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Summary of complications after surgery the incidence of complications such as impotence or incontinence are higher after surgery than watchful waiting.... but as noted below, the rates vary widely based on the expertise of the surgeon |
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Summary of complications after surgery the incidence of complications such as impotence or incontinence are higher after surgery than watchful waiting.... but as noted below, the rates vary widely based on the expertise of the surgeon |
| Quality of Life after Radical Prostatectomy or Watchful Waiting Gunnar Steineck, et al. for the Scandinavian Prostatic Cancer Group Study Number 4. NEJM 2002;347:790 Background We evaluated symptoms and self-assessments of quality of life in men with localized prostate cancer who participated in a randomized comparison between radical prostatectomy and watchful waiting. Methods Between 1989 and 1999, a group of Swedish urologists randomly assigned men with localized prostate cancer to radical prostatectomy or watchful waiting. In this follow-up study, we obtained information from 326 of 376 eligible men (87 percent) concerning certain symptoms, symptom-induced distress, well-being, and the subjective assessment of quality of life by means of a mailed questionnaire. Results Erectile dysfunction (80 percent vs. 45 percent) and urinary leakage (49 percent vs. 21 percent) were more common after radical prostatectomy, whereas urinary obstruction (e.g., 28 percent vs. 44 percent for weak urinary stream) was less common. Bowel function, the prevalence of anxiety, the prevalence of depression, well-being, and the subjective quality of life were similar in the two groups. Quality of life in men who enrolled in the Scandinavian trial was evaluated
approximately four years after randomization, reported in this issue of the Journal by
Steineck. Although base-line data were not collected prospectively, men in the
surgery group had higher rates of erectile dysfunction and urinary leakage but a lower
rate of urinary obstruction than men in the watchful-waiting group. Before 1980, radical
prostatectomy was associated with severe complications: excessive life-threatening
bleeding was common, and after the operation, all men were impotent and 10 to 25 percent
had severe incontinence. However, anatomical discoveries made during the past 20 years
have led to considerable refinements in surgical technique. Among men who are ideal
candidates for radical prostatectomy (who are less than 65 years of age, with localized
disease and no coexisting conditions), experienced academic
urologists report potency rates of 62 to 86 percent and continence rates of 92 to 95
percent. Other centers and surveys of individual surgeons, however, report potency rates
of 10 to 30 percent and continence rates as low as 50 percent. |
