THE EFFECT OF PROSTATECTOMY ON SYMPTOM SEVERITY AND QUALITY-OF-LIFE

Objective To determine the effectiveness of prostatectomy in reducing symptom severity and bother and in improving disease-specific and gene ral quality of life. Patients and methods A prospective, cohort study was performed in National Health Service and private hospitals in the Northern, Wessex, Mersey, and South-West Thames Health Regions which c omprised 5276 men undergoing prostatectomy recruited by 101 of the 106 (96%) surgeons (specialist and non-specialist) performing prostatecto my during a 6-month period. Patients were assessed using the American Urological Association (AUA) Symptom Index Score, the AUA symptom both er score, disease-specific and generic quality-of-life scores, the occ urrence of adverse events (urinary incontinence, erectile impotence an d retrograde ejaculation) and three global (general) questions on the results of their treatment. The outcome was assessed 3 months after su rgery, Results Prostatectomy was effective in reducing both symptoms ( initial mean score 20.1 reduced to 7.4, P<0.001) and symptom bother (i nitial mean score 14.4 reduced to 4.3, P<0.001). Not all men experienc ed a good reduction in symptoms; 121 (3.9%) were worse, 301 (9.6%) wer e the same, and 721 (23%) experienced only slight improvement, The typ e of operation, grade of principal operator and use of pre-operative i nvestigations were not associated with the extent of symptomatic impro vement. Changes in symptom severity were highly correlated with change s in bothersomeness and disease-specific quality of life but not with generic quality of life. A third of men who were continent before surg ery reported some incontinence 3 months later, although only 6% found it a problem. Two-thirds of men experienced retrograde ejaculation and 31% experienced some erectile impotence following surgery. Conclusion s Prostatectomy is effective in reducing symptoms in most men. Men who experience a substantial reduction in symptoms were more likely to re port a favourable outcome. The study confirmed that approximately one- third of men reported an unfavourable result 3 months after their oper ation.