March 6, 2000 (Mill Valley, Calif.) -- Frank Luton was in his mid-40s whenhe had to make a harrowing choice. During a routine physical examination,Luton's doctor discovered a hard spot in his prostate -- a lump that proved tobe malignant. Luton opted to have his prostate removed, even though he knewthere was a chance the surgery could leave him impotent and incontinent.

Today, at age 57, the former corporate executive from Stone Mountain, Ga.,is alive and well and traveling the world as a business consultant. But just ashe feared, the operation that saved his life left him incontinent for the firstsix months and permanently impotent. He now uses a penile implant to restoresexual functioning.

Doctors have long known that both impotence and incontinence can result fromprostate cancer surgery. Unfortunately, a recent study suggests that theseconsequences may be more common than previously thought. A report in theJanuary 19, 2000 issue of the Journal of the American MedicalAssociation detailing the Prostate Cancer Outcomes Study indicated that59.9% of men studied were impotent and 8.4% were incontinent for at least 18months after surgery.

"Impotence as a result of radical prostatectomy is a much larger problemthan is often quoted in the media," says Janet L. Stanford, Ph.D., of theFred Hutchinson Cancer Research Center in Seattle and co-author of the study.Indeed, impotence was common even when doctors used new surgical techniquesdesigned to spare nerves near the prostate that control urine flow anderections.

The study looked at 1,291 men, aged 39 to 79, who had surgery within sixmonths of their prostate cancer diagnosis. Based on the extent of the cancer,patients received one of three procedures: non-nerve sparing, unilateralnerve-sparing (which tries to minimally disturb nerves on one side), orbilateral nerve-sparing (which tries to avoid nerve damage on both sides of thegland). Nerve-sparing surgery might be expected to reduce the rate of impotenceas a side effect. Yet in the study the rates didn't vary dramatically: 65.6%after non-nerve sparing, 58.6% after unilateral, and 56.0% after bilateralnerve-sparing procedures.

"It was a surprise to see that the rates of impotence among menreceiving nerve-sparing versus non-nerve sparing surgery were not thatdifferent," comments Barry Kramer, M.D., an oncologist and deputy directorfor the division of cancer prevention at the National Cancer Institute inWashington, D.C.

Surgery isn't the only treatment for prostate cancer, of course. Otherapproaches include radiation, chemotherapy, or even "watchful waiting"-- postponing treatment and monitoring for changes. "While the treatmentdecision is up to the patient, the dominant factor is ultimately what treatmentwill cure the cancer," says LaMar McGinnis, senior medical consultant forthe American Cancer Society (ACS) and a surgeon himself. He points out thatwhile radiation therapy leads to survival outcomes approximately equal tosurgery, many men feel more confident having the prostate gland removed.Despite the troubling risk of impotence and incontinence, 71.5% of men in theProstate Cancer Outcomes Study reported they would choose radical prostatectomyagain.