Urological surgeon Professor Henry Woo answers the most common questions that GPs have in relation to post-prostatectomy patients ahead of his lecture at Healthed’s 16 August webcast.

Q: How likely is it that a patient will recover their urinary control and erectile function after prostatectomy?

Some of the common questions that GPs ask me about patients in their post radical prostatectomy recovery phase are often to do with the functional recovery, more so than the actual cancer outcome. And naturally, patients are very concerned as to whether they’re urinary control or if their erectile function is going to recover.

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 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 it might take a little longer, and also for that small possibility that it may not recover at all.

When it comes to counselling men about erectile function 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, in men you could argue that it’s our destiny that we’re all going to lose our erectile function if we live long enough. The prevalence is 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 the 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-5 inhibitors, which include tadalafil and sildenafil. And that can be used either on a continuous or on an on-demand dosing schedule. The first six months is probably the most critical time.

It is not uncommon to see penile atrophy occur during that period of time. Once penile atrophy sets in, it is something that cannot be reversed. So, rehabilitation for penile health after surgery is an essential for those men where it is of concern.

“When it comes to urinary incontinence, I think it’s important to set patients expectations appropriately.” – Professor Woo, urological surgeon

Q: When do we know that radiotherapy for prostate cancer is the better option as compared to prostatectomy?

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.

Register here to attend Professor Woo’s 16 August webcast.

Q: If a patient comes to us and asks us for advice as to which path to go down, radiotherapy versus surgery, how do we help them make that decision?

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. Now, the best way to guide these patients is to assist the patient in considering what are the issues that are of particular concern to them. And this could include inputs from experiences of others that they know and what they observed and also, as to whether particular side effects may be of critical importance to them. Now, it’s going to be different for each patient. And, but the key thing is, of course, to help the patient identify what is it that is most important for them.

Q: Is prostate MRI superior to PSA?

The diagnostic pathway for prostate cancer has evolved significantly over the last 10 years. We’ve moved away from looking at PSA as 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. Now, MRI has now emerged as an essential investigation to be performed before making a decision about whether to take a prostate biopsy or not. MRI scans help us identify more clinically significant prostate cancers and at the same time, reduce the risk of us identifying clinically insignificant cancers.

Professor Henry Woo is a urological surgeon at the Sydney Adventist Hospital Clinical School of the University of Sydney. He is also Director of Uro-Oncology and Professor of Robotic Cancer Surgery at the Chris O’Brien Lifehouse.

Register here to attend Professor Woo’s 16 August webcast.

Watch the video of Prof Woo’s Q&A above below: