ProceduresUrogenital

WHY DO MEN REGRET PROSTATE SURGERY?

Men with prostate cancer frequently feel that if the tumor is completely removed surgically there’s a real good chance it is gone for good and a cure is possible. That’s why many men when offered surgery, opt for radical prostatectomy as definitive treatment. The old adage among surgeons that “a chance to cut is a chance to cure” certainly applies here.

The problem with this decision is you don’t know what you’re getting until you get it. You don’t know what your life will be like after you’ve had a radical prostatectomy—until you’ve had a radical prostatectomy. The cancer is gone, but in place of the malignancy, where once was a prostate, the patient now has an empty space, that causes urinary problems and sexual problems, galore! Prior to the development of Nerve-Sparing Robotic-Assisted Radical Prostatectomy, these two problems were very common, and to a lesser degree, they still are. They are unavoidable results of removing the structure that helps control emptying the bladder. As a result, the outcome after prostatectomy often isn’t what the patient expected, and patients express a lot of regret and dissatisfaction with their surgery.

Since this is a common occurrence, researchers looked in to how frequently men regret having the operation. A blurb in the January 4, 2022 issue of JAMA piqued my interest. The bottom line stated that “men who underwent surgery….were significantly more likely to experience regret than those who received active surveillance.” In their report, 16% of the patients who had surgery regretted their decision. I think people who have open heart surgery regret it immediately 100% of the time, but with time, healing, and rehab, they begin feeling much better and regret fades. 

After prostatectomy, however, urinary leakage, the loss of urinary control, erectile dysfunction, and abnormal ejaculation occur, but do not get better. The patient, then, is left to live with these problems for the long term. That’s not easy to do. Sexual dysfunction is the biggest complaint and tops the list of the predictors of treatment-related regret.

Other studies looked at the same problems and all found high rates of treatment regret. When there’s a 40% chance of ED after surgery, and patients know it in advance, the reality of it leads to regret, and the doubting of one’s own judgement. In a study of 1651 patients who had prostate cancer discovered via screening, there was overall 11% dissatisfaction with the treatment received. But for those who chose radical prostatectomy, 32% of patients were dissatisfied and regretted surgery. In this case, it was urinary function problems that led to dissatisfaction. Radical prostatectomy is an operation with a high rate of regret. Pre-op counseling to manage patients’ expectations is essential to reducing regret.

Dr. G’s Opinion: I can’t think of any other surgeries that patients routinely regret having. In most cases, regret occurs when you have an unexpected, bad outcome or result. The operation didn’t go well for some reason. The difference with prostatectomy, however, is that ED and urinary incontinence are expected results that occur quite frequently, and often don’t go away. But if the patient knows to expect this ahead of time, regrets (and lawsuits) can be avoided.

References: News from the JAMA Network. “Some men with Localized Prostate Cancer Regret Surgery.” JAMA 2022 Jan 4;327(1):26.

Kocarek J, et al. Robotic-assisted radical prostatectomy-results of 1500 surgeries. Rozhi Chir 2017 Winter;96(2):75-81.

Resnick MJ, et al. Factors associated with satisfaction with prostate cancer care: results from Cancer of The prostate Strategic Urologic Research Endeavor. BJU int. 2013Feb;111(2):213-20.

Faiena, Patel N, Seftel AD. Prevention of erectile dysfunction after radiotherapy for prostate cancer. Asian J Androl 2014 Nov-Dec;16(6):805-6.

Carvalhal GF, et al. Correlates of dissatsfaction with treatment in patients with prostate cancer diagnosed through screening J Urol 1999 July;182(1):113-118.

Romanzini AE, et al. Predictors of well-being and quality of life in men who underwent radical prostatectomy: longitudinal study. Rev Lat Am Enfermagem 2018 Sep 3;26:e3031

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