Long-term radical prostatectomy outcomes follow a quality-of-life trajectory

NEW YORK (Reuters Health) - Many years after radical prostatectomy, older age at follow-up and higher pathological stage are linked with worse quality-of-life outcomes, report researchers from Italy.

In their cohort of disease-free survivors, "long-term radical prostatectomy outcomes (followed) a distinct quality-of-life trajectory," Dr. Mauro Gacci, from Careggi Hospital in Florence, and colleagues report.

For instance, they found, older men developed worse urinary incontinence regardless of their age at surgery or follow-up duration. Also, beyond eight years after nerve-sparing prostatectomy with hormonal treatment, patients reported substantial sexual dysfunction, "but surprisingly," only minimal sexual bother. Finally, pathological stage was an important predictor of both urinary and sexual function.

In the November 13th Health and Quality of Life Outcomes, Dr. Gacci and associates describe their assessment of quality of life outcomes in 367 prostate cancer survivors who were disease-free at least 5 years after radical prostatectomy.

Multivariate analyses showed a significant positive correlation between follow-up duration and sexual bother and an inverse correlation between age at follow-up and urinary function.

These analyses also showed a negative effect of pathological stage on urinary bother, sexual function, and sexual bother, as well as a positive effect of nerve-sparing surgery on urinary and sexual bother and a negative effect of hormonal therapy on urinary function.

Patients treated with bilateral nerve-sparing prostatectomy without hormonal therapy had better sexual function and sexual bother scores at each time point than did patients who underwent non-nerve-sparing prostatectomy or nerve-sparing prostatectomy with hormonal treatment.

There was progressive deterioration in sexual function and an improvement in sexual bother with increasing follow-up duration, "with the consequent dissociation of the correlation between sexual function and sexual bother from 8 to 10 years after radical prostatectomy," the researchers said.

"These findings can be useful in the counseling of patients," Dr. Gacci told Reuters Health. "At the present time, urologists describe short term quality of life outcomes or long term oncologic outcomes. We report the long term quality of life outcomes according to disease free outcomes."

"Now we are performing a multicenter prospective (with baseline data) study on early continence recovery after prostatectomy," Dr. Gacci added.

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