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21 and 24might reflect a man being able to have sex most of
the time when he wants to compared with about half of the
time. That said, there is no reason to believe that this
assumption would differentially favor either delayed or
immediate intervention. Moreover, the effects we describe
are so large—better function on active surveillance even if
we assume that all men are treated relatively rapidly—that
alternative methods of characterizing IIEF scores are highly
unlikely to influence our findings.
We note that our findings are not a direct argument for
active surveillance. Although the data suggest that the
approach is a safe one further data may modify our
understanding of the oncologic outcome of conservative
management. Similarly, there may be reasons for a man
with low-risk cancer to choose immediate surgery, includ-
ing concurrent benign prostate disease, or baseline erectile
dysfunction coupled with other factors such as excessive
anxiety or strong family history. Our point is only that better
recovery of erectile function in younger men cannot be used
as an argument for early surgery.
5. Conclusions
In conclusion, we found no evidence to support the claim
that immediate RP in younger men leads to better erectile
function outcomes compared with active surveillance. In
fact, predicted average erectile function over 10 yr was
estimated to be better with surveillance due to preservation
of baseline function. This was the case even under the
assumption that all men on active surveillance are treated
within a relatively short period of time. Therefore, age-
related recovery of erectile function following RP should not
be used to justify immediate surgery for men eligible for
active surveillance.
Author contributions: Andrew J. Vickers had full access to all the data in the
study and takes responsibility for the integrity of the data and the accuracy
of the data analysis.
Study concept and design: Vickers, Miller, Ehdaie.
Acquisition of data: None.
Analysis and interpretation of data: Sjoberg, Vickers.
Drafting of the manuscript: Vickers, Lee, Miller.
Critical revision of the manuscript for important intellectual content: All
authors.
Statistical analysis: Sjoberg.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: None.
Other: None.
Financial disclosures: Andrew J. Vickers certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affi liation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: This work was supported by
David H. Koch provided through the Prostate Cancer Foundation; the
Sidney Kimmel Center for Prostate and Urologic Cancers; SPORE grant
from the National Cancer Institute to Dr. H. Scher (grant number P50-
CA92629); and a National Institutes of Health/National Cancer Institute
Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center
(grant number P30-CA008748).
References
[1] National Comprehensive Cancer Network. NCCN Clinical Practice
Guidelines in Oncology: Prostate Cancer. 2017
[2]
.
[3]
[4]
.
[5]
[6]
.
[7]
.
[8]
[9]
.
[10]
.
[11]
.
[12]
.
[13]
[14] .
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