Marcus, et. al report 36% of men who have undergone RP experience incontinence during sex. Dr. Herbert Lepor, Chairman of NYU Dept. of Urology recommends patients be counseled before surgery.

Medicare records show that men treated with Proton Beam Therapy had one third more bowel problems such as bleeding and blockages than men treated with conventional radiation. This from the American Society of Clinical Oncology and 2 other cancer groups.

England’s Alan Doherty, MD is a pioneer in Laparoscopic RP techniques, gets funneled referrals from the British National Health Service, and has done over 1100 cases. He has added to the growing number of reports that traditional open RP is associated with fewer problems with incontinence and ED than the newer and sexier minimally invasive approaches. He now counsels his patients that Minimally Invasive Approaches may get a man back to normal activities sooner, but there is a cost in increased risks of complications.

Memorial Sloan-Kettering Cancer Center in New York (a world leader in cancer therapy) reports that only 13% of men with penetration-sufficient erections before surgery had penetration-sufficient erections after surgery without some type of ED therapy (pills, penile injection therapy, etc.). This is especially true for men over 60 years old. They suggest being wary of promises by some surgeons of up to 90% potency postoperatively.

Men with T1 and T2 cancers who elected to have Radical Prostatectomy (RP), External Beam Radiation Therapy (RT), and Brachytherapy (BT) at “State of the Art” cancer treatment centers. At 2 years, men potent before treatment had ED as follows:

RP: 52%
RT: 42%
BT: 37%

Lesson: Beware statistics quoted by local docs of unrealistic expectations of maintained potency.

http://www.telegraph.co.uk/health/healthnews/9206425/New-treatment-for-prostate-cancer-gives-perfect-results-for-nine-in-ten-men-research

Copy the link to read accolades for focal (partial gland) HIFU therapy. Mark Emberton in England, where HIFU is covered by the National Health Service, is showing that treating only the part of the prostate with the cancer effectively controls the tumor with little to no risk for erectile dysfunction, incontinence, or strictures. We can similarly treat cancers, targeting only the quadrant known to have tumor involvement.

If a man is under 65 with Low Risk prostate cancer, he should strongly consider treatment rather than surveillance.

At the 2010 American Urology Ass’n Meeting (5/10), Bankhead reported a 70% increased risk of hip fractures in men treated with External Beam Radiation Therapy. The fractures occurred only in areas of the hips exposed to the radiation, not in unradiated bones.