What are the side effects doctors don't tell prostate cancer patients?

If you receive a diagnosis of prostate cancer (PCa), you need to know all of the pros and cons of treatment alternatives. But many doctors aren't good at telling PCa patients about the negative side effects of the more invasive or aggressive treatments, such as prostatectomy, radiation, and androgen deprivation. Fortunately, they ARE good at telling other doctors about the drawbacks of these interventions, via articles in professional medical journals and in the urological and oncological press. Here are a few of the many examples I’ve encountered: > Diseases 2025, 13(6), 167 — "The lack of specificity in diagnostic tools results in false positives, leading to unnecessary interventions. … Moreover, economic incentives and the availability of advanced diagnostic technologies further drive overuse. Psychological factors, including fear and anxiety, also play a role in opting for aggressive treatments." > N Engl J Med 2023;388:1547-1558, 11-03-23 — "Active monitoring of prostate cancer has the same high survival rates after 15 years as radiotherapy or surgery. … The negative impacts of radiotherapy and surgery on urinary and sexual function persist … for up to 12 years." > J Clin Oncology, Vol 42, No 4_supp 2024 — "Studies have shown that Gleason scores from biopsies match those from removed prostates only about 45% of the time. This discrepancy means that many men may be undergoing unnecessary surgeries based on inaccurate initial assessments." > J Clin Med, Jan23 — "More than 80% of patients present with localized disease, of these, 15% are at high risk for biochemical recurrence, estimated to be 70% in 5 years. … this group also has … mortality related to prostate cancer with ~85% dying within 10 years. … Most are offered radiotherapy with hormonal therapy, an inadequate … approach associated with significant adverse effects." > Medscape, 11/2023 — "Radiation therapy [has] higher risk of persistent fecal urgency and incontinence of gas, secondary malignancy, and hemorrhagic cystitis. A systematic review of … radiation therapy … was associated with increased odds for a second malignancy of the bladder, colon, and rectum." > World J Mens Health. 2023 Jan;41(1): 129-141 — "… most recoveries to the castrate level happen in the first 2 years, with a minimal increase in recovery at 3 years, and almost no recovery after 36 months. Moreover … more than 25% remain castrated." > SMSNA for Patients, 5/2019 — "But even two years after ADT ends, patients may still struggle with low testosterone … linked to lower bone density, leaving men at higher risk for osteoporosis. Men with low testosterone are also more likely to develop diabetes and heart disease. There are sexual side effects … diminished libido, orgasm difficulties, and erectile dysfunction." > ZERO Prostate Cancer: Hormone Therapy, 2023 — “… some cancer cells grow independently of testosterone and remain unaffected by treatment. … For this reason, hormone therapy can't stop cancer." > BOTTOM LINE: When I was diagnosed with PCa in August 2023, I assumed that doctors would tell me the bad along with the good. Wrong. A full and frank PCa education is a PCa patient’s job.