Prostate cancer: Common GP questions

Prof Henry Woo

writer

Prof Henry Woo

Urological Surgeon; Professor of Surgery and Discipline of Surgery, Head, Sydney Adventist Hospital Clinical School, University of Sydney; Director, Uro-Oncology, Professor, Robotic Cancer Surgery, Chris O’Brien Lifehouse

Prof Henry Woo

Urological surgeon Professor Henry Woo answers common questions that GPs have about prostatectomy

What do you tell patients about the likelihood of problems with urinary control after prostatectomy?

When it comes to urinary incontinence, I think it’s important to set patients expectations appropriately.

The vast majority of men are going to experience urinary incontinence after their radical prostatectomy—however, the vast majority of these men are going to recover over time.

The typical time for recovery is around six months. They do need to prepare themselves for the possibility that it might take a little longer, and also for that small possibility that it may not recover at all.

How do you counsel men who are concerned about whether erectile function is going to recover after a radical prostatectomy?

These men need to consider this in the context of their age, as to whether a nerve sparing radical prostatectomy could be performed or not, and also their pre-existing level of erectile function prior to the operation.

Now, as men, you could argue it’s our destiny that we’re all going to lose our erectile function if we live long enough, and when you think of the prevalence being around 60% for men aged in their 60s and 70% for men aged in their 70s, these men are very much in the age group where not all men are going to see it recover irrespective of what their pre-treatment state was.

The mainstay of penile rehabilitation involves the use of a mechanical device, such as a vacuum constriction device, which needs to be used on a regular basis, as well as PDE-5inhibitors, which include tadalafil and sildenafil, and that can be used either on a continuous or an on demand dosing schedule.

The first six months is probably the most critical time and given that it is not uncommon to see penile atrophy occur during that period of time and once penile atrophy sets in, it is something that cannot be reversed. So penile rehabilitation for penile health after surgery is essential for those men where it is of concern.

How do we know whether radiotherapy or prostatectomy will be the more appropriate treatment?

I think it’s very important to recognise that there isn’t any data that indicates that either surgery or radiotherapy is a superior treatment for localised prostate cancer. Now, having said that, the adverse event profile does differ between the two approaches. And what it really comes down to is the manner in which the adverse effects sit comfortably with the patient who’s considering the two options.

How can GPs advise patients who are choosing between radiotherapy and surgery?

Some patients find themselves in a dilemma as to whether they should have radiotherapy or if they should have surgery, and by that stage, they’ve often had opinions from both a urological surgeon as well as a radiation oncologist.
The best way to guide these patients is to assist them to consider what issues are of particular concern to them…
Now it is going to be different for each patient, but the key thing is, of course, to help the patient identify what is it that is most important for them.

What is the role of PSA testing and MRI?

We’ve moved away from looking at PSA being a diagnostic test for prostate cancer because it certainly isn’t—what PSA is being used primarily as is a risk assessment tool as to whether any further investigations ought to be undertaken.
MRI has now emerged as an essential investigation to be performed before making a decision about whether or not to take a man to a prostate biopsy. MRI scans help us identify more clinically significant prostate cancers, and at the same time, reduce the risk of us identifying clinically insignificant cancers.

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Prof Henry Woo

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Prof Henry Woo

Urological Surgeon; Professor of Surgery and Discipline of Surgery, Head, Sydney Adventist Hospital Clinical School, University of Sydney; Director, Uro-Oncology, Professor, Robotic Cancer Surgery, Chris O’Brien Lifehouse

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