Q. I am trying to decide between a radical prostatectomy and radioactive seed therapy for my newly diagnosed prostate cancer. All the doctors I’ve consulted say I have very early disease (PSA 4.9, Gleason score 6) and that I should be cured either way. I’m basing my decision on side effects, but I need more information on one thing I learned about on the Internet, penile shortening.
A. I won’t try to advise you about your choice of treatment, since there is no clear answer as to which is best. In addition to the options you’re considering, many men would also consider external beam radiation therapy, and older men might consider deferred treatment or active surveillance.
Penile shortening is a common consequence of the radical prostatectomy operation, but since it’s of minor significance, it’s not usually discussed in detail. The shortening is evident within the first 7 to 10 days after surgery, but even then, it averages less than 4/10 of an inch. Penile length often returns toward normal over the next year, particularly in men who recover erectile function.
It’s wise to consider the pros and cons of each treatment modality. The most important side effects are erectile dysfunction, urinary incontinence, and to a lesser degree, rectal problems. Compared to these, minor penile shortening is less likely to bother most men.
That’s the long and short of it.
— Harvey B. Simon, M.D.
Editor, Harvard Men’s Health Watch