Impact of time from diagnosis to treatment on erectile function outcomes after radical prostatectomy
Capogrosso, P1; Ventimiglia, E1; Boeri, L1; Cazzaniga, W1; Gandaglia, G1; Fossati, N1; Briganti, A1; Deho', F1; Gaboardi, F1; Mirone, V2; Montorsi, F1
1: San Raffaele Hospital - University Vita-Salute San Raffaele, Italy; 2: University of Naples Federico II, Italy
Objective: To test the impact of time from diagnosis to treatment on erectile function (EF) outcomes after radical prostatectomy (RP).
Materials and Methods: Data were available for 827 patients submitted to RP at a single academic center in 2002-2017. Time from diagnosis to treatment was defined as the interval between biopsy and RP. Preoperative risk-groups were defined according to the D’Amico’s risk. EF after surgery was assessed with the International Index of Erectile Function-EF domain (IIEF-EF) (EF recovery defined as an IIEF-EF>=22). Cox regression analyses tested the impact of time-to-surgery on the probability of post-RP EF recovery. Kaplan-Meier analysis compared the cumulative incidence of EF recovery according to times from diagnosis to RP. As a second aim, the impact of time-to-surgery on EF outcomes was tested in a sub-cohort of patients eligible for active surveillance (AS).
Results: Overall, 306 (37%), 422 (51%) and 99 (12%) patients were diagnosed with low, intermediate and high risk PCa, respectively. Of all, 148 (17.9%) were eligible for AS but eventually preferred surgical treatment. Patients were surgically treated at a median (IQR) time of 3.5 (2.1,5.5) months from biopsy; a total of 152 (18%) and 22 (2.7%) patients were treated after 6 and 12 months from biopsy. Median (IQR) follow-up was 24 (12,48) months. The overall probability of EF recovery was 32% (95%CI: 29-36) at 24 months post-RP. At Cox-regression analysis, time from biopsy to surgery was not associated with the chance of post-RP EF recovery (HR:1.01; p=0.6) after accounting for age, baseline IIEF-EF, comorbidities, type of surgery (open vs. robotic) and PCa risk category. At Kaplan-Meier analysis, the cumulative incidence of EF recovery after RP did not differ among patients treated within 6, from 6 to 12 and after 12 months from biopsy (p=0.3). Similar results were obtained in the sub-cohort of patients eligible for AS.
Conclusions: Delaying surgery does not affect EF recovery outcomes after RP. Patients may be reassured preoperatively regarding their chance of EF recovery after RP in the case of a delayed treatment. Larger cohorts are needed to test the impact of delaying surgery for more than 12 months from diagnosis on postoperative EF outcomes.
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