expectations and prostate cancer surgery…what about radiation and….”the proton?”

In my opinion patients have a better feel for what to expect in terms of impotence and incontinence with surgery than with radiation. You better believe that the urologists out there are telling there patients about the possibility of complications, this is innate to all surgeries. Patients understand that surgery means anesthesia, risk of bleeding, and other complications. They understand that removing the prostate will “mess with stuff down there.” So the below article is a good one , dealing only with surgery and making the point that maybe it’s about be optimistic…I was that way myself.

My beef is with the radiation folks and particularly the Proton folks. I am okay with radiation, I recommend it all the time. These books that tout radiation or Proton beam as if there will be no complications is disingenuous. I believe that if the surgery patient is overly optimistic about the potential or lack of complications, the radiation patient is very overly optimistic. From the get go they feel that because there is no cutting and that the prostate is not removed that the chance of issues is either very small or non-existent.

You will have to just believe me on this. Yes I have seen complications from surgery, but I have seen them from radiation. In regards to radiation the patient is almost always surprised that they have persistent burning to void, worsening erectile function, a change in bowel habits and etc. This is not being critical of a treatment, as I say in my book….”choose your poison.” Another thing patients tend to blame the doctor for surgical problems, but the radiation (not a person) for the radiation problems.

Now you proton advocates…be careful. Yes it is more focused to the prostate with less surrounding tissue damage. However, the prostatic urethra runs right through the middle of the prostate so it will receive radiation just like conventional radiation. So you will not be off the hook for voiding symptoms particularly if you have antecedent obstructive voiding symptoms before treatment. How do I know this possibility? I have a patient who has to catheterize himself to empty his bladder three times a day since having Proton therapy two years ago. He is  very happy and feels he was very smart and cutting edge, he had the proton.

Whichever treatment you choose read the informed consent. Radiation patients read very well the potential for complications. They are out there, just like surgery, they do occur and if you doing radiation because you’ll be off the hook for voiding or erectile problems, you’d better think again.

Oh yea. Then there’s cure…why is it the Proton therapy programs only treat the mild to mod grades of prostate cancer? If it is so great why not treat all comers? Hey…I don’t know. I am just asking. You proton advocates please opine.

Men Have Overly Optimistic Expectations About Recovery from Prostate Cancer Surgery, Study Finds

ScienceDaily (Aug. 8, 2011) — Nearly half of men undergoing surgery for prostate cancer expect better recovery from the side effects of the surgery than they actually attain one year after the operation, a University of Michigan Comprehensive Cancer Center study finds.

“This is a belief that does not reflect preoperative counseling which, on the contrary, alerts men to urinary and sexual problems after surgery,” says study author Daniela Wittmann, M.S.W, sexual health coordinator at the U-M prostate cancer survivorship program.

The study, published in the August issue of the Journal of Urology, surveyed 152 men undergoing radical prostatectomy, an operation to remove the prostate. All of the men filled out questionnaires before surgery, after receiving preoperative counseling. The questions asked the men about their expectations of urinary, bowel, hormonal and sexual function a year after the surgery.

The study showed that for the most part, men’s expectations of hormonal and bowel function matched what happened one year after surgery. But, when it came to urinary incontinence only 36 percent of the men’s expectations corresponded to what happened one year post-surgery.

In addition, only 40 percent of men found what they expected for sexual function to be true one year post-surgery.

Also, 46 percent of the men found worse than expected outcomes in urinary incontinence and 44 percent of men found worse than expected outcomes in sexual function one year after surgery.

“When we provide preoperative education, we can only inform men in terms of overall statistics. We can’t predict for the individual,” explains Wittmann. “This may mean that, if in doubt, people tend toward being hopeful and optimistic, perhaps overly optimistic.”

The researchers suggest that it is important to provide men with tools for urinary and sexual recovery after surgery and with support that will lead to the best possible outcome.

Patients who undergo surgery for prostate cancer at U-M participate in the prostate cancer survivorship program. The program includes partners as well. It is designed to provide men with excellent surgical care along with tailored, couples-oriented support both before and after surgery to help ease recovery from the side-effects of surgery.

“Although preoperative education is very important and should be explicit about the general expectations regarding outcomes, we also need to help men and their partners with the recovery process after surgery in order to help them regain their intimate lives,” says Wittmann.

Additional authors are Chang He, M.S.; Michael Coelho, B.S.; Brent Hollenbeck, M.D., M.S.; James E. Montie, M.D.; and David P. Wood Jr., M.D., all from U-M.