Prostate removal or radiation therapy to treat cancer is tied to a two- to
four-fold higher than usual risk of later having a hernia repaired, according to
a new study.
It's not clear why hernia repairs are more common among these men.
There might be tissue damage caused by the cancer treatment, or perhaps
doctors are finding hernias that might otherwise go undetected, said Dr Stephen
Pautler, a urologist at St Joseph's Health Care in London, Ontario, Canada.
"You're looking for this in this population," said Pautler, who was not part
of the study. "These men are being actively treated for prostate cancer, so
they're more in tune with the health system and their providers are picking up
Whether this is leading to over treatment of hernias that could be left alone
A hernia is a bulge of tissue, such as the intestine, pushing through a weak
spot in the abdominal wall. Surgery to close the hole is the only treatment.
There are various types of hernias, and the researchers, led by Dr Hanna
Nilsson at Umea University in Sweden, included femoral and inguinal hernias,
which both occur in the groin, in their analysis.
They collected medical information from a Swedish national database on more
than 28 000 men who had been treated for prostate cancer between 1998 and
Among them, nearly 15 000 had their prostate removed with standard open
surgery, another 4 650 had their prostate removed in a minimally invasive
surgery and about 9 000 men had radiation treatment. The research team compared
the number of hernia procedures among these men to 105 000 men who did not have
Six years after the cancer treatment, 14% of men who had open surgery, 10%
who had the minimally invasive surgery and 8% who went through radiation ended
up having a hernia repaired.
In comparison, just 4% of the men who did not have prostate cancer received a
hernia repair, the researchers report in the Annals of Surgery.
The results translate to a four-fold higher likelihood of hernia repair among
men who had open prostate surgery and a two-fold higher risk with radiation
therapy. Pautler said some of the differences might be explained by the damage
done to tissue during surgery.
A real phenomenon
"Surgery increases the risk. I think that's a real phenomenon," he told
Reuters Health. He said he doesn't know why men who received radiation were also
at an increased risk of a hernia repair, but that it might be explained by
additional hernia diagnoses. "The increased detection could also account for some
of the additional hernia repairs among men who had prostate removal surgery,"
It's possible that a man could have a hernia without symptoms and that
wouldn't otherwise receive treatment unless doctors are deliberately
scrutinising the groin. One concern, then, is that the additional hernia repairs
among men with prostate cancer might represent unnecessary surgeries. "Over
treatment is something that does happen and it burdens patients and the
healthcare system. We have to be cautious," said Pautler.
"On the other hand, if a man has a symptomatic hernia, it's quite wise to
have it repaired."Physicians have raised concerns that prostate cancer itself is
being over treated. The US Preventive Services Task Force recommends against
routine cancer screening through a prostate-specific antigen (PSA) test, because
the evidence shows little benefit compared to the "significant potential harms"
of procedures, prompted by PSA results, that don't save lives.
Pautler said that without definitively knowing the causes, it's difficult to
say how to mitigate the increased risk of a hernia among men with prostate
cancer. Opting for minimally invasive surgery might be one route; men who had
this type of surgery were 18% less likely to have a hernia repair than the men
who had their prostate removed by a larger incision.
Pautler said men can also discuss with their doctors the need for hernia
repair. One study of 1 700 men published last year found that some men can avoid
hernia surgery -- without any untoward health effects -- by watchful waiting.
"I think there has to be an open discussion with the healthcare providers.
Just because it exists doesn't mean it has to be fixed," he said.