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Side effects of radical prostatectomy

PaulOct2021
Offline

I'm confused by what seems to be a big difference between NHS Direct and CRUK on the side effects from a radical prostatectomy. I've copied and pasted the key information at the very end and it shows:-

Incontinence

NHS Direct. Pre-operation1%, six months after the operation 46%

CRUK. Pre-operation 39%, six months after the operation 71%

Erectile Dysfunction

NHS Direct. Pre-operation 33%, six months after the operation 88%

CRUK. Pre-operation 29%, six months after the operation 66%

The information for six years after the operation is more difficult to compare, but NHS Direct shows a clear likelihood of continuing side effects, whilst CRUK suggests that after six years the risk of problems is the same for active surveillance and radical prostatectomy.

My Gleason score is 3 + 3, but a recent scan showed an area of possible concern, so I will be having a biopsy under general anaesthetic in early November. When I speak to my consultant about the results of the biopsy I want to be able to make an informed decision, but I'm confused by different reports of the side effects and some clarification would be greatly appreciated.  

NHS Direct

A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.

Before having any treatment, 67% of men said they could get erections firm enough for intercourse.

When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.

When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.

Cancer Research UK

The table below shows the risk of some of the side effects after 6 months of treatment for low risk localised prostate cancer

 

Active surveillance

Surgery to remove the prostate

External beam radiotherapy

Difficulty controlling your bladder

39 out of 100 (39%)

71 out of 100 (71%)

38 out of 100 (38%)

Difficulty getting an erection

29 out of 100 (29%)

66 out of 100 (66%)

48 out of 100 (48%)

Problems controlling your bowels

2 out of 100 (2%)

1 out of 100 (1%)

5 out of 100 (5%)

The risk of the same side effects after 6 years of treatment is similar between the different treatment groups. 

  • Hello Paul and thanks for posting, 

    I have been in touch with the team who write the patient information part of our website (About Cancer) to get some clarification for you. They have told me that the numbers we give are taken from the NICE (National Institute for Health and Care Excellence) prostate cancer guidelines. These were published in 2019 and are referenced at the bottom of our webpage about treatment decisions  where this information sits. In the guidance NICE says that these number were drawn form a large UK trial.

    I noticed that the NHS website  refers to a recent trial, but I didn't spot any reference for it, so if it pre-dates the NICE guidelines or the trial that NICE refers to, this could account for the variation. The NHS web page is dated 2018. 

    These sorts of figures can vary depending on the way each problem is defined and assessed.  It is probably best to find out what your surgeon thinks and ask them if they have any data of their own.

    In the mean time the team that write our information are looking into this too and will change the information on our website if necessary. 

    I hope this helps. 

    Best wishes, 

    Julia 

  • Offline in reply to CRUK Nurse Julia

    Hi Julia

    Many thanks for a prompt and helpful reply. It is quite disconcerting that depending upon which of two of the main sources of information on radical prostatectomy I look at I could come to quite different views about the likelihood of suffering significant side effects. I would much prefer to speak to my consultant confident that I already have good information about side effects, then the limited time I have with him can focus on the specifics of my case.

    I see that the NHS page was last reviewed in June 2018 and a review was due in June 2021. Perhaps I will be lucky and there will shortly be a revised version available, though the current stress on the NHS doesn't exactly leave me feeling optimistic about that. I will also keep an eye on the CRUK and see if there is any change in the information.

    Thanks again

    Paul

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