To examine post-operative urinary and sexual functional outcomes for men with high-risk prostate cancer (HRPCa) who underwent radical prostatectomy (RP) within the Michigan Urological Surgery Improvement Collaborative (MUSIC).
We identified patients who underwent RP for HRPCa in MUSIC between 2014-2023. HRPCa was defined according to American Urological Association criteria. Patients completed Expanded Prostate Cancer Index Composite (EPIC-26) pre-RP and 3-, 6-, 12-, and 24-months postoperatively. Primary outcomes included social continence, defined as 0-1 pads used daily; and recovery of sexual function, defined as the ability to achieve erections firm enough for intercourse. Multivariable and bivariate analyses were performed to identify factors associated with recovery of social continence and sexual function.
1323 patients were included in the post-RP urinary continence analysis and 422 men in the sexual function analysis. 58% and 86% of patients achieved social continence at 3- and 12-months post-RP, respectively. Continence recovery was associated with higher baseline EPIC-26 urinary continence scores (OR 1.10, per 5 points, 95% CI 1.06-1.15, p<0.001), and negatively associated with increasing age (OR 0.78 per 5-year increase, 95% CI 0.71-0.85 p<0.001). 15% of patients had recovery of sexual function at 12-months post-RP. On bivariate analysis, recovery of sexual function was associated with nerve-sparing at time of RP, lower pre-operative PSA, and not receiving post-RP ADT/RT.
RP for HRPCa has acceptable rates of postoperative social continence. However, post-RP recovery of sexual function remains a challenge. This information has important implications for pre-operative counseling and post-operative follow-up for patients with HRPCa.
Urology. 2024 Jun 25 [Epub ahead of print]
Daniel Triner, Kyle Johnson, Sabir Meah, Stephanie Daignault-Newton, Neil Vaishampayan, Apoorv Dhir, Corinne Labardee, Stephanie Ferrante, Kevin B Ginsburg, Brian R Lane, Arvin K George, Alice Semerjian, Michigan Urological Surgery Improvement Collaborative
Department of Urology, Michigan Medicine, Ann Arbor, MI, USA. Electronic address: ., Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC., Department of Urology, Michigan Medicine, Ann Arbor, MI, USA., Department of Urology, Wayne State University School of Medicine, Detroit, MI, USA., Division of Urology, Corewell Health Hospital System, Grand Rapids, MI, USA., Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA.