In a population-based longitudinal cohort (Prostate Cancer Outcomes Study) of 901 men aged 55 to 74 years who had recently undergone radical prostatectomy for prostate cancer, 15.4% of the men had either frequent urinary incontinence or no urinary control at 5 years after surgery, and 20.4% of those studied wore pads to stay dry. Inability to have an erection sufficient for intercourse was reported by 79.3% of men. Reasons for the difference in outcomes between the population-based surveys and previous case series could include the following:
- Age difference among the populations.
- Surgical expertise at the major reporting centers.
- Selection factors.
- Publication bias of favorable series.
- Different methods of collecting information from patients.
Case series of 93, 459, and 89 men who had undergone radical prostatectomy by experienced surgeons showed rates of impotence as high as those in the national Medicare survey when men were carefully questioned about sexual potency, though the men in the case series were on average younger than those in the Medicare survey.[47,48,49] One of the case series used the same questionnaire as that used in the Medicare survey. The urinary incontinence rate in that series was also similar to that in the Medicare survey.
A cross-sectional survey of prostate cancer patients who were treated in a managed care setting by radical prostatectomy, radiation therapy, or watchful waiting showed substantial sexual and urinary dysfunction in the prostatectomy group. Results reported by the patients were consistent with those from the national Medicare survey. In addition, though statistical power was limited, differences in sexual and urinary dysfunction between men who had undergone either nerve-sparing or standard radical prostatectomy were not statistically significant. (For information on sexual and urinary dysfunction, refer to the Sexuality and Reproductive Issues summary.) This issue requires more study.
Case series in men who have undergone radical prostatectomy have shown shortening of penile length (by an average of 1-2 cm).[51,52,53] The functional consequence of the shortening is not well studied, but it is noticeable to some men.
Retrospective cohort studies and case series have shown an increased incidence of inguinal hernia, in the range of 7% to 21%, in men undergoing radical prostatectomy, with rates peaking within 2 years of surgery.[54,55,56,57,58] Observational studies suggest that the rates are higher than in comparable men who have undergone prostate biopsy alone, transurethral resections, and simple open prostatectomy for benign disease;[54,55] or in men with prostate cancer who have undergone pelvic lymph node dissection alone or radiation therapy.[54,56,57] Although the observations of increased rates of inguinal hernia after radical prostatectomy are consistent, it is conceivable that men with prostate cancer who are being followed carefully by urologists could have higher detection rates of hernia as a result of frequent examinations or diagnostic imaging (i.e., "detection bias"). Men should be made aware of this potential complication of prostatectomy.