NBC News
updated 1/7/2013 9:46:14 AM ET 2013-01-07T14:46:14

You’re alive. Let’s start there, prostate-cancer survivors. The treatment worked.

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Yes, the surgeon’s fix may have damaged some sensitive bits. Your sex life may require a pump or, worse, injections to a place better left unpoked. But intimacy remains possible. And to reiterate: You are here, breathing and, hopefully, smiling.

OK, prostate-cancer club members, maybe now you’re mentally prepared for a final snippet of bad news: You may be smaller down there than you were pre-surgery or before hormone therapy. As in your length. As in your manhood.

In short, (apologies), a portion of men who underwent treatment for prostate cancer complained that their penises were smaller when they awoke, according to a new study by researchers from Dana-Farber/Brigham and Women’s Cancer Center in Boston.

The average reported loss among the men was one centimeter — or about one third of an inch. But some patients came through surgery missing nearly an inch and a half from their former expanse, a separate study found.

Still smiling, guys?
Better question: Still breathing?

“It can be really hard for some men, especially when they don’t expect it ahead of time. It’s something we doctors almost never talk about,” said Dr. Paul Nguyen, lead researcher for the new study and a radiation oncologist at the Dana Farber Cancer Institute. The findings are published in the January issue of the journal Urology.

“Before treatment, we talk with men about impotence, about problems with urination. But almost never do we get to the point of talking about losing some penile length.

VIDEO: Most men advised to skip routine prostate cancer test (on this page)

“When it does happen to men, it really does impact their lives. It interferes with their ability to form close relationships with others,” Nguyen told NBC News. “For some men, it’s a real psychological issue. They don’t feel as confident about themselves because of the change in their appearance. It affects a lot of guys’ body image, their self image, and leaves them just not feeling like they used to.”

The study was based on surveys completed by the physicians of 948 men who were treated for recurrences of prostate cancer. Among those men, 25 confided to their docs that they’d lost size. All of those 25 men endured prostate-removal surgery or underwent hormone treatment plus radiotherapy. None of the men who had radiation treatment alone said they noticed any shrinkage.

But among those men studied, the actual number who lost length is probably far higher, Nguyen said, because “some guys are shy about talking about it.” And because, possibly, some fellas just never noticed.

“In this study, only about 3 percent spoke up and said this is a problem. Whereas, when you do measurements of people before and after, about 70 percent of people might have a measurable loss,” he added.

Why does this happen? Warning: We have to use a couple of painful verbs here.

“In this surgery, when you remove the prostate, you have to tug on the penis to connect it back to the bladder. That shortens things a bit,” Nguyen said. “Or you get some kind of scarring after the procedure and this kind of reduces the length a little bit.”

What’s more, androgen deprivation therapy (ADT) — used in some men to reduce testosterone to help kill the cancer — might lead to some tightening of the tissue itself, Nguyen theorized.

Not all of the smaller guys were too devastated to talk about it.

“Today, I can do everything I did before. If it’s on a little smaller scale, so what? At least I still have it,” said a 68-year-old man in upstate New York whose doctor treated his prostate cancer last winter with radiation and ADT.

A six-month checkup showed he was cancer free, said the man, who agreed to talk about his condition only if he remained anonymous. (He wasn't sure, though, exactly how much smaller he became).

“The medical outcome could not have been better. But yes, your sex organs shrink. Everything shrinks, there’s no question about it,” he said, describing himself as “a very active guy with a girlfriend.”

Though the thought of such shrinkage may make some men wince, he's actually grateful for all that remains.

“When you get older, if you really want to live, you have to have some courage. You really do. Otherwise, you won’t live, you’ll just fade away,” he said. “If you’re in an intimate relationship with a woman, and you’re a little older and you have some issues with your genitals, you have to have some humor. That’s how you deal with things. That's the only way. And hey, I’m still performing as I did before, so I am not complaining.”

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Video: Most men advised to skip routine PSA tests

  1. Closed captioning of: Most men advised to skip routine PSA tests

    >> controversial recommendation for millions of men. a government panel is advising against screening healthy men for prostate cancer with the psa blood test . they say harm from the widely used test outweighs its benefits. we've got dr. nancy snyderman as nbc's chief medical editor now joining us. how can a simple blood test , a screening blood test , cause harm and outweigh the benefits?

    >> this test was meant to an for antigen, a protein in the prostate gland . years ago, after a man was diagnosed with prostate cancer , if the blood test went up, it might be indicative of the fact that the tumor was spreading. but increasingly it became sort of a simple blood test . get blood drawn, if the number is outside the normal limits you might have a problem. here's the problem with the test, though, it is so sensitive, that in 80% of the cases, it indicates a problem when there might not be a problem at all. and a man may have inflammation or infection or a benign tumor , or even a cancer that's never going to cause problems. and their concern is, it's so widely used, and wrong so often that it shouldn't be used at all.

    >> but on the other hand, some men say this test has saved their lives.

    >> yes.

    >> so where is the -- how do men know what to do

    >> here's the hard part. the preventive task force that came out with these guidelines, they crunched the numbers. they looked at data. and whether they think it's personal or not they looked at the cold, hard facts. does this screening save lives? and their answers were, no it doesn't. but what you will hear from individual men is, wait a minute, that test saved my life. and, yes, you're going to now balance anecdotes and case histories against the bigger population of hundreds of thousands of men. and that's where a lot of the controversy is going to be.

    >> it should be said that the american urological association has called these tests irresponsible. this is the same force that told us mammograms under 50 are not necessary.

    >> let me caution people when the breast cancer stuff came out who jumped in the radiologists and the breast cancer surgeons. now this is the prostate, who jumps in the urologists. yes, do they have a dog in this fight in both cases? yes. i think this one is going to remain controversial. i don't think it's going to change the needle right now. but if you are a healthy man and you have no other issues, don't consider this a perfect screening test .

    >> dr. nancy snyderman . thank you



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