Radical Prostatectomy is the removal of the prostate
gland during a prostate cancer operation: achieving
an erection of the same quality as before the
operation is rare, and may have been significantly
overestimated by doctors. This is the main result of
a new study which is presented at the European
Association of Urology Congress in Madrid.
The Prostate - Henry
Gray - Anatomy of the Human Body
Radical Prostatectomy can often remove the cancer,
but there is a major possible side-effect, erectile
dysfunction, the inability to have an erection.
This is because the nerves which surround the
prostate are often damaged during the operation, and
these nerves control the ability to have an
erection.
The standard way of measuring erectile function is
via a questionnaire, the International Index of
Erectile Function (IIEF), but this is not
specifically aimed at prostate cancer patients.
Some researchers had felt that the questionnaire did
not take account of the special circumstances of a
sudden change in erectile function brought on by
surgery, or allow comparison with sexual activity
prior to the operation (the IIEF questions only deal
with sexual activity within the previous four
weeks).
A group led by Dr Mikkel Fode, from the Herlev
Hospital in Copenhagen, asked 210 patients to
complete the IIEF questionnaire, around 23 months
after Radical Prostatectomy surgery. However they
added an additional question: “Is your erectile
function as good as before the surgery (yes/no)”.
Only 14 patients (6.7% of respondents) reported that
their erections were as good as before surgery.
This compared with 49 patients (23.3%) who showed no
decline in the in the IIEF score.
As Mikkel Fode said:“The occurrence of sexual
dysfunction after prostate cancer surgery is well
known but our method of evaluating it is new. What
this work shows is that having an erection as good
as before surgery is a rare event, with the vast
majority of men, more than 93% in our sample,
experiencing some sexual problems after prostate
cancer surgery.
Fundamentally, we may have been asking patients the
wrong question, but of course we really need bigger
trials to confirm this.
We think that this work gives a more realistic, idea
of the real problems which most men have after
prostate surgery.
This is important to know before deciding on
undergoing the treatment as your choice might be
affected. For men who have already undergone surgery
it is important to know that they are not alone in
the situation and that their physician will likely
be able to help if they discuss the problem”.
Commenting, Professor Francesco Montorsi, Chair
Department of Urology, Vita Salute San Raffaele
University, Milan, Italy and Editor Emeritus
European Urology said: “As the average age of
patients undergoing radical prostatectomy is
decreasing, maintaining the ability to have an
erection after an operation is increasingly
important to men facing surgery. This is the first
study of its kind, so we need to confirm the
findings but above all to learn from problems which
can face patients after prostate cancer operations.
We need to look more closely at nerve sparing
techniques, and ensure that good post-operative care
is available for each patient”.
The IEFF questionnaire
For more information
the European Association of Urology Congress in
Madrid
Università Vita-Salute San Raffaele - Milano
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