Prostate Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview for Prostate Cancer
Table 9. Treatment Options by Stage for Prostate Cancer continued...
Differences are often reported between population-based surveys and case series from individual centers. Reasons could include the following:
- Age differences among the populations.
- Surgical expertise at the major reporting centers.
- Patient selection factors.
- Publication bias of favorable series.
- Different methods of collecting information from patients.
Case series of men who have undergone radical prostatectomy have shown shortening of penile length (by an average of 1–2 cm).[42,43,44] The functional consequence of the shortening is not well studied, but it is noticeable to some men. (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information.)
Inguinal hernia has been reported as a complication of radical prostatectomy.
Evidence (inguinal hernia following radical prostatectomy):
- 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.[45,46,47,48,49]
- 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;[45,46] or in men with prostate cancer who have undergone pelvic lymph node dissection alone or radiation therapy.[45,47,48]
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.
Radical prostatectomy may cause fecal incontinence, and the incidence may vary with surgical method.
Evidence (fecal incontinence following radical prostatectomy):
- In a national survey sample of 907 men who had undergone radical prostatectomy at least 1 year before the survey, 32% of the men who had undergone perineal (nerve-sparing) radical prostatectomy and 17% of the men who had undergone retropubic radical prostatectomy reported accidents of fecal leakage. Ten percent of the respondents reported moderate amounts of fecal leakage, and 4% of the respondents reported large amounts of fecal leakage. Fewer than 15% of men with fecal incontinence had reported it to a physician or health care provider.
External-beam radiation therapy (EBRT)
Candidates for definitive radiation therapy must have a confirmed pathologic diagnosis of cancer that is clinically confined to the prostate and/or surrounding tissues (stage I, stage II, and stage III). Staging laparotomy and lymph node dissection are not required.
Radiation therapy may be a good option for patients who are considered poor medical candidates for radical prostatectomy. These patients can be treated with an acceptably low complication rate if care is given to the delivery technique.