Article

5-Year Urinary and Sexual Outcomes After Radical Prostatectomy: Results From the Prostate Cancer Outcomes Study

Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA.
The Journal of urology (Impact Factor: 3.75). 06/2008; 179(5 Suppl):S40-4. DOI: 10.1016/j.juro.2008.03.136
Source: PubMed

ABSTRACT Prior studies of postoperative outcomes following radical prostatectomy have been limited by selection bias and short-term followup. In this study we assessed temporal changes in urinary and sexual function up to 5 years following radical prostatectomy in a population based cohort.
A sample of 1,288 men with localized prostate cancer who underwent radical prostatectomy and completed a baseline survey within 6 to 12 months of diagnosis were included in the analysis. Two and 5-year functional and quality of life data were collected, as was information on the use of erectile aids. Temporal functional changes and potentially confounding or modifying factors were assessed using longitudinal regression models.
Of these men 14% reported frequent urinary leakage or no urinary control 60 months after diagnosis, which was slightly higher than the 10% reporting incontinence at 24 months (p = 0.007). At 60 months 28% of the men had erections firm enough for intercourse compared with 22% at 24 months (p = 0.003). Sildenafil was the most commonly used erectile aid (43% ever used) and 45% of users reported that it helped "somewhat" or "a lot."
Urinary and sexual dysfunction were common 5 years following radical prostatectomy in this large, community based cohort of prostate cancer survivors. While a small minority of subjects experienced changes in urinary or sexual function between years 2 and 5 after prostatectomy, functional outcomes remained relatively stable in the majority of participants.

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Available from: Ann S Hamilton, Aug 28, 2015
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    • "For patients with clinically localised PCa, radical prostatectomy (RP), particularly nerve-sparing radical prostatectomy (NS-RP), is the best choice treatment, with a life expectancy of ≥10 years2. However, despite the advancement in NS-RP, erectile dysfunction (ED) and urinary incontinence are still commonly encountered in these patients3. "
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    ABSTRACT: Prostate cancer (PCa) is the most common solid neoplasm diagnosed in developed countries. Nerve-sparing radical prostatectomy (NS-RP) has been widely accepted as the best choice treatment for localised PCa. However, erectile dysfunction (ED) and urinary incontinence are commonly observed after NS-RP. Using meta-analysis, we examined if phosphodiesterase type 5 inhibitors (PDE5-Is) could improve the symptoms of ED in patients undergoing NS-RP. This review contained seven randomised placebo-controlled trials with a total of 2,655 male patients. Patients in PDE5-Is group showed significant improvement in the International Index of Erectile Function-Erectile Function domain score (IIEF-EF), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile question 2 (SEP-2) and SEP-3. Although the incidence of treatment-emergent adverse events (TEAEs) were high in both groups (56.44% vs. 40.63%), the safety profile were acceptable, with low incidence of discontinuation rate due to adverse events. Therefore, PDE5-Is are recommended for the treatment of post-NS-RP ED. Patients should be informed of possible adverse events.
    Scientific Reports 07/2014; 4:5801. DOI:10.1038/srep05801 · 5.58 Impact Factor
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    • "Surgery is a major treatment modality for prostate cancer [1] and has been hypothesised to reduce mortality more than other treatments for localised prostate cancer [2]. However, the risks of surgery are known to include erectile dysfunction [3] even when nerve-sparing approaches are used [4]. Long-lasting sexual and urinary difficulties are the most common and troubling side-effects following radical prostatectomy [5] alongside loss of libido, ejaculatory dysfunction, orgasmic dysfunction and penile shortening [6]. "
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    ABSTRACT: Men who undergo surgery for prostate cancer frequently experience significant side-effects including urinary and sexual dysfunction. These difficulties can lead to anxiety, depression and reduced quality of life. Many partners also experience psychological distress. An additional impact can be on the couple relationship, with changes to intimacy, and unmet psychosexual supportive needs in relation to sexual recovery and rehabilitation. The aim of this exploratory randomised controlled trial pilot study is to determine the feasibility and acceptability of a novel family-relational-psychosexual intervention to support intimacy and reduce distress among couples following prostate cancer surgery and to estimate the efficacy of this intervention.
    Trials 05/2014; 15(1):183. DOI:10.1186/1745-6215-15-183 · 2.12 Impact Factor
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    • "The majority (90%) of men with low-risk prostate cancers receive radical intervention, with 50–60% undergoing radical prostatectomy as their primary treatment [3] [4]. Side effects such as sexual dysfunction, urinary incontinence, bowel problems, anxiety, weakness, fatigue, hot flushes, and pain are frequently experienced, depending on the type of treatment given [5] [6] [7] [8] [9]. Existing data also confirm the impact of different prostate cancer treatments, or the disease in general, on quality of life (QoL) and patients' emotional well-being [6] [7]. "
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    ABSTRACT: Objective. To assess the impact of low-to-moderate risk prostate cancer on patients' quality of life (QoL) at diagnosis and within the first year of treatment. Subjects and Methods. Men (n = 672) aged 50-75 years with prostate cancer (Gleason score ≤7, PSA ≤20 ng/mL and clinical staging T1c-T2b) were enrolled in five European countries. Patients completed five questionnaires, including EORTC Quality of Life Questionnaire-Prostate Cancer 25 (QLQ-PR25) and EORTC Quality of Life Questionnaire-Cancer 30 (QLQ-C30). Questionnaires were completed at baseline, at 3 months and 12 months after starting treatment. The primary endpoint was the change in QLQ-PR25 urinary symptoms subscale score from baseline to the assessment at 3 months. Results. Mean (SD) age was 65.0 (5.7) years and 400 (66%) men had Gleason score ≤6 prostate cancer. The most frequently used initial treatment was radical prostatectomy (71% of patients). QLQ-PR25 urinary symptoms subscale score was significantly increased at 3 months (P < 0.001), indicating that urinary symptoms worsened after treatment. The score was lower at 12 months than at 3 months, but it was still significantly higher than at baseline (P < 0.001). Hormonal treatment-related symptoms, sexual functioning, and sexual activity scores significantly worsened at 3 and 12 months (all P < 0.001). For the QLQ-C30 questionnaire, global health status/QoL score significantly decreased at month 3 but was not different from baseline by month 12. Scales for physical, role, and social functioning, and fatigue, showed significant deterioration at 3 and 12 months. Conclusions. Low-to-moderate risk prostate cancer may have a substantial effect on patients' QoL within one year following treatment.
    03/2014; 2014(5):472949. DOI:10.1155/2014/472949
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