NEW YORK (Reuters Health) - A new study shows nearly half of men feel worse after having their prostate gland removed due to cancer, although three-quarters would do it again given the same circumstances.
Tens of thousands of men each year undergo the surgery, called prostatectomy, and may suffer long-term consequences to their quality of life, in particular sexual function.
In the current study, published in the Journal of Urology, researchers asked 236 men how they were doing up to 1 year after surgery.
Three out of four had regained their physical and mental well-being and had no more problems with incontinence than before the operation. But just one out of four had recovered his ability to have intercourse.
The research team, led by Dr. Adrian Treiyer at St. Antonius Hospital in Eschweiler, Germany, also teased out the circumstances that were tied to better recovery.
Men were more likely to get their quality of life back if they had a type of surgery that leaves the nerves controlling erection intact, for instance, and if they participated in a rehabilitation program.
While the study doesn't prove that rehab is helpful -- men who did better might be likely to join such a program, for example -- the possibility is worth noting, said Dr. Mark Litwin, a urologist at the University of California, Los Angeles, who was not involved in the study.
Rehab programs, which are relatively new in prostate cancer care, can include talk therapy or a drug regimen to treat erectile dysfunction.
"It's not just about recovery of the penis and its ability to become erect, but helping men come to terms with being a cancer survivor," Litwin told Reuters Health.
Both physical well-being, such as experiencing less pain, and mental health, including feeling good and functioning well socially, were tied to remaining continent and not encountering any complications after surgery.
"Some of these things, no one can control, such as baseline PSA," Litwin said. "But some they can. Patients can doctor-shop and find the best care."
In the type of surgery the patients had, surgeons make a cut between the belly button and the pubic bone to get to the prostate, which is then removed entirely -- so-called radical prostatectomy.
About one in six American men get prostate cancer at some point in their life, according to the American Cancer Society. But they don't necessarily have to have their prostate removed because of it.
Some may get radiation treatment instead, or they may have their tumor destroyed by a kind of surgery that uses freezing liquids. Others may choose just to be monitored -- so-called watchful waiting -- to see if the cancer grows slowly enough to be safely ignored.
All of these strategies have problems of their own, and the right option depends on both the cancer and the patient's values.
Litwin said most studies have focused on the drawbacks to prostate cancer surgery, and indeed, the new findings confirm that most men have worse sexual function after the procedure.
"Quality of life definitely takes a hit, both physically and emotionally," Litwin added, "but ultimately, it tends to go back to normal."
SOURCE: bit.ly/dKM5ig, Journal of Urology, online March 18, 2011.
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