The debilitating side effects of prostate cancer treatment must be one of the world’s worst kept secrets. But physicians still struggle to communicate this clearly to their patients when they are making treatment decisions. This is according to a journal article published last week in the Journal of Prostatic Cancer and Prostatic Diseases looking at initial prostate cancer treatment consultations.

More than half of the physicians at a top US hospital either didn’t mention risks of erectile dysfunction and/or urinary issues, mentioned them in name only or in broad generalisations, whether they were describing surgical or radiation treatment.

Doctors not talking about urine control problems

Consultation about urine effects

In the radical prostatectomy cases studied, 12% of doctors didn’t even mention the risk of urinary incontinence after surgery. A further 22% mentioned it in name only, and another 8% only gave broad generalizations. And example of the generalizations’ noted: “Patients do really well after the surgery functionally, [with] minimal effect on potency and continence.”

For those preparing their patients for radiation treatment, 22% didn’t mention the risk of lower urinary tract problems at all and a further 47% mentioned it in name only. Only 3% of these physicians gave their patients details, including average probability data for post-treatment urinary issues and an estimate of the duration of these problems.

Doctors not talking about erectile dysfunction (ED)

For the radical prostatectomy patients, 15% of doctors didn’t mention the chance of ED, another 25% mentioned it in name only, and another 22% relied on broad generalizations. In the case of radiation patients, fully 42% of doctors didn’t mention risks of ED (which tend to rise over time after radiation), 19% mentioned it in name only and another 14% relied on generalizations, for example “your young age and good erectile function would predict you’d do well afterwards.”

Conclusion: doctors, tell your patients directly about side effects of prostate cancer treatment

Effective communication of treatment side effects was often omitted, not quantified, and/or lacked a timeline in treatment consultations in our sample. Physicians should articulate, quantify, and assign a timeline for treatment side effects to optimize shared decision-making with patients – Daskivich et al (2024) J. Prostate Cancer and Prostatic Diseases

The authors say it all! This adds current data to the discussion on navigating awkwardness and taboos around sexual matters.

The problem is systemic, and we shouldn’t simply blame doctors. My doctor actually told me more than I remembered afterwards – I simply didn’t take it in! I look forward to publication of my December 2023 address to the Institute of Psychosexual Medicine supporting systemic change, and outlining ways to overcome the barriers and taboos stopping clear discussion about these side effects.

Editor’s note March 2024: my article Assumptions and Taboos: breaking down barriers to men’s sexual health and relationships has now been published in the Institute of Psychosexual Medicine Journal, no 83, pages 10-14  Please contact me if you want to read the article and are having trouble accessing it at the IPM Journal site.