EURURO Vol. 73 No. 1

38 148

Platinum Priority – Editorial
Referring to the article published on pp. 33–37 of this issue
Erectile Function Recovery After Surgery in Young Men with
Low-risk Prostate Cancer: Probably Not Just a Matter of Age,
Certainly Not the Main Point of Discussion
Paolo Capogrosso
a Università Vita-Salute San Raffaele, Milan, Italy; bDivision of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San
Raffaele, Milan, Italy
The incidence of low-risk prostate cancer (PCa) has
increased throughout the last few decades mainly because
of the widespread use of prostate-specific antigen (PSA)
testing. In this context, longitudinal data have confirmed
the overall safety of a prospective monitoring strategy for
these patients . The rationale behind active surveillance
(AS) management is to reduce the morbidity burden
associated with potential overtreatment for individuals
harboring indolent disease. A non-negligible proportion of
patients with low-risk PCa initially managed with AS may
eventually undergo radical treatment either because of
disease progression or for personal preference related to
psychological issues . It has been suggested that in these
cases, the delay from diagnosis to treatment negatively
impacts on functional outcomes of radical prostatectomy
(RP) . This could be particularly true for young men
(typically, those with a strong interest in sexual function-
ing); indeed, several studies widely confirmed the signifi-
cant relationship between age and the probability of erectile
function (EF) recovery after RP suggesting that delaying
surgery in youngmenmay eventually reduce their chance of
EF recovery as they grow older.
In this issue of European Urology, Lee et al analyze
outcomes for 1103 patients with low-risk PCa treated with
RP at a single high-volume center. All patients included in
the analysis underwent nerve-sparing (NS) RP performed
by an experienced surgeon. The authors applied a statistical
modeling approach to compare the International Index of
Erectile Function-EF domain (IIEF-6) score between imme-
diate and delayed surgery. They estimated the natural
decline in EF among untreated men, comparing pretreat-
ment IIEF-6 scores at different ages. Similarly, they assessed
the detrimental impact of surgery on the 2-yr postoperative
IIEF-6 score according to different ages. The analysis
showed that each year increase in patient age resulted in
an average decrease of 0.21 IIEF-6 points in the preoperative
setting and in an average of 0.18 IIEF-6 points of recovery
after surgery. According to these data, they estimated long-
term EF scores for two hypothetical scenarios in which
patients had been treated immediately or 3–5 yr after PCa
diagnosis, showing that delayed treatment was associated
with higher (or at least comparable) IIEF-6 scores at 10- to
15-yr follow-up assessment. Overall, these data suggest that
when counseling young men with low-risk PCa for AS, they
could be reassured that in the case of subsequent surgery,
worse recovery of EF is not expected when compared to
immediate treatment.
The authors should be commended for providing such
useful evidence with a direct impact on clinical practice;
however, we respectfully believe that these findings should
be interpreted with caution for several reasons.
First, as a baseline assumption, the authors theorized
that EF declines only as a function of age. Indeed, they did
not find evidence of an association between comorbidities
and a faster decrease in preoperative IIEF-6 score. Therefore,
the relation between postoperative EF recovery and the
level of comorbidity burden was not investigated. In this
context, Briganti et al showed that patients with higher
available at
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DOI of original article:
* Corresponding author. Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina
60, 20132 Milan, Italy. Tel. +39 02 26437286; Fax: +39 02 26432969.
E-mail address: (F. Montorsi).
0302-2838/© 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.