5-Year Urinary and Sexual Outcomes After Radical Prostatectomy: Results From the Prostate Cancer Outcomes Study

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Abstract 

Purpose

Prior studies of postoperative outcomes following radical prostatectomy have been limited by selection bias and short-term followup. In this study we assessed temporal changes in urinary and sexual function up to 5 years following radical prostatectomy in a population based cohort.

Materials and Methods

A sample of 1,288 men with localized prostate cancer who underwent radical prostatectomy and completed a baseline survey within 6 to 12 months of diagnosis were included in the analysis. Two and 5-year functional and quality of life data were collected, as was information on the use of erectile aids. Temporal functional changes and potentially confounding or modifying factors were assessed using longitudinal regression models.

Results

Of these men 14% reported frequent urinary leakage or no urinary control 60 months after diagnosis, which was slightly higher than the 10% reporting incontinence at 24 months (p b = 0.007). At 60 months 28% of the men had erections firm enough for intercourse compared with 22% at 24 months (p b = 0.003). Sildenafil was the most commonly used erectile aid (43% ever used) and 45% of users reported that it helped “somewhat” or “a lot.”

Conclusions

Urinary and sexual dysfunction were common 5 years following radical prostatectomy in this large, community based cohort of prostate cancer survivors. While a small minority of subjects experienced changes in urinary or sexual function between years 2 and 5 after prostatectomy, functional outcomes remained relatively stable in the majority of participants.

Key Words: prostate, prostatic neoplasms, prostatectomy, urinary incontinence, impotence

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References 

1. Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ, et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002;347:790
2. Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol. 1999;162:433
3. Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156:1707
4. Walsh PC, Marschke P, Ricker D, Burnett AL. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology. 2000;55:58
5. Kao T-C, Cruess DF, Garner D, Foley J, Seay T, Friedrichs P, et al. Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol. 2000;163:858
6. Litwin MS, Flanders SC, Pasta DJ, Stoddard ML, Lubeck DP, Henning JM. Sexual function and bother after radical prostatectomy or radiation for prostate cancer: multivariate quality-of-life analysis from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor). Urology. 1999;54:503
7. Litwin MS, Pasta DJ, Yu J, Stoddard ML, Flanders SC. Urinary function and bother after radical prostatectomy or radiation for prostate cancer: a longitudinal, multivariate quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor. J Urol. 2000;164:1973
8. Potosky AL, Harlan LC, Stanford JL, Gilliland FD, Hamilton AS, Albertsen PC, et al. Prostate cancer practice patterns and quality of life: the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 1999;91:1719
9. Fowler FJ, Barry MJ, Lu-Yao G, Roman A, Wasson J, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy (The National Medicare Experience: 1988-1990 (updated June 1993)). Urology. 1993;42:622
10. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure. Med Care. 1998;36:1002
11. Talcott JA, Rieker P, Clark JA, Propert KJ, Weeks JC, Beard CJ, et al. Patient-reported symptoms after primary therapy for early prostate cancer: results of a prospective cohort study. J Clin Oncol. 1998;16:275
12. Liang KY, Zeger SL. Longitudinal analysis using generalized linear models. Biometrika. 1986;73:13
13. Rubin DB. Multiple Imputation for Nonresponse in Surveys. New York: John Wiley & Sons; 1987;
14. Jonler M, Moon T, Brannan W, Stone NN, Heisey D, Bruskewitz RC. The effect of age, ethnicity and geographical location on impotence and quality of life. Br J Urol. 1995;75:651
15. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128:492
16. Zippe CD, Kedia AW, Kedia K, Nelson DR, Agarwal A. Treatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra). Urology. 1998;52:963
17. Lowentritt BH, Scardino PT, Miles BJ, Orejuela FJ, Schatte EC, Slawin KM, et al. Sildenafil citrate after radical retropubic prostatectomy. J Urol. 1999;162:1614
18. Zippe CD, Jhaveri FM, Klein EA, Kedia S, Pasqualotto FF, Kedia A, et al. Role of Viagra after radical prostatectomy. Urology. 2000;55:241
19. Madalinska JB, Essink-Bot ML, de Koning HJ, Kirkels WJ, van der Maas PJ, Schroder FH. Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol. 2001;19:1619
20. Krupski TL, Saigal CS, Litwin MS. Variation in continence and potency by definition. J Urol. 2003;170:1291
21. Wei JT, Dunn RL, Marcovich R, Montie JE, Sanda MG. Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol. 2000;164:744
22. Legler J, Potosky AL, Gilliland FD, Eley JW, Stanford JL. Validation study of retrospective recall of disease-targeted function: results from the prostate cancer outcomes study. Med Care. 2000;38:847
23. Taylor JM, Cooper KL, Wei JT, Sarma AV, Raghunathan TE, Heeringa SG. Use of multiple imputation to correct for nonresponse bias in a survey of urologic symptoms among African-American men. Am J Epidemiol. 2002;156:774
24. Lubeck DP, Pasta DJ, Flanders SC, Henning JM. Approaches to missing data inference results from CaPSURE: an observational study of patients with prostate cancer. Pharmacoeconomics. 1999;15:197