But a new study finds that counseling helped married men and women figure out what sorts of treatments for erectile dysfunction worked for them and how to incorporate those methods during sex. In doing so, they returned some luster to their love lives.

via Couples Counseling Boosts Sex Lives After Prostate Cancer.

Couples often have a hard time dealing with the emotional and physical changes after prostate cancer surgery.  There are ways to help men have erections after surgery if oral medicines are not working.

I try to bring up the need to have erections and the impact on the couple at most visits.  This article states counseling for couples if sexual function is important is helpful as well.

via Statins During Radiotherapy for High-Risk Prostate Cancer Improve Outcomes – Renal and Urology News.

Statins are medicines that are taken to lower cholesterol.  Many studies have shown they are beneficial in preventing heart disease and many diseases.  Some experts believe that these medicines help prevent prostate  cancer and this study shows that patients with HIGH risk prostate cancer receiving radiation therapy had a better result when they were on statins.

Incontinence during sex is a long-lasting problem for roughly one in eight men who have had their prostate removed due to cancer, a study of more than 1,400 patients has found.

via After prostate surgery, some men leak during sex | Reuters.

This article describes that some men will have loss of urine during sexual intercourse.  This usually happens during climax.  The article refers to this problem as climacturia.  I have seen men that recover normal erectile function, but have this problem of leaking urine during intercourse.  It usually improves with time but not always.  I have not kept accurate statistics on this problem, but have a feeling that it is less with robotic surgery for my patients.

Among patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a PSA level of 20 ng per milliliter or less, the use of short-term ADT for 4 months before and during radiotherapy was associated with significantly decreased disease-specific mortality and increased overall survival. According to post hoc risk analysis, the benefit was mainly seen in intermediate-risk, but not low-risk, men. Funded by the National Cancer Institute; RTOG 94-08 ClinicalTrials.gov number, NCT00002597.

via Radiotherapy and Short-Term Androgen Deprivation for Localized Prostate Cancer — NEJM.

This study revealed a reduction in overall survival at 10 years and disease-specific mortality at 10 years.  Patients studied were low and moderate risk prostate cancer patients receiving radiotherapy as definitive therapy.

Only the moderate risk patients were shown to have a benefit.

Additionally, real-time integrated video and communications systems from Black Diamond Video will place Saint Clare’s in the company of renowned health care organizations with the same technology, such as Cleveland Clinic, Duke, Mass General and Yale, among other select hospitals nationally.

via Saint Clare’s Hospital Celebrates Facility Opening – Hopatcong, NJ Patch.

I have been performing robotic surgery at Saint Clare’s for 5 years.  I am fortunate to work with a dedicated team of nurses and anesthesiologists and my partner, Dr Alex Gelllman when I perform my robotic prostatectomies there.  I was very pleased to learn about the upgrade to the davinci Si platform and the new operating rooms.  This should be a benefit to Dr Gellman’s and I andn our patients.

BOSTON – Massachusetts lawmakers are considering a bill that would give patients the right to have their operations videotaped if they pay for it.

The measure would let licensed medical videographers tape the procedures. They would not have to be in the operating room at the time. A copy of the surgery would be given to the hospital for its records. Hospitals that refused would face a $10,000 fine.

The bill is scheduled for a Statehouse hearing Tuesday before the Public Health Committee.

Another bill set to be heard at the same time would create a special commission to investigate the use of robotic surgery in Massachusetts and develop a training protocol.

via Mass. bill would allow videotaping of surgeries – BostonHerald.com.

Two interesting bills are going to be voted on in Massachusetts according to this article.

The first would allow the taping of any surgery.  This would be paid for by the patient.  I have given patients videos of their robotic surgeries when they are recorded and come out OK on the DVD.  I also have had relatives of patients in the operating room at certain times, but I think most surgeons would not support this bill.

Surgery is rarely a “perfect” with fluid and bleeding obscuring view.  I do not think a lay person would be able to understand and would be concerned about the implications in a malpractice case.  I would recommend these videos by non-admissible in any legal proceedings, although I would be open to allowing expert witnesses testify to what they saw.

The second case involves the training and credentialing of robotic surgery.  I am very interested to see why robotic surgery is different than other forms of surgery.  In my opinion, laparoscopic surgery was harder to learn originally than robotic surgery is today and this was never subjected to additional legislation.

I do think that the individual medical societies that the surgeons participate in and hospitals that have robotic systems have specific training protocols which should try to be standardized.

INTERPRETATION: 6 months of neoadjuvant androgen deprivation combined radiotherapy is an effective treatment option for locally advanced prostate cancer, particularly in men without nodal metastases or pre-existing metabolic comorbidities that could be exacerbated by prolonged androgen deprivation.

via Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial..

This study shows that men that are undergoing radiation therapy for prostate cancer had a benefit by adding 6 months of hormonal therapy compared to no hormonal therapy.

ScienceDaily (Mar. 25, 2011) — Men with high-risk prostate cancer who take statin drugs commonly used to lower cholesterol while receiving radiation therapy are less likely to have their cancer return than patients who do not take these medications, according to a study published in the March issue of the International Journal of Radiation Oncology•Biology•Physics, an official journal of the American Society for Radiation Oncology (ASTRO).

via Statins make radiation more effective at curing prostate cancer, study suggests.

Statins are a class of cholesterol lowering medicines that have been shown to prevent many diseases including heart disease.

There have been studies that show a benefit in prostate cancer prevention and recurrence rates.

A friend of mine, and in my opinion the world’s leading authority on clinical applications of supplements and medicines for prostate cancer prevention, Dr. Mark Moyad, is in the process at looking at statins in patients on active surveillance for prostate cancer to see if it will slow the progression of disease in these patients.

Acting on anecdotal evidence, Dr. Nelson and his co-authors, Peter Scardino, MD, and John P. Mulhall, MD, assessed the erectile function of 250 men average age, 59±8 years pre- and post-radical prostatectomy. Of the men with baseline erectile function scores ≥24 mild to no dysfunction, about one-third 32% regained function; however, well over half 60% required medication to do so. Only 13% of men reporting mild to no dysfunction prior to prostatectomy reported returning to full baseline function at 24 months without medication.

via Better patient counseling needed on post-RP erectile function – - UrologyTimes.

This study from Memorial Sloan Kettering points out that it is important to explain to patients that the ability to achieve an erection  is less after surgery.   Many factors account for a patients ability to recover erectile function including, age, preoperative function, sexual activity, the type of nerve sparing that can be performed (based on the amount of cancer), skill of the surgeon, type of surgery (open vs. robotic), and other factors.

I try to give an estimate of the probability of the ability to get erections after surgery with and without PDE5 medicines (viagra, levitra, cialis) for each patient.