Prostate Cancer / What's New
Decision-making in localized prostate cancer: Quality of life issues
Men with localized prostate cancer may have effective treatment with several different approaches. Although long term (7 year) comparisons of surgical treatment versus radiation (seeds; interstitial brachytherapy) have indicated that better control of cancer occurs after surgery (Polascik et al., Urology 51:884, 1998), many men are concerned about the risks of surgery on their quality of life.
Seed (interstitial radiation; brachytherapy) treatment carries significant risks of impotence and incontinence. A study of all Medicare patients who underwent brachytherapy demonstrated that at least 6.6% of men required subsequent treatment for incontinence (Benoit et al., Urology 55:91, 2000.) Actuarial analysis of men after seed implantation showed that 29% of men had a decrease in sexual function one year after implantation, with a 39% decrease after two years (Stock et al., Int'l Journal Radiation Oncology Biology & Physics 35:267, 1996.) Previous studies in men who underwent external beam radiotherapy have suggested that a progressive decrease in sexual function occurs after radiation, whereas men after radical prostatectomy have improved sexual function over time (Schlegel & Walsh, in Current Problems in Infertility and Impotence, Chapter 47, 1990.
Seed implantation remains an important treatment option for older men with localized cancer, where the risks of less effective treatment are limited due to the concomitant presence of other medical problems - i.e., control of cancer without cure may be adequate. At Cornell, further information on seed implantation is available from Dr. M. Mendel Shemtov; call (212) 746-54xx to schedule a consultation. For younger men, 15-30 year data on the effectiveness of seed implantation for cancer cure is lacking. Based on the higher recurrence rates after interstitial radiation compared to surgery at 7 years, it would seem prudent to recommend surgery for younger men with localized prostate cancer.
Results of men treated in the general community suggest that a higher proportion of patients with prostate cancer will not have normal return of urinary control or erections, as would be expected at Centers of Excellence for the surgical treatment of prostate cancer (Stanford et al., JAMA 283:354, 2000.) These findings highlight the importance of learning more about your surgeon before considering radical prostatectomy as the best treatment for localized prostate cancer.
The Cornell Urology surgeons have been leaders in development of improved techniques of nerve-sparing radical prostatectomy, a technique developed to minimize the effect of surgery on subsequent quality of life, especially sexual and urinary function. Basic components of the anatomy of the pelvis were clarified and implementation of new techniques to minimize complications were developed by surgeons now at New York Presbyterian Hospital (Schlegel & Walsh, Annals of Surgery 208:145, 1988.) This has resulted in establishment of prostate cancer care as a Center of Excellence at Cornell. It is not unusual for major medical centers like Cornell to have better results for treatment of complicated or involved disease processes than what would be expected in the general community.
Patients who have heart attacks, require major operations or have other treatments requiring specialized care tend to have fewer complications and higher success rates when treated at Centers that perform a high number of those procedures/treat many patients. Although more patients with prostate cancer are treated at New York Presbyterian Hospital than at any other medical institution in the New York area, our professional staff caters to each individual patient to assure that their specific medical considerations and needs are provided for. For more information on a urologist who specializes in treatment of prostate cancer at Cornell, please click below.
Peter N. Schlegel, M.D.
E. Darracott Vaughan, M.D.
M. Mendel Shemtov, M.D.
Neil H. Bander, M.D.
