Gerald Chodak, MD


June 20, 2012

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Hello. I am Dr. Gerald Chodak from Medscape. At the American Urological Association (AUA) in May, a study was presented by Khurana and associates,[1] looking at quality of life in men undergoing active surveillance, prostate seed implants, or radical prostatectomy. The study was well done in that the assessments were done prior to treatment, and then periodically after treatment, up to 2 years.

This is a pilot study, and there are some weaknesses that need to be considered. Nevertheless, the results are interesting and important for men who are going to receive counseling about treatment.

For the men who had active surveillance, there was no significant change in either urinary function or sexual function up to 2 years after their initial enrollment in that treatment. For men who had radical prostatectomy, however, there was a significant decline in both of those areas, and these measures were significantly worse compared with men in the active surveillance group.

For men who had prostate seed implants, the differences at 2 years were not significant compared with the active surveillance group. The concern, however, is that only urinary control and sexual function were assessed, and 2 years may be still too early to know the final outcome of seed implantation.

The bottom line is very important. Way too many men who are undergoing radical prostatectomy are being told, "Well, you may have a little trouble with some sexual function." They are given the impression that there is a high chance that functioning will return to normal, and they may underestimate their risk for problems in both urinary and sexual functioning.

We need to provide better counseling for men who are going to have these therapies so they understand the potential tradeoffs of surgery or seed implantation. For surgery, outcomes are not as good as patients have been led to believe in the past. This is going to depend on many factors, such as the patient population, and maybe most important, on the surgeon who is providing the treatment.

Ultimately, patients would be best served if surgeons maintained their own outcome data and quality-of-life survey data, so these could be reported to patients, and make sure that patients are adequately counseled about the potential risks of that therapy. Unfortunately, I don't think that is going to happen anytime soon, unless insurance companies or someone else makes it a requirement for reimbursement. Until that happens, we have to hope that men keep asking the right questions so that at least they will have a better idea of what to expect after each of the treatment options.

I look forward to your comments. Thank you.


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