Long-Term Effects of Prostate Cancer Treatment

Sexual Function Problems or Urinary Incontinence Still Common 5 Years Later

Medically Reviewed by Michael W. Smith, MD on May 25, 2005

May 25, 2005 -- Two new studies show that sexual or urinary function problems are still common five years after prostate cancer treatment.

The studies, presented at the American Urological Association's annual meeting, looked at the long-term effects of prostate cancer surgery or radiation.

Changes After Surgery

The first study included 1,288 men with prostate cancer whose cancer had not spread beyond the prostate. They all had prostate cancer surgery.

Before surgery, 87% said they had no problem with urinary control and 81% said they had erections firm enough for intercourse. Those numbers fell in the months and years after surgery.

Six months after surgery, half of the men said they had occasional urinary leaks after surgery; those numbers didn't change much during the five-year study. Nearly one in four said they had total urinary control, but this improved to 35% at the end of the study. Fewer reported frequent leaks or no urinary control.

Six months after surgery, 89% of the men said their erections weren't firm enough for intercourse and 70% said sexual function was a "moderate

to big problem." After five years, 71% still had erections that were not firm enough for intercourse, say the researchers, who included David F. Penson, MD, MPH, an assistant professor of urology at the University of Washington.

The researchers say Viagra was the most commonly reported erectile aid, with 43% of the men saying they had ever used it. Among Viagra users, 45% said it helped "somewhat" or "a lot." Viagra is manufactured by Pfizer, a WebMD sponsor.

Radiation vs. Surgery

The second study was smaller and took a different approach. Instead of focusing only on prostate cancer surgery, it compared surgery to prostate cancer radiation.

The study included 137 men with prostate cancer who were randomly assigned to one of the treatments. They were followed for two years by researchers including Savino Di Stasi, MD, PhD, of Rome's Tor Vergata University.

Quality-of-life scores dropped significantly for the men in the surgical group in the first month after surgery. But after that, their quality of life rebounded; both group's scores were similar to those before treatment. Quality of life included measures of bowel, urinary, and sexual functions.

Sexual Function Trends

Both groups had some setbacks in sexual function.

Right after treatment, sexual function was significantly better in the radiation group. However, sexual function improved over time in the men who got surgery, while it declined to a modest but significant extent in the radiation group, says the study.

Two years after treatment, 70% of the men in the surgery group had erectile dysfunction, compared with 61% who had received radiation.

Urinary, Bowel Function Results

The men who had surgery reported significantly worse urinary function than the radiation group. The surgical patients' urinary function improved during the first year after their operation. Two years after surgery, one in 10 of the men who had surgery was incontinent, compared with 3% of the radiation patients.

The opposite was true for bowel function. Two years after treatment, more than one in four men in the radiation group (27%) had bowel dysfunction, compared with 6% of the surgery patients.

Treatment Options

Besides surgery or radiation, some men opt for "watchful waiting" -- closely monitoring the disease, which often spreads very slowly, says the ACS.

Earlier this month, Swedish researchers reported that in men with early prostate cancer who had prostate cancer surgery, there was a significant cut in deaths from prostate cancer and risk of the spread of cancer. However, the death risk for all of the men wasn't very high over 10 years. Those findings appear in The New England Journal of Medicine's May 12 issue.

Men with prostate cancer should talk to their doctors about treatment risks, benefits, and any side effects they experience.

About Prostate Cancer

Prostate cancer is the most common type of cancer found in U.S. men (except for skin cancer), says the American Cancer Society (ACS). The ACS estimates that there will be about 232,000 new cases of prostate cancer in the U.S. this year, with about 30,350 men dying of the disease.

The death rate for prostate cancer has been dropping, says the ACS. A man's risk of prostate cancer increases with age.