Predicting erectile function outcome in men after radical prostatectomy for prostate cancer

Abstract

What's known on the subject? and What does the study add? Over the last decade, the surgical treatment of prostate cancer has evolved towards minimal access surgery, particularly via a robot‐assisted technique. However, there is still debate regarding the true benefit for patients with respect to a functional outcome such as erectile function. The present prediction model provides a reliable estimation of the likelihood of regaining erectile function after prostatectomy. OBJECTIVE To identify the reported rates of potency after prostatectomy in the recent literature for men without preoperative erectile dysfunction (ED) and to develop a statistical model for predicting the expected potency after prostatectomy. MATERIALS AND METHODS A Medline search was conducted with the keywords ‘potency’ and ‘prostatectomy’ from 2003 to 2009. In total, 33 studies in the English language reporting pre‐ and postoperative erectile function were identified. Data from studies reporting outcome after open, laparoscopic and robot‐assisted prostatectomy were analyzed separately. Only data obtained from potent men before surgery were included in the analysis. RESULTS In potent men before surgery, the main predictors of post‐treatment erectile function are age and time after treatment. The cumulative range of potency rates at 48 months for all ages (45–75 years) was 49–74% for open, 58–74% for laparoscopic and 60–100% for robotic prostatectomy. The predicted outcome differs by type of operation and patient age. CONCLUSIONS Men aged <60 years have a significant likelihood of regaining erectile function after radical prostatectomy. The reported statistical model provides a reliable estimation of erectile function outcome after prostatectomy for men with localized prostate cancer and intact erectile function.

Application of Erection Hardness Score as a Diagnostic Tool to Assess Erectile Function Recovery after Robot-Assisted Radical Prostatectomy

“…For example, Ficarra et al reported that at 12 months post-RARP, potency recovered between 54 and 90% and at 24 months between 63 and 94% [4]. According to Kilminster et al potency at 48 months varied between 60-100% [11]. Our results show a 74.8% EF recovery in the first year after RARP, which is close to the above results.…”

“…There are several studies that perform systematic reviews and meta-analyzes of the EF after RARP [4,11]. For example, Ficarra et al reported that at 12 months post-RARP, potency recovered between 54 and 90% and at 24 months between 63 and 94% [4].…”

Are we ready to predict late effects? A systematic review of clinically useful prediction models

“…(8, 11–14, 17–21) One study was a metaanalysis of multiple studies of erectile dysfunction, which was limited by poor study design (failure to account for between-study variability). (10)…”

“…(10, 12, 13, 17, 18, 20) An example is the study by Romond et al, in which the authors suggest that their clinical risk score can be used to balance the benefits and harms of adding trastuzumab to the standard chemotherapy regimen in breast cancer. (17) One application to survivorship is the use of the prediction model for patient counseling and setting expectations.…”

“…(10, 12, 14, 18, 21) The nomograms graphically combine levels of risk factors to yield a total point score corresponding to an absolute risk of a late effect. The remaining studies used different presentations for calculating risks.…”