Surgery

Candidates: Any man up to approximately age 75 if he is in good health, has a life expectancy of at least ten more years, and there is no evidence of cancer outside the prostate. Many cardiac and other serious medical conditions make men ineligible for surgical treatment.

Chance of cure: Good, if the cancer has not spread beyond the prostate.

Convenience: Highly inconvenient in that it involves major surgery with anesthesia and several weeks of recuperation.

Sexual side effects: Rate of impotence 40 to 90 percent depending on the man's age and whether nerve sparing is possible. Maximum impotence immediately after surgery, then may slowly improve for two years or longer.

Urinary side effects: High rate of incontinence immediately after surgery, then usually improves. Use of pads after two years is 5 to 10 percent. Occasional urinary stricture.

Bowel side effects: Minimal.

Other side effects: Weakness and risk of blood clotting (thrombosis) following surgery.

Follow-up treatment if needed: Beam radiation and hormone therapy commonly used. Seed radiation not possible.

Uncertainties: Less worry than any other treatment. Surgery provides accurate information on the cell type, size, and margins of the tumor and whether the cancer has spread to the lymph nodes, seminal vesicles, and other organs. Post-op PSA is an accurate indicator of recurrence.

Unknowns: The possibility that the cancer has spread beyond the prostate, not detected at surgery.

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