Ranges of Complications
Very real harm can result from prostate cancer treatment, especially surgery. But the range in the probability of suffering any of these complications is large. This is not very reassuring.
Several factors, including age, health, and the expertise of the surgeon, affect the chance of having adverse effects. Young, healthy men treated by experienced surgeons at the best hospitals tend to have the best outcomes. Older men with more co-morbidities treated at hospitals that handle fewer cases tend to have a higher rate of significant adverse effects.
For a particular man, the experience of the surgical team is the key factor. The wide range of probabilities of complications reported in the literature largely reflects the experience of the surgeon, especially with similar men. Many published reports come from institutions and surgeons with the most experience. Their rates of complications may underestimate the rates observed in community settings.
There is also a problem in the reporting of adverse effects. Study results are usually written by treating doctors whose interpretation of the severity of adverse effects might be very different from the men experiencing them.
All of this means that the information about the probability of complications that a man depends on to make a decision about surgery should be specific to the surgeon doing the procedure. It is better to know the risk for each complication that has been experienced by this surgeon rather than to depend on the rates of risks reported by selected medical centers.
Prostate surgery is a technically difficult procedure because of the dense network of blood vessels and nerves in this area. Damage to these is responsible for many urinary and sexual-functioning problems. But developments have been made in surgical techniques that can reduce the damage to these structures. A nerve-sparing approach has been shown to reduce the likelihood of being impotent, but it is not feasible in all situations.
