Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer - The prostate cancer outcomes study

Context Patients with prostate cancer and their physicians need knowledge o f treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patie nts. Objective To measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer. Design The Prostate Cancer Outcomes Study, a population-based longitudinal cohort study with up to 24 months of follow-up. Setting Population-based cancer registries in 6 geographic regions of the U nited States. Participants A total of 1291 black, white, and Hispanic men aged 39 to 79 y ears who were diagnosed as having primary prostate cancer between October 1 , 1994, and October 31, 1995, and who underwent radical prostatectomy withi n 6 months of diagnosis for clinically localized disease. Main Outcome Measures Distribution of and change in urinary and sexual func tion measures reported by patients at baseline and 6, 12, and 24 months aft er diagnosis. Results At 18 or more months following radical prostatectomy, 8.4% of men w ere incontinent and 59.9% were impotent. Among men who were potent before s urgery, the proportion of men reporting impotence at 18 or more months afte r surgery varied according to whether the procedure was nerve sparing (65.6 % of non-nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve-s paring). At 18 or more months after surgery, 41.9% reported that their sexu al performance was a moderate-to-large problem. Both sexual and urinary fun ction varied by age (39.0% of men aged <60 years vs 15.3%-21.7% of older me n were potent at greater than or equal to 18 months [P<.001]; 13.8% of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at greater than or equal to 18 months [P =.03]), and sexual function also varied by race (38.4% of black men reported firm erections a t greater than or equal to 18 months vs 25.9% of Hispanic and 21.3% of whit e men; P =.001), Conclusions Our study suggests that radical prostatectomy is associated wit h significant erectile dysfunction and some decline in urinary function. Th ese results may be particularly helpful to community-based physicians and t heir patients with prostate cancer who face difficult treatment decisions.