New research gives men with early-stage prostate cancer a way to estimate their chances of keeping sexual function after treatment. The study involved about 1,000 men. They were given a questionnaire before and after treatment. The questionnaire was fairly accurate in predicting post-treatment sexual function. In men who had surgery, it was 77% accurate. In those who had radiation, it was 90% accurate. The odds of sexual function varied widely. For example, between 53% and 92% of men who had standard radiation maintained their sexual function. A man's specific odds depended upon his prostate-specific antigen (PSA) level and whether he also had hormone therapy. The findings may help men get an idea of what to expect after treatment. The study was published in the Journal of the American Medical Association. The Associated Press wrote about it September 20.

What Is the Doctor's Reaction?

For some cancers, the treatment options are few. Also, the factors that influence decision-making are more straightforward.

This is certainly not true for prostate cancer. Many factors influence treatment choices. They include:

  • Age

  • Overall health and life expectancy. In general, if life expectancy from the time of prostate cancer diagnosis is fewer than 10 years, quality of life is usually better without specific treatment.

  • The stage of cancer

  • How aggressive the cancer appears under the microscope

There is also the choice of no immediate treatment. This is what doctors call watchful waiting. Watchful waiting is not a "do nothing" strategy. It is a decision to actively monitor the activity of the prostate cancer. Most men die with prostate cancer, rather than because of prostate cancer. So watchful waiting can be a wise treatment decision for many men.

For men who do choose to have treatment of prostate cancer, there are three main options:

  • Surgery

  • External radiation -- radiation delivered a machine that aims the rays at the prostate gland

  • Radiation seeds – small radioactive pellets placed directly into the prostate gland

Each has side effects, such as urinary incontinence and inability to maintain an erection (erectile dysfunction, or ED for short).

In today's issue of the Journal of the American Medical Association, researchers report the results of a study that provide an average risk of ED from the three treatment options. However, treatment was only one factor that determined if a man might have erectile dysfunction after surgery. The other important factors included whether the man had ED prior to prostate cancer treatment, the patient's age and the blood level of prostate specific antigen (PSA). Higher PSA levels often indicate more advanced disease.

For this study, erectile dysfunction was defined as an inability to maintain an erection firm enough for sexual intercourse.

Men, even otherwise healthy men, commonly experience erectile dysfunction. Surveys have shown that up to 20% of men ages 50 to 59 report ED. In men ages 70 to 75, approximately 35% report ED. In this study, more than 25% of the men with prostate cancer reported ED prior to starting any treatment.

The researchers focused their attention on the men who said they had firm enough erections for intercourse prior to prostate cancer treatment. Similar to other studies, surgery was the most likely to cause ED. Sixty percent of men with no sexual problem prior to surgery did have ED 2 years after surgery. For men that received external radiation, ED occurred in 42%. For men that had radioactive seeds, it was 37%.

The extent of surgery and whether nerve-sparing prostate surgery was used made some difference in the risk of ED.

What Changes Can I Make Now?

Celebrities often encourage men to get a blood test for PSA to screen for prostate cancer. But PSA testing can be misleading. Most high PSA results are not caused by prostate cancer. And men with a normal PSA can have a very aggressive type of prostate cancer.

So even before men reach a point of choosing therapy, they first need to decide if they want to have the PSA test done.

For 50-year-old men at average risk of prostate cancer who have a life expectancy of greater than 10 years, screening is a reasonable choice if they answer "yes" to these two questions:

  • Are you willing to proceed with a prostate biopsy if PSA or digital rectal exam indicates the possibility of prostate cancer?

  • Would you accept treatment based upon the result of the biopsy?

African-American men and men with a family history of early age prostate cancer have a higher risk of prostate cancer and prostate cancer death. I advise screening starting at an earlier age, usually 45.

There are some things you can do to possibly reduce your risk of prostate cancer:

  • Eat a diet rich in fruits and vegetables. Broccoli and Brussels sprouts may have some special advantages.

  • Eat minimal amounts of animal fats.

  • Don't char meats on the grill.

  • Maintain a healthy weight.

  • Exercise regularly.

Even if none of these turn out to decrease prostate cancer risk, they decrease your risk of heart attack, stroke and potentially other types of cancer.

What Can I Expect Looking to the Future?

This study provided an average risk of ED after the different types of prostate cancer treatment. But it is important for men to know that the risk of ED after treatment varied considerably.

So, the choice for any individual man is only partially influenced by the numbers. How important is sexual activity for you? And other side effects made be even more important. For example, would you be devastated if you developed urinary incontinence?

This study did not look at men that opted for watchful waiting, with no immediate treatment of their prostate cancer. Always ask your doctor if this is a reasonable option for you.

Last Annual Review Date: 2011-09-21 Copyright: Harvard Health Publication

Reference: Cancer section on Better Medicine

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