Sex or survival: trade-offs between quality and quantity of life.

TLDR

Localized prostate cancer can be treated with surgery or radiotherapy, with surgery often considered to confer higher survival yet associated with a higher rate of sexual impotence. The study assessed how men value survival versus sexual potency when asked to trade one for the other. Using a treatment‑choice technique, 50 men aged 45–70 without known prostate cancer were interviewed. Among 50 men, 32% refused to trade any survival benefit while 68% were willing to sacrifice a 10% or greater 5‑year survival advantage for sexual potency, with a median trade of 10% (range 0–80%) and willingness linked to education level, indicating that some men may opt for lower survival to preserve potency and underscoring the need for thorough discussion of both treatment options.

Abstract

Patients with localized prostate cancer may be treated with either surgery (radical prostatectomy) or radiotherapy. Although controversial, many physicians believe that surgery offers a higher survival rate. However, the surgical treatment may also produce a higher rate of sexual impotency. Our study assessed how men value survival and sexual potency when asked to trade off one for the other. Using the treatment-choice technique, we interviewed 50 men aged 45 to 70 years without known prostate cancer. At hypothetical rates of survival (90% at 5 years for surgery) and impotency (90% for surgery and 40% for radiotherapy) representing published estimates, 32% of respondents were unwilling to trade off any survival, but 68% were willing to trade off a 10% or greater advantage in 5-year survival (by choosing radiotherapy) to maintain sexual potency. The median 5-year survival traded off was 10% (range, 0% to 80%). Willingness to trade off survival for sexual potency was significantly related to level of education, but not to age, interest in sex, frequency of sexual intercourse, or ability to achieve erection. We conclude that some men may choose treatment with lower long-term survival to increase their chance of remaining sexually potent. Because these men may be difficult to identify in clinical practice, physicians should thoroughly discuss both surgery and radiotherapy options with patients who have localized prostate cancer.