Most left impotent by prostate cancer therapy

NEW YORK — Only 10 percent of men treated for early prostate cancer could sustain an erection sufficient for sex 15 years later, said researchers who found impotence rates were the same whether the treatment was surgery or radiation.

The findings were produced by the longest and broadest study on quality of life outcomes in two common therapies for prostate cancer. Researchers repeatedly surveyed 1,655 men diagnosed with localized disease and given surgery or external beam radiation.

While surgery patients had higher impotence rates two years after treatment, by 15 years erection failure “was nearly universal” with both treatments, according to the study reported Wednesday in the New England Journal of Medicine. The research adds to the controversy over whether doctors treat men with early prostate cancer too aggressively.

“This is a picture of what really happens in prostate cancer,” said David Penson, an urologist at Vanderbilt University Medical Center in Nashville, Tenn., and a senior author on the study. “It is the most comprehensive portrait of the patient experience in prostate cancer that is out there.”

Last May, the U.S. Preventive Services Task Force advised against using the prostate-specific antigen blood test to spot a tumor, saying the screening leads to over treatment and unnecessary side effects. In July 2012, a 731-patient study comparing prostate cancer surgery with observation found no statistical difference in death rates between the two groups after 10 years.

“We are starting to realize we are over-treating this disease,” Penson said in a telephone interview. Some low-risk patients with prostate cancer “don’t need treatment.”

More than 238,000 American men are diagnosed with prostate cancer each year, and more than 29,000 die from it, making it the second leading cause of cancer death in men, according to the American Cancer Society. Most cases are discovered before the cancer spreads. In those cases, patient survival is almost 100 percent over five years.

In the Vanderbilt study, 87 percent of men treated with surgery were impotent at 15 years, while 93.9 percent of those treated with radiation therapy were impotent. The median age at the start of the study in 1994 was 64 for men in the surgery group and 69 for men in the radiation therapy group. Most reported not being bothered by the problem.

The study didn’t have a comparison group of older men without prostate cancer, so it was impossible to parse out how much of the impotence was due to the prostate treatment versus other age-related problems.

In terms of other side effects, men who had radiation therapy had more bowel urgency after two years, while men who received surgery had higher rates of urinary incontinence after the same period of time. By 15 years, though, there was no significant difference in rates of bowel urgency or urinary incontinence between the two groups, according to the results.

“For a guy who is looking at this, it is a quantity versus quality of life question,” said Penson. “What am I trading off from a survival benefit, and if I choose to do therapy, what is the quality-of-life hit going to be?”

The results make a case for monitoring the disease in more men without immediately treating it, Penson said. Under such a strategy, called active surveillance, doctors perform regular biopsies and blood tests, and only proceed with curative treatment if the prostate disease shows signs of progressing, he said.

Active surveillance “is certainly what I would do if I had low-risk prostate cancer,” he said.

Patients should quiz their doctors about how advanced their prostate disease is and what the risk is that it will spread before they assume they need immediate curative treatment, Penson said.

“There is much more openness” now among doctors about holding off on treatment for those who are at low risk of dying from their prostate cancer, he said.

More in Local News

A customer walks away after buying a hot dog from a vendor on 33rd St and Smith Street near the Everett Station on Friday. The Everett Station District Alliance pictures the area east of Broadway and south of Hewitt Avenue as a future neighborhood and transit hub that could absorb expected population growth. (Andy Bronson / The Herald)
How can Everett Station become a vibrant part of city?

A neighborhood alliance focused on long-term revitalization will update the public Tuesday.

Agency didn’t expect such big demand for needle clean-up kits

The Snohomish Health District ran out of supplies quickly, but more are arriving daily.

EvCC teachers take their contract concerns to the board

Their union says negotiations have been disappointingly slow. The community college isn’t commenting.

Here’s what to do if you want to vote and aren’t registered

Oct. 30 is the deadline for new-voter registration in time for the November election.

Two teens struck by truck in Lynnwood

The teens, between the ages of 14 and 16, were taken to the hospital as a precaution.

Luring attempt reported in Mountlake Terrace

The driver allegedly instructed a boy to get in the truck and help grab a scooter he was giving away.

Injured hiker rescued near Granite Falls

Woman fell and hit her head on a rock Saturday, and her condition worsened overnight.

Council passes six-month moratorium on safe injection sites

Proposal by County Councilman Nate Nehring passed unanimously.

Man arrested after police find van full of drugs, cash and guns

An officer on patrol noticed a vehicle by itself in the middle of a WinCo parking lot at 2 a.m.

Most Read