Dr. David Samadi reviews how men with low-risk prostate cancer may be choosing the wrong treatment for preserving sexual function

Dr. David Samadi looks at recent findings from a study showing preference for preserving sexual function did not reflect the treatment choices of men with low-risk prostate cancer.

Men who are given a diagnosis of prostate cancer should always ask two questions – how aggressive is my cancer and two, what are my treatment options? Many men may already be doing this but according to a recent study published in the Journal of the National Cancer Institute, found that for men with low-risk prostate cancer and who have a good chance of preserving their sexual functioning, did not always choose the best treatment option for this.

“When men first learn they have prostate cancer, it can be a time of high-stress and confusion,” said Dr. David Samadi.  “All they know is they want the cancer removed as soon as possible which could lead to snap decisions being made without considering the consequences.  For men who have early-stage, low-risk, slow-growing prostate cancer, one excellent option is active surveillance.  This is the best option that will preserve the patient’s quality of life including their sexual functioning.  Unfortunately, this may not be communicated very well between the patient and his doctor to where the patient may end up having a more invasive treatment that can be effective but also could lead to poor outcomes in sexual functioning.”

When it comes to treating men with early-stage prostate cancer, there are multiple options with similar advantages but can vary in terms of their impact on quality of life.  These options include surgery, radiation, and active surveillance. Surgery and radiation can have side effects interfering with a man’s sexual functioning.  To preserve a man’s sexual function, active surveillance is the best option but what was not known was if patient preference affects treatment selection.  The aim of this study was to identify patients who had a strong preference in preserving sexual functioning and if that preference was reflected in the choice of treatment each man with low-risk prostate cancer ultimately chose. 

Researchers at the University of North Carolina Lineberger Comprehensive Cancer Center conducted a survey of almost 1,200 men with prostate cancer with more than half (52.6 percent) indicating that preserving sexual function was “very important.”  Out of the 1,200 men, 568 men were identified as having low-risk prostate cancer and who would benefit the most by choosing active surveillance to best preserve their sexual functioning.  

“What was very surprising to the researchers was that out of the group of men with low-risk prostate cancer, only 43.4 percent went with active surveillance as their treatment option,” exclaimed Dr. Samadi.  “Active surveillance is a very good way to go for men who have prostate cancer in its earliest stage.  It basically involves monitoring the cancer closely by possibly preforming a prostate specific antigen blood test (PSA) and a digital rectal exam either every six months or yearly.  Since there are no invasive procedures such as radiation or surgery being done, a man’s ability to have sex would be preserved with no side effects.  I would still see these men on an ongoing, regular basis actively surveying their cancer situation looking for any changes in a man’s symptoms.  If any changes do arise, then we would decide from there if another course of treatment should be considered.” 

Dr. Samadi went on to explain, “What the results of this study indicate is that many men with low-risk prostate cancer may not have known about active surveillance as an option.  Choosing surgery or radiation, which are more aggressive treatments, can have side effects such as sexual dysfunction or reduced urinary function.  This is why it is important for men to speak up with what their priorities in choosing a treatment option.  In addition, I as a physician, can help them sort out what options will best retain sexual functioning and quality of life.

Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi, for a free phone consultation and to learn more about prostate cancer risk, call 212-365-5000.