I have long said that prostate cancer surgery is a PROCESS, not a one-time event. RP doesn’t end when the anesthesia wears off. You are likely to have problems that need further attention, such as impotence or incontinence, even if it’s temporary. And of course you will need a doctor who will follow you for signs of recurrence. Careful monitoring of PSA and periodic DREs are a must.
Keep this in mind when interviewing potential surgeons. Ask about their accessibility after surgery. Unfortunately, there are some “cut and run” types who will leave you on your own to cope with nasty side-effects.
I believe the medical profession has not addressed the issue of follow-up care for RP patients adequately. So I was pleased as punch to receive in my daily mail an abstract of a study done at the Yale University School of Nursing called:“Follow Up of Men Post-Prostatectomy: Who is Responsible?” (Yale Univ. School of Nursing, November 13, 2008.)http://www.urotoday.com/index.php?option=com_content&task=view_ua&id=2218600
Finally, they’re asking the right question
Here is how the researchers framed the problem:
“Men living with prostate cancer represent a large, at-risk population deserving access to comprehensive follow-up services stemming from chronic aspects of living with the disease. Current research about the quality and accessibility of prostate cancer follow-up services is limited.”
The purpose of the Yale study was to “describe the patient, provider, and health plan characteristics speculated to influence prostate cancer follow-up care.”
The researchers found a lot of deficiencies in the follow-up care of post-RP patients, among them a lack of coordination among doctors and duplication (of PSA tests, for example), even though all of the men were seen by urologist. And there were many chronic, untreated side effects:
“All of the men participated in follow-up visits to a cancer care provider (urologist) and were monitored for recurrence by prostate-specific antigen (PSA) testing. Fewer men had rectal examinations performed. For nearly half of the men, the general medical provider duplicated the PSA test, indicating a lack of coordination among providers. Persistent late effects included urinary incontinence (60%) and erectile dysfunction (71.9%). No significant associations were found among patient, provider, and health plan characteristics to their utilization.”
I have to say the “persistent late effects” of incontinence and ED in this population were unusually high. But it confirms that prostatectomy patients need ongoing care and support. (For example, I always recommend that any RP patient who has not recovered erectile function after two months see an ED specialist. At least give “penile rehabilitation” a try).
A major finding of the Yale study was that “nurses can play a major role in providing good follow-up health care for RP patients”:
“Nurses are uniquely positioned to assume a central role in promoting access to comprehensive, non- duplicative post-prostatectomy follow-up care. Additionally, nurses can provide effective counseling, advocacy, and education for men living with prostate cancer.”
Nurses are underestimated and underutilized but they’re part of the solution. So bring on the sisters (and brothers)!
Urol Nurs. 2008 Oct;28(5):370-80.