Probability of erectile function recovery in young men treated with radical prostatectomy – findings of a contemporary series
Capogrosso, P1; Ventimiglia, E1; Cazzaniga, W1; Boeri, L1; Gandaglia, G1; Fossati, N1; Briganti, A1; Deho', F1; Gaboardi, F1; Mirone, V2; Montorsi, F1; Salonia, A1
1: San Raffaele Hospital - University Vita-Salute San Raffaele, Italy; 2: University of Naples Federico II, Italy
Objective: In order to properly counsel younger prostate cancer (PCa) patients, we looked at the probability of erectile function (EF) recovery after radical prostatectomy (RP) in a contemporary series of men <60 years old treated in a single academic center.
Materials and Methods: Complete data were available for 264 patients <60 years submitted to RP at a single center in 2010-2017. Preoperative clinical variables including age, comorbidities, PSA, clinical stage and biopsy findings were analyzed. Preoperative risk-groups were identified according to the D’Amico’s risk classification. A preoperative International Index of Erectile Function EF-domain score (IIEF-EF) was available for all patient. Similarly, post-RP EF was routinely assessed (EF recovery was defined for IIEF-EF≥22). Kaplan-Meier analyses estimated the probability of EF recovery after RP. Cox-regression models tested the association between predictors (age, baseline IIEF-EF, PCa risk group, comorbidities and type of surgery [open vs. robotic-RP]) and the chance of post-RP EF recovery.
Results: Median (IQR) age at surgery was 56 (53-58) years. A total of 122 (46%) patients had a low-risk PCa, while 110 (42%) and 32 (12%) had intermediate and high-risk disease, respectively. Before surgery 65% (171) of patients had normal EF (IIEF-EF≥26). Overall, 85% (225) of patients were treated with robotic RP; median (IQR) follow-up post-RP was 22 (9-36) months. Patients with normal preoperative EF showed a 64% (95%CI: 55-72) probability of EF recovery at 36 months compared to 34% (95%CI: 24-47) for those with impaired baseline EF (p<0.001). Similarly, patients with low-risk PCa showed a chance of EF recovery of 62% (95%CI: 53-72) and 71% (95%CI: 61-80) at 36 and 48 months after RP, respectively. Patients with better baseline EF (HR:1.02; 95%CI:1.02-1.08, p=0.001) showed significantly higher chances of EF recovery at multivariable analysis; those with high-risk disease (HR:0.34;95%CI:0.1-0.8, p=0.01) were less likely to recover EF after RP.
Conclusions: These data from a contemporary series of patients treated in a high volume center suggest that physicians may give good expectations in terms of post-RP EF recovery to young men with low to intermediate risk diseases; at the same time, patients should still be adequately warned regarding a non-negligible risk of ED after surgery.
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