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 of treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patients. 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 United States. Participants A total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease. Main Outcome Measures Distribution of and change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis. Results At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after 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-sparing). At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age (39.0% of men aged <60 years vs 15.3%-21.7% of older men 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 at greater than or equal to 18 months vs 25.9% of Hispanic and 21.3% of white men; P =.001), Conclusions Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.