Potential Side Effects Of Prostate Removal

Prostate cancer surgery may result in a shortened penis for some patients

(RxWiki News) To treat potentially deadly prostate cancer, the surgical removal of the prostate is sometimes necessary. The procedure can have potential side effects, including a shortened penis.

In a new study, a small percentage of men complained that their penis seemed shorter after having surgery (prostatectomy) to treat their prostate cancer. Those who received radiation therapy alone had no issues with penis size.

"If considering prostate surgery, know the potential side effects."

Paul Nguyen, MD, a radiation oncologist at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) in Boston, led this research together with medical student Ari Parekh.

The authors reviewed 948 surveys completed by physicians who were treating men with prostate cancer that had returned.

Investigators evaluated patients' perceptions of penis size and how this may lead to lowered life satisfaction, problems in emotional relationships and misgivings about the specific type of prostate cancer treatment they chose.

Almost 4 percent of the patients complained of smaller penises following surgery.

Close to 3 percent of those who had radiotherapy plus androgen deprivation therapy (ADT) had the same concern. ADT is a type of hormone therapy that reduces the levels of male hormones (or androgens) in the body.

Those who had radiotherapy alone did not mention any problems regarding penis size. Radiotherapy included both radiation administered by an external x-ray machine and brachytherapy, which is the implantation of radioactive seeds into the prostate.

The research was not based on actual penis measurements, rather patients' perceptions.

“Prostate cancer is one of the few cancers where patients have a choice of therapies, and because of the range of possible side effects, it can be a tough choice,” said Dr. Nguyen. “This study says that when penile shortening does occur, it really does affect patients and their quality of life. It's something we should be discussing up front so that it will help reduce treatment regrets.”

Co-author of the study and surgeon at the University of California, Los Angeles Medical Center, Jim Hu, MD, added that previous research has confirmed that a decrease in penis size can result from prostatectomy.

“This is most common with non-nerve sparing surgery, as this may result in fibrosis [formation of a scar] and atrophy [wasting away] of erectile tissue due to damage to nerve and vascular structures,” Dr. Hu said.

The patients studied had enrolled in a registry called COMPARE that collects data on men whose prostate cancer shows signs of recurring after initial treatment. Of the 948 participating, 22 percent were younger than 60, and the majority were in their 60s, 70s and 80s.

Just over half had undergone surgery to remove their cancerous prostate. About 24 percent received radiation therapy combined with hormone-blocking treatment, and 22 percent had radiation therapy alone.

E. David Crawford, MD, professor of surgery, urology, and radiation oncology, and head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center in Denver, told daily Rx News, "The major complications of local prostate cancer treatments are the two big I's—impotence and incontinence. Improvement in both surgical and radiation techniques have significantly reduced these complications in the past few years. Over the years, I have performed over 3,000 radical prostatectomies, and only rarely did men complain of a shortened penis."

Dr. Crawford, who was not involved with this study, added that his patients avert any penis-size issues through penile rehabilitation, which may involve use of a vacuum erection device to create an erection. "The good news is that, regardless of whether you use this or not, most men report a 'normal size' within 18 months of the surgery," he said.

As far as next steps are concerned, Luc Cormier, MD, PhD, of Dijon University Hospital in France, said in an accompanying editorial comment that “sexual activity needs to be thoroughly measured owing to the obvious relationship with the patients' perception of penile length.”

The study was published in the January issue of the journal Urology. The research was supported by an anonymous family foundation along with other foundation funding.

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Review Date: 
January 7, 2013