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. 2009 Nov 13:7:94.
doi: 10.1186/1477-7525-7-94.

Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy

Mauro Gacci  1 , Alchiede Simonato, Lorenzo Masieri, John L Gore, Michele Lanciotti, Annalisa Mantella, Mario Alberto Rossetti, Sergio Serni, Virginia Varca, Andrea Romagnoli, Carlo Ambruosi, Fabio Venzano, Marco Esposito, Tomaso Montanaro, Giorgio Carmignani, Marco Carini
Affiliations

Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy

Mauro Gacci et al. Health Qual Life Outcomes. .

Abstract

Background: After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP).

Methods: 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA <or= 0.2 ng/mL) at the follow up >or= 5 years were recruited.Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp), tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score), nerve sparing (NS) procedure, and hormonal treatment (HT).We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration.

Results: Time since prostatectomy had a negative effect on SF and a positive effect SB (both p < 0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p < 0.001) and better SB (p < 0.001).Higher stage PCa negatively affected UB, SF, and SB (all: p <or= 0.05). NS was associated with better UB, SF and SB (all: p <or= 0.05); conversely, HT was associated with worse UF, SF and SB (all: p <or= 0.05).More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT) demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time.

Conclusion: Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders), subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother appear to have divergent trajectories.

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Figures

Figure 1
Figure 1
Mean UF, UB, SF, and SB scores in subjects who underwent NS-RP without HT (Group A - green bars) and non-NS-RP or NS-RP with HT subjects (Group B - red bars), stratified according to years of follow up. UF: urinary function; UB: urinary bother; SF: sexual function; SB: sexual bother. [* p < 0.05].
Figure 2
Figure 2
Comparison of function and bother among Group A subjects at interval follow-up. The table reports Pearson correlation coefficients and p-values assessing the correlation between function and bother. Non-significant results (p > 0.05) are in bold. UF: urinary function; UB: urinary bother; SF: sexual function; SB: sexual bother; RP: radical prostatectomy.
See this image and copyright information in PMC

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