EURURO Vol. 73 No. 1

Platinum Priority

–

Prostate Cancer

Editorial by Paolo Capogrosso and Francesco Montorsi on pp. 38

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39 of this issue

Improved Recovery of Erectile Function in Younger Men after

Radical Prostatectomy: Does it Justify Immediate Surgery in

Low-risk Patients?

Justin K. Lee

a , b

[8_TD$DIFF]

, Daniel D. Sjoberg a , Mariam Imnadze Miller a , b

[9_TD$DIFF]

, Andrew J. Vickers a , * ,

John P. Mulhall

b , Behfar Ehdaie b

Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA;

Urology Service, Department of Surgery,

Sidney Kimmel Center for Prostate and Urological Cancers, New York, NY, USA

E U R O P E A N U R O L O GY 7 3 ( 2 0 18 ) 3 3 – 3 7

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted August 2, 2017

Associate Editor:

Matthew Cooperberg

Keywords:

Prostate neoplasm

Radical prostatectomy

Erectile dysfunction

Active surveillance

Patient-reported outcomes

Abstract

Background:

Although active surveillance is increasingly used for the management of low-risk

prostate cancer, many eligible patients are still nonetheless subject to curative treatment. One

argument for considering surgery rather than active surveillance is that the probability of

postoperative recovery of erectile function is age dependent, that is, patients who delay surgery

may lose the window of opportunity to recover erectile function after surgery.

Objective:

To model erectile function over a 10-yr period for immediate surgery versus active

surveillance.

Design, setting, and participants:

Data from 1103 men who underwent radical prostatectomy

at a tertiary referral center were used.

Outcome measurements and statistical analysis:

Patients completed the International Index

of Erectile Function (IIEF-6) pre- and postoperatively as a routine part of clinical care.

Preoperative IIEF-6 scores were plotted against age to assess the natural rate of functional

decline due to aging. Reported erectile scores in the 2-yr period following surgery were used to

assess post-surgical recovery.

Results and limitations:

Each year increase in patient age resulted in a

[10_TD$DIFF]

0.27 reduction in IIEF

scores. In addition to IIEF reducing with increased age, the amount of erectile function that is

recovered from presurgery to 12-mo postsurgery also decreases (

[11_TD$DIFF]

0.16

[12_TD$DIFF]

IIF points/yr, 95%

con

dence interval

[13_TD$DIFF]

0.27,

[14_TD$DIFF]

0.05,

[15_TD$DIFF]

0.006). However, delayed radical prostatectomy in-

creased the mean IIEF-6 score over a 10-yr period compared with immediate surgery

(

= 0.001), even under the assumption that all men placed on active surveillance are treated

within 5 yr.

Conclusions:

Small differences in erectile function recovery in younger men are offset by a

longer period of time living with decreased postoperative function. Better erectile recovery in

younger men should not be a factor used to recommend immediate surgery in patients suitable

for active surveillance, even if crossover to surgery is predicted within a short period of time.

Patient summary:

Younger men have better recovery of erectile function after surgery for

prostate cancer. This has led to the suggestion that delaying surgery for low-risk disease may

lead patients to miss a window of opportunity to recover erectile function postoperatively. We

conducted a modeling study and found that predicted erectile recovery was far superior on

delayed treatment because slightly better recovery in younger men is offset by a longer period

of time living with poorer postoperative function in those choosing immediate surgery.

* Corresponding author. Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York,

NY 10017, USA. Tel. +1-646-888-8233.

E-mail address:

vickersa@mskcc.org

(A.J. Vickers).

http://dx.doi.org/10.1016/j.eururo.2017.08.007