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Recovery of Social Continence and Sexual Function in Men With High-risk Prostate Cancer after Radical Prostatectomy: Results From a Statewide Collaborative - Beyond the Abstract

Pre-operative counseling on expected functional outcomes, such as continence and sexual function, are critical components of shared-decision decision-making prior to radical prostatectomy for men with localized prostate cancer (PCa). This is particularly important for patients with high-risk PCa in which surgeons may have wider dissection planes or omit nerve-sparing to achieve oncological control. High-risk PCa patients may require post-prostatectomy androgen deprivation therapy (ADT) and/or radiation therapy (RT) which may also exacerbate recovery of continence or sexual function.

In our recent manuscript titled, “Recovery of Social Continence and Sexual Function in Men with High-Risk Prostate Cancer after Radical Prostatectomy: Results from a Statewide Collaborative,” we examined post-RP functional outcomes among men with high-risk PCa over a ten-year period across the Michigan Urological Surgery Improvement Collaborative (MUSIC).1 MUSIC collects validated questionnaires on all patients undergoing radical prostatectomy at baseline and fixed intervals post-operatively. 1323 patients with good baseline continence were included in the continence recovery analysis. We found that at 3 months post-RP, 58% of patients reported recovered urinary continence (defined as 0-1 pads per day) which rose to 86% by 12 months. Recovery of continence was associated with lower age and better baseline urinary symptoms.

In addition to continence, we analyzed the rate of erectile function recovery among 422 men with good baseline erectile function. Overall, recovery of sexual function was poor with only 17% men reporting erections firm enough for intercourse at 1-year post-prostatectomy in a population with good baseline erectile function. Recovery of sexual function was associated with nerve-sparing and less receipt of post-prostatectomy ADT and/or RT. Interestingly, only 18% of men who had bilateral nerve-sparing had recovery of sexual function at 1 year. Only 43% of patients in the sexual function cohort had bilateral nerve-sparing at the time of radical prostatectomy highlighting the high-risk nature of this cohort.

In spite of advances in robotic surgery, as many as 16% of patients who undergo a radical prostatectomy regret their decision.2 The need for more aggressive surgical management as well as post-operative ADT/RT may contribute to worse post-operative continence and sexual function which may lead to decision regret for men with high-risk prostate cancer. We analyzed data from a diverse statewide collaborative that provides real-world numbers on functional outcomes after radical prostatectomy for patients with high-risk PCa. With regards to continence recovery, 14% of patients have ongoing leakage at 1 year. Older patients and patients with worse baseline urinary symptoms based on validated questionnaires should be appropriately counseled on the heightened risks of long-term incontinence. All men must be counseled that recovery of sexual function is low even with bilateral nerve-sparing. Additionally, the need for additional post-RP therapies (ADT/RT) may exacerbate erectile function recovery.

Written by: Daniel Triner, MD PhD & Alice Semerjian, MD

Department of Urology, University of Michigan, Ann Arbor, MI

References:

  1. Triner D, Johnson K, Meah S, et al: Recovery of Social Continence and Sexual Function in Men With High-risk Prostate Cancer After Radical Prostatectomy: Results From a Statewide Collaborative. Urology 2024.
  2. Wallis CJD, Zhao Z, Huang L-C, et al: Association of Treatment Modality, Functional Outcomes, and Baseline Characteristics With Treatment-Related Regret Among Men With Localized Prostate Cancer. JAMA Oncol 2022; 8: 50–59.
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