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Journal of Urology highlights that even after men are made aware of the risks of prostatectomy they still have unrealistic expectations

A study to be published in August 2011 suggests that men are undergoing prostate cancer surgery with unrealistic expectations regarding their recovery of urinary control and sexual function, in spite of getting “the facts” in counselling sessions.

“Men have unrealistic expectations of urinary and sexual function after prostatectomy despite preoperative counseling,” says the study available online from the Journal of Urology.

Researchers recruited men who were scheduled to have a radical prostatectomy between June 2007 and November 2008. These men were given extensive counselling about the usual outcomes, including information about the statistical risk of incontinence and erectile dysfunction.

Then these men filled out a questionnaire before they had surgery (but after having received counselling). The questions asked them about what they expected in terms of their urinary, bowel, and sexual function at one year after the surgery. Of the men, 36 percent expected that, one year after surgery, they would have the same urinary control as before surgery, and 40 percent thought they would have the same sexual function. Surprisingly, even after counselling, some men expected to have better urinary and sexual function a year after surgery, 12 percent and 17 percent, respectively. This belief, says lead researcher Daniela Wittmann of the University of Michigan, is “out of step with reality.”

When the men completed a survey a year after surgery, 47 percent had attained lower than expected urinary control and 44 percent lower than expected sexual function.

The researchers speculate that the same “psychological mechanisms” that can help men heal—emotions such as optimism, for example—may be the cause of these unrealistic expectations.

“We can only [inform men] in terms of overall statistics; we can’t predict for the individual man, which means that, if in doubt, people tend toward being hopeful and optimistic,” Wittmann says.

Commenting on this study, Tracey Krupski of the University of Virginia suggests that support networks can really help new cancer patients facing these treatment side effects. Often, men need this support to approach their doctors with questions about these worrying but non-life-threatening side effects. And, if no treatment is effective or possible, a support network can help men adjust to the “new normal.”

According to Wittmann, involving the partners of men with prostate cancer is fundamental in counselling and in helping men cope with the realities of life after surgery.

“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 says.

See the new PCCN pages on coping with urinary incontinence and erectile dysfunction after prostate cancer treatment.


Dianiela Wittmann and colleagues, 2011, Patient preoperative expectations of urinary, bowel, hormonal, and sexual functioning do not match actual outcomes 1 year after radical prostatectomy, Journal of Urology, vol. 186, no. 2, 494–499.

Article from http://www.prostatecancer.ca/PCCN.aspx

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---Dr. H. Ballentine Carter
of Johns Hopkins

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MPH, Department of Urology, University of California at San Francisco