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    Prostate Cancer: New Help for Tough Choices

    Quality of Life continued...

    In his latest study, Litwin looked at urinary function and bother in men who underwent either external-beam radiotherapy or surgery for their prostate cancers. It is generally believed that surgery is more likely to result in a rapid cure, but that the risks of losing erectile function and urinary control are much higher.

    This was true in the first year after treatment. But beginning in the second year, men who underwent surgery began to regain lost erectile and urinary function, while those who underwent radiation therapy began to lose it.

    As for urinary bother, the results were surprising. Men were bothered significantly more by urinary symptoms after radiation than after surgery for the entire two years after treatment.

    "Physicians tend to push their own particular type of therapy because they believe in it," Litwin says. "But I do believe that patients who choose either of the therapies have a concept of what the outcome will be. That is why patients are often surprised, and bothered, when the outcome isn't what they expected."

    Better Surgery

    A major problem with prostate surgery is that the nerves that control both erectile function and urination run through bundles on either side of the prostate gland. Unfortunately, prostate tumors often appear on the side of the gland right next to these nerve bundles -- and sometimes they push right up against them.

    New nerve-sparing surgery has greatly reduced the number of men who lose the ability to have erections and to control urination. But when the tumor sits in a bad place, a surgeon often will have to cut the nerve to make sure the entire tumor is removed.

    "Patients with nerve-sparing surgery do best in terms of recovering their sexual potency," Disa says. "If you damage the nerves but don't destroy them, you have a 75% chance of recovery. If one of the nerves is destroyed, this drops to about 50% -- and if both nerves are destroyed, there is no chance of recovering potency."

    But now, help is on the way. Disa and colleagues have pioneered a new technique in which a nerve taken from just below the ankle can be used to replace one or both of the nerves destroyed by prostate surgery.

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