Prospective longitudinal comparative study of long-term urinary and sexual function after primary surgical treatment for localized prostate cancer.

Abstract

Introduction: We aimed to prospectively and independently assess real world outcomes of Australian mens' urinary and sexual function following retropubic (RRP), laparoscopic (LRP) and robotic assisted (RARP) radical prostatectomy surgery for localized prostate cancer Methods: From 2009 to 2012 men with localized prostate cancer undergoing surgery by one of fourteen study urologists working across eight private-sector sites were included in the study. Patients were consented for the study and data was collected by self-reported questionnaires prospectively at 3,6,12,18 and 24 months by researchers independent of treating urologists. Urinary and sexual function data were obtained using EPIC, SHIM and IPSS questionnaires. Results: Overall 1005 men were recruited with the study participation rate of 79.2%, with 836 men having completed surveys at each follow-up (Table 1). At 24 months follow up the median EPIC urinary and sexual summary scores were at 95.6 and 47.4% of baseline respectively. The rate of erectile function preservation at 24 months in men with good erectile function preoperatively (SHIM≥ 20) was 27% for the entire cohort. On multivariable cox regression model (including age, Gleason score, prostate volume, preoperative SHIM score, surgical modality), age (OR 0.94 95% CI (0.91-0.97); p=0.001), preoperative erectile function (OR 1.26 95% CI (1.14-.41); p<0.001) and laparoscopic approach (OR 0.23 95% CI (0.09-0.60); p=0.002) were predictors of good erectile function at 24 months. Conclusions: Surgical therapy for localized prostate cancer provides excellent long-term urinary function as measured by EPIC urinary summary score in our series. Long-term sexual function was less preserved as demonstrated by 24 months EPIC sexual summary score. The rate of sexual function preservation for men with good pre-existing sexual function treated by surgical therapy in this real world prospective independently collected community based study is far lower than previously reported by tertiary referral centres. Pre-existing erectile function, age and modality of surgery impact the final long-term sexual function. The impact of surgeons' training and experience are likely to be important determiners of long-term sexual function and will be addressed in future studies.