Friday, March 23, 2012

Obesity and Radical Prostatectomy

This post is based purely on anecdotal reports, but I think it bears sharing. This may change how you think of your health and (I hope) increase your motivation to lose fat (if you are one of the 2/3 of Americans who are overweight or obese).

A young woman I know who is on her way into medical school next fall has been shadowing a surgeon on his rounds and in the O.R. over the last couple of weeks. The surgeon has performed several prostate surgeries in that time, ranging from biopsies to full removal of the gland and the associated tumor tissue (radical prostatectomy).

Among the many risks and side effects of a radical prostatectomy include (all quotes are from WebMD):
  • Sexual impotence - "About half of men are able to regain some of their ability to have erections.3 But this takes time. It can take as little as 3 months. But for most men, it will be 6 months to a year.4"
  • Urinary incontinence -  "Up to half of all men who have a radical prostatectomy develop urinary incontinence, ranging from a need to wear urinary incontinence pads to occasional dribbling. Studies show that one year later, between 15% and 50% of men report urinary problems.5"
  • Additional issues - "Damage to the urethra," "damage to the rectum."  "The same general risks as other major operations, including heart problems, blood clots, allergic reaction to anesthesia, blood loss, and infection of the wound."
Once of the ways modern medicine has tried to reduce these risks and outcomes is through nerve-sparing surgery. The hope is to preserve as much nerve function as possible so that these men do not become impotent or suffer from urinary incontinence. Outcomes are better with this approach, but still not ideal.

And this brings me to the point of this post. After seeing several "normal" men (i.e., overweight, and mostly with intra-abdominal fat) get this procedure, with the attempt to spare as much nerve tissue as possible, she saw the same procedure performed on a man with very low bodyfat, probably 6-8%.

With the prior men the surgeons literally had to dig through yellow adipose tissue to find the prostate, and then identifying and preserving the nerves was difficult, but with the low-bodyfat patient there was no significant adipose tissue to dig through, the nerves were easily identified and marked, and in all likelihood, he will suffer none of the negative side effects.

The moral of this story is that if you are a man, about 1 in 6 will be diagnosed with prostate cancer during our lifetimes, but only 1 in 36 men die from the disease. Since this is now a disease that most men will live with, who wants to live those years with impotence and wearing an adult diaper?

We reduce the risk of that outcome significantly simply by being in good, healthy shape, which means regular exercise and healthy diet. It's not too much to ask, is it, if it will allow you a better quality of life? 

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