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Prostate Cancer: Localized: Surgical Therapy II (PD19): Podium 19: Saturday, September 11, 2021

PD19-10 PATIENT AND DISEASE SPECIFIC RISK FACTORS AND NERVE SPARING HAVE A SIGNIFICANT IMPACT ON LONG TERM SEXUAL FUNCTIONAL FOLLOWING MINIMALLY INVASIVE RADICAL PROSTATECTOMY

Raison, Nicholas; Musollari, Gledisa; Man, Kathy; Bhate, Natasha; Sethi, Joanne; Forde, Alexandra; Ahmed, Hashim; Minhas, Suks; Winkler, Mathias

doi: 10.1097/JU.0000000000002008.10
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INTRODUCTION AND OBJECTIVE:

Erectile dysfunction remains a major source of morbidity for patients following radical prostatectomy (RP). This study aims to identify patient related as well as peri- and post-operative factors that may affect long-term sexual function following RP.

METHODS:

A prospectively maintained database of patients who had undergone minimally invasive RP was analysed. Patient reported outcomes measures were assessed in all patients using the validated RAND 36-Item Survey and UCLA prostate cancer index questionnaires completed at regular intervals PROMS evaluated functional (urinary, bowel and sexual scored out of 100) and general health outcomes following RP. Further data including clinical and pathological details for all patients was collected. Univariable logistic regression analysis was used to identify potential factors. Analysed factors were age, comorbidities, BMI, previous LUTS surgery, neoadjuvant or adjuvant radiotherapy or ADT, nerve sparing (NS), prostate size and complications. Potential factors were analysed graphically. Patients with pre (n=6) and post (n=163) RP radiotherapy were included.

RESULTS:

494 of 700 patients had PROMS and were analysed with a mean follow up of 31 months (range 1-150 months). Mean preoperative sexual function score 54 (range 0-100) with sexual function score continuing to improve until 24 months. There was no long-term deterioration in either overall mental or physical health. NS had a significant effect on long term sexual function (p < 0.001) with progressive benefits following bilateral intrafascial and unilateral intrafascial/ extrafascial NS compared to no NS (Figure 1). Age and prostate size were the only patient related factors to impact post-operative sexual function (p=0.003 and p=0.03 respectively). Sexual function was also affected with the D’Amico risk group (p=0.001) and use of postoperative ADT (p=0.02). Adjuvant or neoadjuvant radiotherapy had no effect.

CONCLUSIONS:

Patient and disease specific factors and nerve sparing can have a significant effects on post operative sexual function. Discussion with the patient on individual risks should undertaken when making treatment decisions.

Source of Funding:

No funding

© 2021 by American Urological Association Education and Research, Inc.