August 27, 2008, 9:26 am Regrets After Prostate Surgery

One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.

The research, published in the medical journal European Urology (http://www.europeanurology.com/article/ ... 1/abstract), is the latest to suggest that technological advances in prostate surgery haven’t necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.

Of the 219,000 men in the United States who learn they have prostate cancer each year, nearly half undergo surgical removal of the gland, according to the National Cancer Institute.

Duke University researchers surveyed 400 men with early prostate cancer who had undergone either a traditional “open” surgical procedure or newer robotic surgery to remove the prostate. Overall, the vast majority of men were satisfied. However, 19 percent regretted their treatment choice. Notably, men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure.

Researchers say the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative surgery than traditional prostatectomy. Even among men who had the same scores on erectile function and other measures of post-surgery recovery, the robotic patients still reported a higher level of dissatisfaction and regret than other men.

Part of the problem may be that doctors who perform robotic prostatectomies commonly cite potency rates as high as 95 percent and above among their patients, giving patients an unrealistic view of life after surgery.

But the data are highly misleading. Researchers often define potency as simply being able to achieve an erection that is “adequate” for intercourse — but for many men, that definition doesn’t capture their ongoing struggle to return to a normal sex life. Earlier this year, researchers from George Washington University and New York University used a more realistic definition of potency, showing that after surgery, fewer than half of the men studied felt their sex lives had returned to normal within a year.

Another important finding of the new research showed that men were less likely to regret their choice shortly after surgery. The men who were long past surgery experienced more regret. That finding likely speaks to the fact that as time passes after surgery, men gain a more realistic view of lingering health and quality-of-life issues like erection problems and other changes in their sex lives.

The Duke researchers said that the study shows urologists need to communicate more carefully the risks and benefits of the treatment prior to surgery so that men have more realistic expectations of what to expect.

To learn more, read “Sex After Prostate Cancer (http://well.blogs.nytimes.com/2008/01/1 ... e-surgery/),'’ a Well blog post that includes my column about the issue as well as numerous comments from men and women about the aftermath of prostate cancer treatment.

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Everybody should read Blaise's article. It discribes what typically happens to sexuality after remedial efforts to curer the cancer.

Everybody should click on Blasie's recommended, "Sex After Prostate Cancer" article to read story after story of what happens to sexuality after the treatment.

All this enforces the point to get the best advice, the best Doctors, and the best Clinics in the first place to avoid the best you can of having these things happen to you. That is why, in my opinion, you really cannot trust the local Urologist who is greed prone to do the service regardless of your medical needs. Again, go to the National Compreshensive Cancer Network, www.nccn.org to located the closest Clinic you can get to and to educate yourself on the diagnosis of prostate cancers. Indeed, these clinics are all networked with each other, are doing research together, and, in fact, practice medince. You will feel the difference.

Further, in the "Sex After Prostate Cancer" article, a:dong: patient suggested you make an effort to consult with both the Urologist surgeon and the Radiation Oncologist. Do that, though they should be working in concert with each other, just make sure you get both sides of the story. We're all awaiting a pill, trust me and good luck. and thank you again, Blaise for advancing this position regarding prostate cancer.

If the choice is "no life" or "no sex", what is your priority?

"no life" is the end for you and the lack of sex wont matter but what about your loved ones and those who love and depend on you?

"no sex" both you and your partner will be able to adjust to this condition if the love bond is strong and time should help to control the desires. If she only cared about having a penis stuck in her vagina (and you only cared about sticking it in one) then you didn't have much to begin with.

Mac (imported) wrote: Fri Aug 29, 2008 10:17 am If the choice is "no life" or "no sex", what is your priority?

"no life" is the end for you and the lack of sex wont matter but what about your loved ones and those who love and depend on you?

"no sex" both you and your partner will be able to adjust to this condition if the love bond is strong and time should help to control the desires. If she only cared about having a penis stuck in her vagina (and you only cared about sticking it in one) then you didn't have much to begin with.

Yea, I remember the old Jack Benny routine. "Your money or your life." Long pause. "I said your money or your life." Response, "I thinking, I'm thinking."

I think at least part of the higher level of unhappiness with the da Vinci robotic prostatectomy may come from the fact that many, including many university settings, are just starting to use it. The smaller urology practice I visit in High Point, NC has done more of these procedures than any other group in the state and that includes the three teaching hospitals. My expectations are lower than most.

If I need it, I will choose da Vinci because it has demonstrably better cure rate and lower rate of serious side effects. I doubt that prostate cancer is the cause of my misery, but one does not know until all the test are done and the results are in.

Most likely, I am looking at needing a laser procedure to reduce an enlarged prostate.

Speed

I've watched two men I love die from not dealing with it so I think the guys crying about the problems they experience post op can go stick it.

I am wondering

If a person's testosterone levels are still within average range ,

and they have prostate surgery

does this mean they still have sexual thoughts, urges, desires,

but can not fulfill them through sexual intercourse or masterbation?

To me that would be a big encouragement to eliminate testosterone from one's sytem.

For those who are faced with prostrate removal, here is one web site that may provide some information, or even perhaps consolation.

http://www.phoenix5.org/stories/firstpe ... stRRP.html

Removing the Prostate often damages the nerves that go to the penis making sexual stimulation difficult or even impossible. It also removes the source of fluid for ejaculation so males without a prostate have "dry" orgasms. Which I'm told are very nice! Prostate surgey also tends to damage the ability of the man to get erections causing ED/Impotence. Men often find relief with ED meds, VEDs or even penile implant surgery. Men with Prostate Cancer will probably find solutions to this and continue to enjoy an active sex life.

Some men with advanced Prostate Cancer opt for Castration or Chemical Castration to eliminate most of the testosterone. Testosterone "grows" cancer faster so this is a last resort and only intended to extend life.

Your very right mrt prostate removal is dangerous, and can lead to sexual problems. I the bet built up sexual energy would be kinda like soda all shaken up, but it can't release, it would be hell for many. Maybe one day they can re grow the damage areas so guys who have had the surgery can perform sexually and get that release.

mrt is correct about guys missing the point that they are alive so shut up about the complications from prostate medicine.

Nonetheless, mrt, how would you like to survive such a inflagration on your lifestyle only to discover you were ill-diagnosed and that you hadn't needed any procedures in the first place.

How could that happen? In my opinion, it has happened to 75% of the men under prostate "care". That is an outrage. Indeed, it stems from Urologists who need to put their daughters through college, want a new Benz, and want to keep their surgical teams warmed up. It has nothing to do with your situation -- they need you also, to help pay for the millions of dollars of medical equipment they have gorged themselves with in their offices, they need to pay the bank once a month. If you happen in their office, you are a perfect target to operate on sending you or your insurance company a $12,000 tro $30,000 bill.

That's why in the WSJ three years ago the Urological Association made a promise to review if any tests should be taken, if any tests acutally saved lives since they admitted have secrued up ten of thousands of men's lifestyles for nothing.

Hence, as a way out of this cattle run, I have urged people, in my opinion, to click into www.nccn.org to locate the closest Clinic to go to. That Clinic is involved with 22 other Clinics in the USA where they practice medicine, where they are researching for clues to solve the prostate problem -- not such pop you up on the surgical table or zip in "seeds". Secondly, from the site to can track normal medical approaches to resolving your prostate problem.

Any time anybody messes around with your prostate which is like a kids tree hut, you will never be the same. If that has to be so. so be it, as long as it is a medically sound approach for you, not an economic relief at your expense to the thug, in my opinion, doctor who pats you on the rump saying I'd do it just to make sure.