Why Regret Is So Hard to Measure
Regret isn't a clinical diagnosis you can check off a list. It's a personal, evolving feeling that can intensify or fade over time. Some men regret the surgery immediately due to surgical complications. Others only feel it years later when they realize the trade-offs weren't worth the cancer control they gained. And then there are those who, in hindsight, wonder if they should have chosen active surveillance or radiation instead.
The Role of Expectations
A major factor is what patients expect going in. If a man is told his incontinence will last "a few weeks" but it persists for months or years, disappointment can turn into regret. Similarly, if erectile function doesn't recover despite optimistic preoperative counseling, the psychological impact can be profound. The issue isn't always the surgery itself—it's the gap between hope and outcome.
Timing Matters
Regret often peaks in the first two years after surgery, when men are still adjusting to physical changes and reassessing their decision. But it can also emerge much later, especially if new treatment options become available or if a man develops chronic pain or other long-term complications. That's why follow-up studies track quality of life at multiple intervals—regret isn't static.
What the Research Actually Shows
Large-scale studies paint a nuanced picture. A 2020 analysis of over 2,000 men who had radical prostatectomy found that about 30% reported moderate to severe regret, most commonly linked to urinary incontinence and sexual dysfunction. Another study from the Prostate Cancer Outcomes Study showed that while 90% of men were satisfied with their decision five years later, roughly 40% still experienced significant bother from side effects.
Age and Cancer Risk Influence Regret
Younger men, particularly those under 65, tend to report higher regret rates. Why? They have more years ahead with the side effects, and their pre-surgery sexual function and urinary control were likely better. Conversely, older men with high-risk cancer might feel less regret because the surgery gave them more years of life, even if quality of life is diminished.
Surgeon Experience and Technique Matter
Studies consistently show that surgeons who perform more prostatectomies have better outcomes—fewer complications, faster recovery, and lower regret rates. Nerve-sparing techniques, when appropriate, can preserve erectile function, and newer approaches like robotic-assisted surgery may reduce incontinence risk. But even with the best technique, some degree of side effect is almost inevitable.
The Side Effects That Drive Regret
Two issues dominate: urinary incontinence and erectile dysfunction. Urinary leakage can range from occasional dribble to complete loss of control. For some men, wearing pads becomes a daily reality. Erectile dysfunction after prostatectomy occurs because the nerves controlling erections are intertwined with the tissue removed or damaged during surgery. While some function can return—often over 12 to 24 months—many men never regain their preoperative level.
Other Complications
Less talked about but equally impactful are changes in orgasm sensation, penile shortening, and chronic pelvic pain. Some men also experience urinary tract infections or strictures that require additional procedures. These issues don't always appear immediately and can develop months or years later, adding to long-term regret.
Psychological Impact and Support
The emotional toll is real. Men who valued sexual activity or an active lifestyle before surgery may struggle with identity and self-worth afterward. Depression and anxiety are more common in this group, especially without proper psychological support. Yet many men don't seek counseling because they feel embarrassed or believe they should just "tough it out."
The Role of Partners
Regret isn't just personal—it affects relationships. Partners may also grieve the loss of sexual function or worry about long-term care if incontinence is severe. Couples who communicate openly and seek support together often adapt better. Some find that intimacy evolves into new forms that don't rely on penetrative sex, but that adjustment takes time and effort.
Alternatives to Surgery
Radical prostatectomy isn't the only option. Active surveillance is often chosen for low-risk cancer, avoiding treatment side effects altogether. Radiation therapy, including external beam and brachytherapy, can control cancer with different risk profiles—sometimes fewer urinary issues but potentially more bowel problems. Focal therapies, which target only the tumor, are emerging but remain experimental in many places.
Weighing the Trade-Offs
The decision often comes down to how a man values cancer control versus quality of life. A 50-year-old with a slow-growing tumor might opt for surveillance, while a 65-year-old with aggressive cancer might accept higher regret risk for the chance of cure. There's no universally right choice—only the right choice for that individual's priorities.
Can Regret Be Reduced?
Preparation is key. Men who understand the full range of possible outcomes going in are less likely to feel blindsided. That means honest discussions about incontinence severity, recovery timelines, and the likelihood of permanent erectile dysfunction. Some centers now use decision aids—brochures or videos that walk through scenarios—to ensure patients know what they're signing up for.
Post-Surgery Support
Early physical therapy for pelvic floor muscles can improve incontinence outcomes. Medications, penile rehabilitation (using vacuum pumps or medications like Viagra), and even penile implants can address erectile dysfunction. The earlier these interventions start, the better the chances of recovery. But they require proactive effort and realistic expectations.
Frequently Asked Questions
How common is severe regret after prostatectomy?
Severe regret—where a man wishes he had never had the surgery—is reported by about 10% to 20% of patients in long-term studies. Most others experience some level of disappointment but don't necessarily wish they could undo the surgery.
Does regret decrease over time?
Often, yes. Many men adapt to changes, especially if side effects improve. However, for those with persistent severe incontinence or complete erectile dysfunction, regret can remain stable or even increase, particularly if they feel unprepared for the long-term impact.
Are there ways to predict who will regret the surgery?
Research suggests younger age, higher preoperative sexual function, and unrealistic expectations are risk factors. Men who prioritize sexual and urinary function over absolute cancer control may be more prone to regret. Shared decision-making tools can help identify these concerns early.
The Bottom Line
Regret after prostatectomy is common but not universal. Between one in five and one in two men experience some degree of it, driven mostly by urinary and sexual side effects. The key to minimizing regret is honest, detailed preoperative counseling, choosing an experienced surgeon, and having a clear plan for post-surgery rehabilitation. For some, the trade-off is worth it; for others, it's a lifelong compromise. The only way to know which path is right is to weigh the statistics against your own values—and to go in with your eyes wide open.