Urinary and Sexual Function After Radical Prostatectomy for Clinically Localized Prostate Cancer

Reviewers: Li Liu, MD
Source: JAMA, 2000 Jan 19; 283(3): 354-60

Background

Urinary incontinence and impotence are among the most common side effects after radical prostatectomy for early stage prostate cancer. The rates of incontinence range from 4% to 40% and impotence from 30% to 75% depending upon the selection of the patients and clinical practices. Dr. Janet L. Stanford of the Fred Hutchinson Cancer Research Center in Seattle and a multicenter team reported the incidences of these side effects in patients who underwent radical prostatectomy for prostate cancer.

Methods

A total of 1,291 black, white, and Hispanic men, age 39 to 79, with primary prostate cancer who underwent radical prostatectomy within 6 months of diagnosis were included. They were followed for up to 2 years.

Results

• 8.4% of the patients were incontinent.
• 59.9% of patients were impotent with impotence defined as the inability to achieve an erection firm enough for intercourse.Patients over the age of 60 were more likely to experience impotence than younger men.
• Men between the ages of 75 to 79 were more likely to experience severe incontinence than younger men.
• The rates of firm erection at 2 years were 38.4%, 25.9%, and 21.3% for black, Hispanics, and whites, respectively.

Discussion

In this study, radical prostatectomy was associated with significant erectile dysfunction and some compromise in urinary function. Erectile dysfunction may significantly affect quality of life, particularly in younger men. Medications and other measures are currently available to address this problem. Some studies have suggested that radical prostatectomy and radiation therapy are equally effective in local tumor control in selected patients with early stage prostate cancer. Patients should be aware of potential treatment sequelae of each and how these might be treated if they arise.