How should urologists counsel prostate cancer patients?

The most important thing is to convey realistic expectations. I tell all the patients who come to see me the same thing: Don’t base your decision [on which treatment to opt for] on sexual function. After three years, the outcomes from all the procedures are the same. Patients need to make an informed decision.

If they don’t know what questions to ask and the physician doesn’t bring up sexual function, they’re going to make an ill-informed decision. Every day I have a man sit in front of me with tremendous regret—with tears in his eyes—who tells me, “If I had known it was going to be like this, I would have never opted for that treatment.” Such patients weren’t given realistic expectations.

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It takes 18-24 months for most men to reach maximal recovery of sexual function after radical prostatectomy. The problem is that if patients are told they will recover [sexual function] in six months and erections haven’t come back after nine months, they get depressed and stop doing anything [sexual].

Another consequence of unrealistic expectations is demonstrated in a European paper that was published earlier this year and looked at satisfaction with open vs. robotic-assisted prostatectomy. Satisfaction was lower with the robot because patients undergoing robotic prostatectomy are given unrealistic expectations, and their urinary and sexual outcomes are no better than with the non-robotic laparoscopic or open approach.