Don't count out men who have not recovered urinary and erectile function at 12 months after radical prostatectomy.
Ottawa-Don't count out men who have not recovered urinary function (UF) and erectile function (EF) at 12 months after radical prostatectomy (RP).
That’s because there is still a reasonable opportunity for these men to recover UF and EF, according to data presented at the Canadian Urological Association annual meeting in Ottawa.
"Radical prostatectomy remains one of the most common treatments for localized prostate cancer, but unfortunately both urinary incontinence and erectile dysfunction are significant side effects that cause significant burden on quality of life. Physicians often assume and tell their patients that there is little chance of recovery after 12 months following RP if they have not achieved function within this time frame," said Justin K. Lee, MD, of Memorial Sloan Kettering Cancer Center (MSKCC) in New York.
Studies in the literature have shown that there is little improvement beyond the 12-month mark post RP, but these studies have largely provided average scores and recovery rates relative to baseline function for all patients, explained Dr. Lee. "These studies mainly looked at patients’ pre-operative, baseline function, while our focus was men who had (erectile and urinary) dysfunction at 12 months," he said.
Keeping consistent with the findings from the literature, Dr. Lee and co-authors hypothesized that there would be little chance of recovery beyond 12 months if patients had not achieved function at 1 year.
The authors looked at 2,537 patients who underwent RP over a 6-year period at MSKCC, a tertiary care facility, excluding men who had pre-operative urinary incontinence and erectile dysfunction (ED). They provided self-reported scores of UF and EF at 12 months and subsequently.
Good EF was defined by an International Index of Erectile Function score of 22 or more, with a possible score up to 30, and good UF was defined by a validated urinary questionnaire score of 17 or more, with a possible score up to 21.
They found 629 men and 897 had failed to achieve good UF and EF, respectively, at 1 year after surgery. They found there was increasing probability of reaching good UF at 24, 36, and 48 months (33%, 49%, and 61%, respectively). They also used pad-free status as an outcome for UF and found decreased probabilities of UF recovery, but observed a similar upward trend at the same points in time (29%, 40%, and 47%, respectively). Patients who reported ED at 12 months also were observed as having gradually increasing probability of EF recovery at 24, 36, and 48 months (21%, 32%, and 42%, respectively).
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The investigators found, to their surprise, no difference in rates of UF and EF recovery based on age.
"Men with urinary incontinence or erectile dysfunction at 12 months have a higher than anticipated rate of recovery despite being dysfunctional at 12 months. We can use this information for counselling patients in the post-operative setting," said Dr. Lee.
Whether recovery of UF and EF are attributable to natural history or reflective of multi-disciplinary care offered patients who undergo RP at MSKCC is a question that needs to be explored in future research, said Dr. Lee, noting patients are recommended to take phosphodiesterase-type-5 inhibitors early on after surgery as part of the multi-disciplinary care they receive at MSKCC. Biases of patients’ responses also need to be explored.
"We are looking to see how our survivorship care influences the results. We don't have it captured in our database who took PDE-5 inhibitors and who was on ICI (intracavernous injections). We are starting to capture that information," said Dr. Lee.
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