Table 1 Modes of communication of major postoperative and post-radiation side effects.
From: Variation in communication of side effects in prostate cancer treatment consultations
Mode of Communication | Frequency (n, %) | Illustrative Quote |
|---|---|---|
Postoperative Erectile Dysfunction | ||
Not mentioned | 6 (15%) | |
Name Only | 10 (25%) | “The other thing that patients notice after surgery is issues with erectile function.” |
Generalization | 9 (22%) | “Sexual function, if you’re coming into it with some issues the likelihood that at 74 you would regain your sexual function from baseline after surgery is pretty low.” |
Average Probability without Timeline | 3 (8%) | “It’s about 33–50% of men will have some form of erectile dysfunction and that can have a various range so not ever guy when I say erectile dysfunction would be flaccid it would mean that some guys would be softer, notice it’s harder to get an erection, need things like Viagra or Cialis to have an erection.” |
Average Probability with Timepoint | 8 (20%) | “The erectile dysfunction is also 100% initially and this takes 12–24 months to get better. It gets better in most patients but in 20%, it doesn’t.” |
Precision Estimate | 4 (10%) | “It is just the erectile function of your penis that can be affected. And the best predictor of how well you’re doing to do in terms of your erectile function after surgery is what you bring to the table beforehand based on your age and based on your erectile function. So you are super-young and your erectile function is excellent… I would say that your likelihood of regaining your baseline function in a year for both continence and erectile function is upwards of like 90%.” “So, it takes about a year to go back to normal [potency]. Now, if you have good erections now -- you’re sixty-two -- the likelihood that you are going to regain your baseline potency is—is pretty high. So, being sixty-two and having perfect erections now, I’d say you’re eighty percent likelihood of getting to that at a year…so my guess is that you’re going to have an earlier recovery of both of these functions than patients who are older. |
Postoperative Urinary Incontinence | ||
Not mentioned | 5 (12%) | |
Name Only | 9 (22%) | “…the broad risks are urinary leakage or incontinence…” |
Generalization | 3 (8%) | “Patients do really well after the surgery functionally, [with] minimal effect on potency and continence.” |
Average Probability without Timepoint | 3 (8%) | “And what I’m telling you is your likelihood of getting back to this level in terms of both continence and potency is about 90%.” |
Average Probability with Timepoint | 19 (48%) | “I look at [urinary incontinence] as a temporary inconvenience because beyond a year about 10% of men need a pad and the rest are totally continent.” |
Precision Estimate | 1 (2%) | “In general the curve looks like this: if you look at all men with prostate cancer in both continence and potency is that this is your baseline, 100% of urinary function, continence or potency. This is 3 months, 6, 9, 12. And this is surgery, okay, baseline. Right after surgery things get worse and then they get drastically better between 3 and 6 months. And then they get a little better up to a year and then it falls off. So the statistics we quote out are here… So it’s less of a decremented function and earlier return to baselines. So these are all averages.” |
Post-Radiation Erectile Dysfunction | ||
Not mentioned | 15 (42%) | |
Name Only | 7 (19%) | “All the radiation options are going to carry a risk of erectile dysfunction.” |
Generalization | 5 (14%) | “Again, your young age and good erectile function would predict you’d do well afterwards.” |
Average Percent Incidence without Timepoint | 8 (22%) | “But I would say, 40% to 50% of men incur some erectile issue as a result of radiation therapy.” |
Average Probability with Timepoint | 1 (3%) | “And the way I describe radiation’s effect on the sexual function is usually what it does is it’s sort of like an acceleration of the aging process. So if you took men that are in the 60, 70-year-old age group and you did nothing to them and you followed them for 15 or 20 years, almost every single one of them would lose their function because it’s just over time, you know, that’s sort of the nature of being a human man is the erectile function gets worse when you get into that 80- or 90-year-old range. And so with radiation, the sexual function, that aging process, I would describe it as accelerated, so if it would’ve taken, you know, a certain amount of time, it can, you know, take less time, so if it would’ve taken 15 years, maybe it takes five or six years or seven years to, you know, sort of accelerate to that place. About two thirds of men, if they have a decrease in function from radiation, they can still respond to medicines like Cialis or Viagra or some of these other medicines.” |
Precision Estimate | Not observed | |
Post-radiation lower urinary tract symptoms | ||
Not mentioned | 8 (22%) | |
Name Only | 17 (47%) | “[Radiation] comes with a little bit of baggage as well, like not incontinence, but it causes, the radiation beam hits the bladder, and it can cause urinary frequency or urgency, waking up at night, those kind of symptoms.” |
Generalization | 5 (14%) | “And the risks of [urinary symptoms] especially with your pre-existing issues with urination are high. And that makes me worry that we treat you and your life will be made worse by the SEs.” |
Average Probability without Timepoint | 3 (8%) | “In most men, especially men with good urinary function, the urinary function comes back pretty close to baseline. There’s about 15 percent of men, one in six roughly, that are going to need some type of medication for urinary function that they didn’t need before.” |
Average Probability with Timepoint | 3 (8%) | “Long term, as we talked about, about 15 or 20 percent of people are going to have just increased irritation of the bladder even after the treatment is done” |
Precision Estimate | 0 (0%) | N/A |
