The difficulties with choosing a prostate cancer treatment were highlighted once again by a recent study published in the Journal of Urology. The follow-up study of men who chose to undergo radical prostatectomy found that nearly 50% of patients felt worse after having the gland removed. Despite their physical and psychological discomfort, however, 3 out of 4 men did not regret their treatment selection.

At 3, 6, and 12 months’ follow-up, the researchers surveyed 236 men who underwent open radicalretropubic prostatectomy. Three-quarters of the patients surveyed regained their preoperative physical and mental health, as well continence level; however, 74% said they now had sexual dysfunction issues related to potency.

The study also noted several factors that were associated with better quality of life outcomes after the surgery. These included a preoperative prostate specific antigen level of <20 ng/ml, using a nerve-sparing technique, nointraoperative or postoperative complications, no adjuvant treatment, and participation in a postoperative rehabilitation program.

Based on the results of their study, the researchers suggested that, “Men should undergo a combined mental and physical counseling program before surgery to predict postoperative health-related quality of life, potency, and continence after radicalretropubic prostatectomy.”

Prostate cancer is one of the most difficult cancers to treat, with no clear, evidence-based standards for the timing and type of intervention. The treatment decision often comes from a physician-patient discussion of the benefits and potential side effects of the various treatments.

Other than removal of the entire prostate gland, treatment options may include active surveillance, focal therapy that ablates only the caner site, and radiation. Researchers are also studying biomarkers and enhanced imaging techniques to help create more certainty in prostate cancer treatment decisions.

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Treiyer A, Anheuser P, Bütow Z, Steffens J. A singlecenter prospective study: Prediction of postoperativegeneral quality of life, potency and continence after radical retropubic prostatectomy. J Urol.2011;185(5):1681-1685.