Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy

Mauro Gacci, Alchiede Simonato, Lorenzo Masieri, John L. Gore, Michele Lanciotti, Annalisa Mantella, Mario A. Rossetti, Sergio Serni, Virginia Varca, Andrea Romagnoli, Carlo Ambruosi, Fabio Venzano, Marco Esposito, Tomaso Montanaro, Giorgio Carmignani, Marco Carini

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Abstract

Background: After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP). Methods: 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA ≤ 0.2 ng/mL) at the follow up ≥ 5 years were recruited. Results: Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp), tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score), nerve sparing (NS) procedure, and hormonal treatment (HT). Conclusion: We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration. Time since prostatectomy had a negative effect on SF and a positive effect SB (both p <0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p <0.001) and better SB (p <0.001). Higher stage PCa negatively affected UB, SF, and SB (all: p ≤ 0.05). NS was associated with better UB, SF and SB (all: p ≤ 0.05); conversely, HT was associated with worse UF, SF and SB (all: p ≤ 0.05). More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT) demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time. Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders), subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother appear to have divergent trajectories.

Original languageEnglish
Article number94
JournalHealth and Quality of Life Outcomes
Volume7
DOIs
Publication statusPublished - Nov 13 2009

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Gacci, M., Simonato, A., Masieri, L., Gore, J. L., Lanciotti, M., Mantella, A., Rossetti, M. A., Serni, S., Varca, V., Romagnoli, A., Ambruosi, C., Venzano, F., Esposito, M., Montanaro, T., Carmignani, G., & Carini, M. (2009). Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Health and Quality of Life Outcomes, 7, [94]. https://doi.org/10.1186/1477-7525-7-94