Urology Centre, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
Study Type - Outcomes (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? Patients with localized prostate cancer face a bewildering number of treatment choices. Modern technology and innovation in treatment techniques have seen patient expectations rise exponentially, leading to an increase in regret of treatment choice. This study has shown that the demonstration of erectile function techniques helps inform decision-making and reduce long-term regret of treatment choice in localized prostate cancer.
To determine whether preoperative demonstrations of intracavernosal and vacuum therapies for erectile dysfunction (ED) influence the decision of treatment choice, reducing long-term regret.
In all, 82 consecutive men with localized prostate cancer, scheduled for radical prostatectomy and reporting an International Index of Erectile Function score of >21, were prospectively enrolled at a single cancer centre. Following standard preoperative counselling, half of the men were invited to attend a further consultation for intracavernosal and vacuum therapy demonstrations. All patients were evaluated pretreatment and then 3 monthly using the five-point International Index of Erectile Function score and the 14-item Hospital Anxiety and Depression scale. At 12 months treatment choice changes were recorded and patients were assessed for treatment choice regret using Clark's validated two-item regret questionnaire. Statistical analysis was performed using the Mann-Whitney and Fisher's exact tests. Results were compared with a control population of 41 men who did not undergo additional ED counselling.
In all, 8/41 men (19%) changed their treatment choice, opting for brachytherapy rather than radical prostatectomy. Only 1/41 in the control population changed their decision before surgery. At 1 year, one patient (2%) in the intervention group expressed regret at his treatment choice (radical prostatectomy) compared with eight (20%) in the control group (P= 0.03, two-sided Fisher's exact test); ED was identified as the major cause of this regret.
Preoperative demonstrations of ED therapies can optimize decision making in prostate cancer and help reduce long-term regret.
Written by:
Kinsella J, Acher P, Ashfield A, Chatterton K, Dasgupta P, Cahill D, Popert R, O'Brien T. Are you the author?
Reference: BJU Int. 2011 Aug 25. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10237.x
PubMed Abstract
PMID: 21883815
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