Life after prostate surgery worse than men expect

Nearly half of men who undergo surgery for prostate cancer find that life after the surgery is worse than they expect, with less sexual function and greater incontinence problems than they anticipated, according to a poll.

Before the surgery, some men in the study, published in the Journal of Urology, had expected to have better urinary and sexual function a year after the surgery than before it -- a belief that researchers, led by Daniela Wittmann at the University of Michigan, said was out of step with reality.

"Men have unrealistic expectations of urinary and sexual function after prostatectomy despite preoperative counselling," Wittmann and her colleagues wrote.

As part of the survey, 152 men undergoing radical prostatectomy filled out a questionnaire before they had surgery but after they had received counselling on the risks of the procedure. The questions asked about their expectations of urinary, bowel and sexual function a year after the surgery.

About half the men expected the same function after surgery than before, but 17 per cent anticipated better sexual function after the surgery.

On a follow-up survey one year later, just 36 per cent of the men said their expectations for urinary function matched the true outcomes, and 40 per cent said their expectations for sexual function matched reality.

Wittmann, the sexual health coordinator at the urology department at the University of Michigan, noted that it's hard to predict how likely a patient is to recover urinary and sexual function.

"We can only (inform them) in terms of overall statistics, we can't predict for the individual man, which means that, if in doubt, people tend towards being hopeful and optimistic," she said.

Recent studies have showed than only about one in four men recovered the ability to have intercourse one year after surgery, and that some degree of incontinence was common, although men tended not to be significantly bothered by it.

Tracey Krupski of the University of Virginia, who wrote an editorial published with the study, said that men's unrealistic expectations can be double-edged sword.

Optimism is known to help people heal, but on the other side, "it may ultimately lead to disappointment when adjusting to a long-term disability."

Krupski said that a support network may help new cancer patients understand the realities of life after surgery, while Wittmann said that involving patients' partners is also vital to successfully regaining sexual relationships.

"Sex is a partnered activity for most people. The partner can be very effective as part of an intimate team recovering from the side effects of this surgery," she said.

The study did not examine whether men would make a different treatment decision given their hindsight after the surgery, but Wittmann said she thinks only a small proportion would choose not to have surgery, given the cancer-related risks.