COMMENTARY

Getting Through to Prostatectomy Patients

Gerald Chodak, MD

Disclosures

July 19, 2011

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Hello. I'm Dr. Gerald Chodak for Medscape. In past videos, I've talked about the need to provide better counseling so men can decide which treatment seems right for them. This requires good information about the odds of getting good results and the odds of experiencing side effects or complications. That information should be provided from written questionnaires.

A recent study[1] calls into question how men view this information and whether they really do have realistic expectations about what may happen to them. The study was from the University of Michigan; investigators offered surveys to 648 men undergoing a radical prostatectomy with either an open or robotic method. A total of 152 men agreed to participate and completed both preoperative and 1-year postoperative EPIC [Expanded Prostate Index Composite] surveys.

Researchers asked the men to list their expectations and compare these with the ultimate results achieved. Results are shown in the Table. As you can see, for 36% of men, results matched their expectations for urinary incontinence, and for 40%, results matched their expectations for sexual function. Of note, 17% had better than expected results for incontinence and 15% had better than expected results for sexual function.

Table. Outcomes vs Expectations After Radical Prostatectomy

Outcome Urinary Incontinence Sexual Function
Matched expectations 36% 40%
Results better than expected 17% 15%
Results worse than expected 47% 44%

What is troubling is that 47% of the men actually had worse outcomes than they expected for urinary control or incontinence and 44% had worse sexual function than they expected.

What does this mean? Despite great attempts to provide good preoperative counseling, men are either not hearing that information or they're choosing to ignore it and believe that they are going to have better outcomes than they are being told they might have.

What does this mean for counseling patients going forward? First, it means that men may not be hearing the information in a way that allows them to choose the treatment that is most suited for them. Second, this challenges us to find better ways to conduct preoperative counseling and teaching. Perhaps this means [that preoperatively] men should speak with other men who have experienced this, so that beforehand they have more realistic expectations.

Regardless, some men may decide that this is like being in a lottery and that they will get a better result than they have been told to expect. That may be their way of coping with the stress and anxiety associated with getting this treatment.

Whatever the cause, further work is needed to sort this out so that we accomplish the goal of providing better information, to enable men to make a decision that will be most suited to them. Ultimately, their satisfaction and that of their partners will depend on what they anticipate will happen to them and whether it reflects the eventual results.

This is a challenging problem for us, but it is a challenge that we need to continue to explore so that we do a better job of helping men decide which treatment is right for them. I look forward to your comments. Thank you.

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