Some surgeons are also testing a new
procedure called a sural nerve graft—tak-
ing a piece of the sural nerve, which runs
from the calf to the ankle, and grafting it
between the severed cavernosal nerves.
In one study reported in Urology, 63 per-
cent of men who underwent sural nerve
grafting in addition to prostatectomy
recovered full erectile functioning. The
procedure is still considered experi-
mental, however, and some insurance
companies won’t pay for it.
Find prostate
cancer resources,
plus advice on choos-
ing a doctor and a
support group, at
aarpmagazine.
org /health.
