By: Dan Sperling, MD
Over two years ago, I filed away an article from the New York Times that got my attention—but as my practice grew, I didn’t think about it. I recently ran across it, and in revisiting it I found I had to agree with the writer, Tara Parker-Pope.[i] (The writer is the editor of the NYT Well blog.)
Ms. Parker-Pope interviewed patients and surgeons on the reality of erectile dysfunction after radical prostatectomy. Not only did she want the numbers, she wanted to know how the patients felt and thought. From the physician perspective, she was curious about how honest doctors were with their patients. In short, what’s the real story when you get right down to it?
She opens her article with a quote from a 51-year old former patient: “I had surgery by a doctor who said 98 percent of my patients are perfectly fine. Of course, I wasn’t perfectly fine.” This must have been a rude awakening. Patients understand that no doctor can give an iron-clad, 100% guarantee of cure without side effects. Still, a figure like 98% will influence a man’s expectations and hopes despite ample information on the internet that it’s reasonable to expect at least temporary ED after radical prostatectomy. Removing a prostate surgically requires manipulating those nerves away from the surgical margins; this can cause some trauma, and it may take those tiny nerves some time to recover.
It appears that Ms. Parker-Pope was inspired to investigate the human reality after the Journal of the American Medical Association published research on 1000 RP patients. Only half were able to achieve erections two years after their surgery. The author writes, “Yet, for years, men facing prostate cancer surgery have been reassured by their doctors, who could cite studies in prominent medical journals, that their sex lives would be just fine after treatment. Doctors would often boast of sexual recovery rates in excess of 90 percent, but failed to disclose that those numbers applied to a select group of patients rather than to most men who walked in the door.”
Ms. Parker-Pope interviewed the senior author of the JAMA study, Dr. Martin G. Sanda. It is his philosophy that men should have full disclosure and the chance to make their own decisions based on honest numbers. Do men want the facts? According to Dr. Sanda, “I probably lose some patients because someone else is promising them the moon, but more often than not, I find that couples appreciate the transparency and honesty…You don’t want the man to forgo effective treatment for cancer because of a fear of sexual side effects. The discussion needs to be linked with talking about what’s available to help keep them sexually active.”
Our MRI-guided focal laser ablation treatment has a very low risk of any side effects, because it’s so precise and because we make every effort to protect the urethra and to avoid the delicate nerve bundles. However, we know we can’t promise patients the moon. Everyone’s anatomy is a little different, and no two cancers are alike. Even so, we know that we are offering a safe and effective treatment that can preserve a man’s lifestyle without burning any future bridges. It’s my professional goal to expand focal laser ablation so it’s available to all patients who qualify for this alternative to RP.
[i] Parker-Pope, Tara. “The Side Effects? Well, There Is One…” New York Times, Sep. 24, 2011.