Risks of Surgery
The biggest risk is having surgery when it is not necessary. Only harm can result when there is nothing to gain. Unfortunately, it is never known if a man really receives any benefit. Research in progress will at least show if surgery can improve survival for men at specific clinical stages of disease.
As with any major surgery, death during the procedure is possible, although rare (1 to 20 out of 1,000). It is usually related to the general anesthetic or to a cardiovascular complication. Other serious nonfatal post-operative complications may occur in about 4 to 7 out of every 100 procedures. These include cardiovascular events, thromboembolisms, and serious infections. They are more common at older ages, especially over 70. Permanent rectal injuries may also occur in about 3 out of 100 procedures.
The most common and troubling harms of surgery, however, have to do with two basic bodily functions -- the ability to control one's bladder and to have sex. There is a good possibility of suffering at least some erectile dysfunction (impotence) or urinary incontinence as a result of the surgery.
Erectile problems are almost inevitable unless a nerve-sparing technique is successfully used. Whether or not this technique can be used, however, is usually not known going into the surgery. It depends on the location and characteristics of the tumor that are found during surgery. There is a chance that a planned nerve-sparing approach will have to be converted into the more damaging wide excision during the procedure to make sure that the entire tumor is removed.
Of all men who have adequate erectile function prior to surgery, regardless of age or stage, over half can expect some erectile difficulties after surgery. The range of probability is about 25 to 85 out of 100 men experiencing problems. Younger (under 60), healthy men who have nerve-sparing surgery have the best chance of maintaining sexual function -- about 75 out of 100 will regain sexual function although it may take a year. The chance of having persisting erectile problems increases with age and the extent of disease. But, there are medical and surgical treatments available to induce erections, and erectile difficulties do not interfere with libido or the sensation of orgasm.
Between 20 and 63 out of 100 men will require pads or clamps following surgery to control urinary dripping. For most it is mild, requiring no more than one protective pad per day. For some there is “stress incontinence”, the inability to control urine under stress (e.g., physical exertion, laughing, sneezing, etc); this may occur in about 10 out of 100. Severe incontinence, necessitating continuous wearing of protective pads, is unusual, occurring in about 1 to 7 out of 100 cases. Some men (perhaps 5 in 100) eventually require surgery to correct their urinary difficulties. Nerve-sparing surgery may reduce the likelihood of mild incontinence in younger men to about 10 out of 100.
Urethral strictures, which require at least one procedure to dilate the urethra, may develop due to scar tissue formation in about 10 to 20 out of every 100 cases. This causes the urethra to narrow, and makes urination more difficult.
There is also the chance that surgery will not remove all of the cancer. Surgeons can never be completely sure that they were able remove all of the cancerous cells. The chance of some cancer cells being missed and the recurring in men who thought it had all been removed during surgery is about 20 to 30 out of 100. Those whose tumors are not fully removed with surgery require further treatment with radiation or chemotherapy.
