Sexual consequences of prostate cancer treatment

Your July 2005 issue seems mislabelled. There are indeed sexual consequences of advanced and aggressive prostate cancer, but the tragedy is that the largest part of the epidemic of male sexual depredation is a result of treatment, not disease.

Your issue would better be titled “Severe Sexual Consequences of Aggressive Treatment of Prostate Cancer.”

Offering editorial comment¹ from a urologist is like inviting a logger to discuss the preservation of old-growth forests. The surgeon advises family physicians to explain to patients that they “might experience changes in ejaculation.”

Might? What truthful family physicians will tell their patients is, “This means the end of sex as you know it for almost all men treated. And by the way, as many as four in 10 of you will end up wearing a diaper at least some of the time.”

Then, truthful family physicians will make sure their patients understand that aggressive screening and treatment of prostate cancer might, at best, prolong their lives a few months. (See Tom Pickles’s review of the lack of proven benefit with current therapies.²)

Surely avoiding prostate-specific antigen screening in asymptomatic patients and restricting surgical and radiation interventions to clinically obvious cancers is the plan family physicians providing evidence-based care should follow.