Prostatectomy and radiation effects on urinary, bowel and erectile dysfuntion 2, 5 and 15 years after prostate cancer diagnosis

This paper evaluated the long-term influence of prostate cancer treatment with prostatectomy or radiotherapy on urinary, bowel and sexual function. Prostatectomy was associated with a higher rate of urinary and erectile dysfunction, whereas radiotherapy caused more frequent bowel urgency at 2 and 5 years after diagnosis.

Prostate cancer (PC) is a form of cancer that develops in the prostate, a gland only found in men, between the bladder and the penis. How PC is treated depends on its severity. Low risk (confined) cancers are often just observed. Other cancers require surgery such as a prostatectomy (removal of the prostate), or directed external radiotherapy. This involves a radiation beam being targeted at the site of the cancer. However, these procedures can affect the surrounding organs and cause sexual, urinary and bowel dysfunctions.

This paper looks at 1655 men between the ages of 55 and 74 who were diagnosed with prostate cancer between 1994 and 1995. 1164 of these men were treated with prostatectomy and 491 men with radiotherapy. Urinary, bowel and sexual dysfunction were assessed at 2, 5 and 15 years after PC diagnosis.

Results of this study show that patients who had a prostatectomy were more likely to have urinary and erectile dysfunction than those treated with radiotherapy 2 and 5 years after their treatment. However, they were less likely to have bowel problems compared to men treated with radiotherapy. 15 years after cancer was diagnosed there was no difference seen in urinary, erectile or bowel dysfunction between the two treatments. 

In conclusion, men undergoing prostatectomy or radiotherapy for confined PC had declines in all functional outcomes throughout early, intermediate and long-term follow-up. 

The study is however limited by the lack of a “control group”, meaning comparison to healthy (cancer-free) men.