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Extract

Nerve-Sparing Prostatectomy

The rate of radical prostatectomy increased nearly sixfold between 1984 and 1990, owing in part to reported improvements in postoperative sexual potency after the use of newly developed nerve-sparing procedures. However, nerve-sparing prostatectomy. particularly when unilateral improves postoperative sexual function less than previously thought, according to Talcott et al. (p. 1117). They recommend that nerve-sparing prostatectomy be used judiciously.

The investigators siudied men with early prostate cancer who completed questionaires before surgery and at 3 and 12 months after surgery.

Twelve months after surgery, full potency (adequate for intercourse) was reported by none of 12 who had non-nerve-sparing surgery, none of 18 who had unilateral nerve-sparing surgery, and only four of 19 who had bilateral nerve-sparing surgery. Men who had any nerve-sparing surgery more frequently reported substantial incontinence at 3 months, but not at 12 months, than did those who had non-nerve-sparing surgery.

Estrogen-Progestin Therapy

To counteract the increased risk of endometrial cancer associated with estrogen replacement therapy (ERT), progestins have been added in recent years to ERT, either in sequential fashion for 5–15 days per “month” (sequential estrogen progestin replacement therapy [SEPRT]) or with each ERT dose (continous combined replacement therapy [CCRT]). Pike et al. (p. 1110) report here that SEPRT for less than 10 days is associated with only a slight reduction in the increased risk. However, SEPRT for 10 or more days was associated with virtually complete normalization of risk, as was CCRT.