Male prostate cancer surgery patients are not getting what they expect…

In this brief and interesting Medscape video lecture, Dr. Gerald Chodak discusses the relevance of new research addressing men’s expectations following prostate surgery. 152 patients who had received extensive preoperative counseling regarding prostate surgery and expected outcomes completed a survey prior to and one year following their surgery. The surveys asked for responses about incontinence, bowel and sexual function, among other variables.

At one year following surgery, 47% and 44% of the men reported having lower than expected function for urinary incontinence and sexual function, respectively. The researchers report surprise that 12-17% of the men expected better than baseline urinary and sexual function following surgery. The study concludes that “Men have unrealistic expectations of…function after prostatectomy despite preoperative counseling.” The study also hypothesizes possible psychological causes for this reaction.

We have all met patients who are frustrated with post-surgical outcomes when their expectations are not achieved. These patients can sometimes be so frustrated that it may impair the ability to “move on” and focus on the level of function or healing that is available. It may be that we have opportunities to work with these men on a pre-operative basis, and it may be helpful for us to discuss the follow-up issues, if only for the patient to air any concerns and be directed towards the physician with any significant concerns.

Surgeons are often quick to remind patients that the goal of surgery is to “save lives, not preserve sexual function.” Some physicians focus on nerve-sparing techniques to minimize injury to the pelvic muscle function. Regardless of the surgeon’s approach, the patient may be interested in discussing the outcomes and the implications of the outcomes with his pelvic rehab professional. This research demonstrates that there is an important discrepancy between patient’s expectations and the outcomes.