Prostate cancer is a slow-growing disease associated with aging, though younger men may develop more aggressive forms. Another process also associated with aging is dementia, which means declining mental and cognitive function. The incidence of both conditions begins to increase from age 65 onward.
The most common treatment recommended for men with low-to-intermediate risk prostate cancer is complete surgical prostate removal, or radical prostatectomy (RP). As with many cancers, the idea of being “cured” by removing the affected organ has a certain psychological reassurance: “Don’t worry, we can get it all out and you never have to think about it again.” The problem is that RP is major surgery, which can include pain, inflammation, numerous medications, psychological stress, and the aftereffects of anesthesia. In other words, surgery is traumatic on the mind and the body, even though it is being done to save life. There is longstanding evidence that surgery and recovery are especially hard on people whose mental function has begun to decline. On the other hand, a 65-year old man who is in otherwise good health may have early signs of declining mental function that have not yet been recognized. One author wrote, “Studies show as many as 81% of patients who meet the criteria for dementia have never had a formal diagnosis, and families may overlook symptoms as just natural age-related memory loss. Patients with dementia are at higher risk for a complication known as postoperative delirium, and are more likely to have worse surgical outcomes, longer hospital stays, functional declines and death.”[i]
New guidelines strongly recommend that every person over age 65 be evaluated for mental fitness. This is not only to assess that the patient understands and agrees to the risks involved with surgery, but also to ensure that he is able to cooperate and participate fully in his recovery. In some cases, the effects of surgery can actually accelerate mental deterioration. Post-surgery patients who are forgetful or prone to confusion may skip or bungle important care instructions. For example, after RP improper catheter care can lead to serious complications at home. A standard, easy to administer mental evaluation can help doctors and family members anticipate how well a patient will be able to participate in his follow-up protocol.
Early signs of dementia
As people age, a certain amount of mental fuzziness is expected. There is often a very fine line between being a little “batty” and manifesting senile dementia. Unless symptoms are frequent or aggravated, it is easy to excuse away forgetfulness or fogginess as the result of stress, fatigue, etc. The early warning signs of dementia include:
- Changes in short-term memory
- Difficulty finding the right words
- Mood changes
- Listlessness (lack of interest in normal activities)
- Difficulty completing normal tasks
- Decline in sense of direction
- Repeating questions or statements
- Difficulty following storylines
- Becoming less adaptable to change
As hospitals embrace evolving standards of care, it is to be hoped that radical prostatectomy is recognized as “medically traumatic” as much as heart or abdominal surgery. Even robotic assisted RP is not a walk in the park; it involves major anesthesia, physical trauma to the urethra and neurovascular bundles, and going home with a catheter. The practice of cognitive evaluation before surgery should be extended to RP patients. And patients should be informed before RP that, as with any surgery, the after effects may include some impact – however temporary – on mental function.
[i] Landro, Laura. “A Mental Test Before Surgery.” Wall Street Journal, Nov. 28, 2016. http://www.wsj.com/articles/a-mental-test-before-surgery-1480352395