To prospectively examine the influence of weight status on urinary and sexual function in clinically localized prostate cancer patients treated by radical prostatectomy (RP).
The Prostatectomy, Incontinence and Erectile dysfunction study recruited patients at two US institutions between 2011-2014. At baseline, height and weight were measured, and urinary and sexual function were collected by the modified Expanded Prostate Cancer Index Composite-50. This index was repeated at the 5-week, 6-month, and 12-month post-surgical assessments and compared to baseline using linear generalized estimating equations. Logistic equations were used to evaluate the likelihood of functional recovery at the 6- and 12-month assessments.
Pre-surgery, nonobese patients (68.8% of 407 patients) had similar urinary function as those with obesity (p=0.217), but better sexual function (p=0.006). One year after surgery, 50.5% and 28.9% patients had recovered to baseline levels for urinary and sexual function, respectively. Recovery was not, however, uniform by obesity. Compared to those with obesity, nonobese patients had better urinary function at the 6- (p<0.001) and 12-month post-surgical assessments (p=0.011) and were more likely to recover their function by the 6-month assessment (OR=2.55, 95% CI=1.36-4.76). For sexual function, nonobese patients had better function at the 6- (p=0.028) and 12-month (p=0.051) assessments, but a similar likelihood of recovery one-year post-surgery.
Nonobese prostate cancer patients had better and likely earlier recovery in urinary function post-surgery, and better sexual function both pre-and post-surgery. These findings support the potential for tailored pre-surgical counseling about RP side-effects and prehabilitation to improve these side-effects.
Urology. 2023 Feb 23 [Epub ahead of print]
Lin Yang, Andrew Harper, Kellie R Imm, Robert L Grubb, Eric H Kim, Graham A Colditz, Kathleen Y Wolin, Adam S Kibel, Siobhan Sutcliffe
Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA. Electronic address: ., Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada., Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA., Department of Urology, Medical University of South Carolina, Charleston, USA., Division of Urological Surgery, Department of Surgery, Washington University School of Medicine, St Louis, USA., Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA., Coeus Health, Chicago, IL, USA., Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Urology, Department of Surgery, Brigham & Women's Hospital, Boston, USA.