The Side Effects? Well, There Is One…

The article I am going to share with you today is a little different from our normal blog topics. Many times when we talk about prostate surgery side effects, we discuss incontinence. However, there are many other side effects that can result from prostate surgery, one of which is erectile dysfunction. The article below was originally written by Tara Parker-Pope who is the editor of The New York Times Well blog.

Erectile Dysfunction

When Paul Nelson of New Canaan, Conn., learned he had prostate cancer at the age of 46, he opted for robotic prostatectomy with a famous New York surgeon who played down worried of erectile dysfunction.

“I had surgery by a doctor who said 98 percent of my patients are perfectly fine,” said Mr. Nelson, now 51. “Of course, I wasn’t perfectly fine.”

The reality for many of the 240,000 men in the United States in whom prostate cancer is diagnosed each year is not all that rosy, at least when it comes to their intimate lives. After surgery and radiation treatments, many men quickly discover that sex will never be normal again. Sensations change. Many men can no longer achieve erections without pumps or pills. For some, the ability to have sex goes away entirely.

Yet, for years, men facing prostate cancer surgery have been reassured by their doctors, who could cite studies in prominent medical journals, that their sex lives would be just fine after treatment. Doctors would often boast of sexual recovery rates in excess of 90 percent, but failed to disclose that those numbers applied to a select group of patients rather than to most men who walked in the door.

What to expect

Now, research published last week in the Journal of the American Medical Association finally offers men some straight talk about what to expect from treatment for prostate cancer. The findings, based on a study of 1,000 men in different treatment centers, suggests that surgery and radiation treatments take a far greater toll on male potency than most men are led to believe. Among men in the study who reported good sex lives before cancer, fewer than half were able to achieve normal erections two years after treatment.

The new data should allow men and their doctors to determine a more realistic view of a man’s changes for sexual recovery after treatment. Depending on age, erectile function, the extent of cancer and the type of treatment, a man’s chances of returning to a somewhat normal sex life can range from less than 10 percent to 70 percent or more.

Such sobering statistics are a rarity in any discussion of prostate cancer; partly because surgeons and cancer experts worry that a man might forgo treatment rather than risk his sex life.

That thought has occurred to Richard Tuttle, who was 58 and working in New York City when he learned he had prostate cancer. His surgeon was “charming and wonderful,” he said, but didn’t prepare him for a decline in sexual function.

“The big C word is horrible, and you want to get rid of it as quickly as possible,” said Mr. Tuttle, now 60 and living in Cincinnati. “But I sometimes wonder if it would be better not to have the surgery and enjoy your sex life.”

Men should have the chance to make their own decisions

Dr. Martin G. Sanda, senior author on the JAMA study and director of the prostate care center at Beth Israel Deaconess Medical Center in Boston, said he believed that men should have the chance to make their own decisions with the most information available.

“I probably lose some patients because someone else is promising them the moon, but more often than not, I find that couples appreciate the transparency and honesty,” Dr. Sanda said. “You don’t want the man to forgo effective treatment for cancer because of a fear of sexual side effects. The discussion needs to be linked with talking about what’s available to help keep them sexually active.”

Kent Madin, 61, of Bozeman, Mont., said he wished his doctor had given him more information about how radiation therapy in 2008 would affect his sex life.

“There isn’t someone really working on the synergy of the physical and the emotional,” Mr. Madin said. “We have a reasonable sex life, but it takes extra work.”

There are support groups offering candid talk. After his own not-fine experience with prostate cancer, Mr. Nelson started FrankTalk.org, an online discussion board about the cancer.

“You will have great sex again, but will it be like it has been? No,” said Mr. Nelson. “As long as guys know that going in, they can deal with it, but they’re not told.”

Dr. Jason Engel, director of urologic robotic surgery at George Washington University Hospital, said part of the problem was that many doctors only performed operations and didn’t stick around to treat the erectile dysfunction that resulted.

Surgery

“The surgery is the easiest part for the patient, and it’s the easiest part for the surgeon,” said Dr. Engel, who has performed 1,200 robotic procedures. “The work is when you’re seeing him later and giving him pep talks about leaking and impotence.”

Jonathon Alsop, 53, a Boston wine writer, said his surgeon, Dr. Sanda, prepared him for sexual side effects, but nine months after surgery, he sometimes felt like a teenager.

“I never know what my body is going to do from moment to moment, and when I do have sex, I’m pretty sure I’m doing it wrong,” he said. “I try to have a sense of humor about it.”

Original article: The New York Times