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worsen after prostatectomy, with recovery stable 12 months after surgery. Mean urinary bother returned to baseline by 4 months post-prostatectomy. Some 55.8% and 77.5% of patients return to their urinary function and bother baselines, respectively, 1 year after surgery. Mean sexual function and bother both declined after surgery, with new stable baselines achieved by 24 and 36 months postprostatectomy, respectively. Of the patients, 24.2% returned to their sexual function baseline by 24 months. No postoperative improvement was noted in mean sexual bother until the 12 months postprostatectomy. Of the patients, 36.8% returned to their sexual bother baseline by 36 months. Minimal change was noted in the bowel and hormonal domains. CONCLUSIONSMean urinary function and incontinence did not recover to preoperative baseline after prostatectomy, although it did not add distress because mean urinary bother returned to pre-prostatectomy levels. Mean sexual function declined postprostatectomy, with continued recovery up to 24 months. Sexual bother recovered later but, once it reached a new baseline, the distress does not lessen with time, probably indicating an inability to adjust to their functional loss. KEYWORDS EPIC, prostate cancer, sexual recovery, urinary recoveryWhat's known on the subject? and What does the study add? Previous studies typically assessed early outcomes ( ≤ 2 years) after prostatectomy often without individual pre-operative scores for comparison. Our study followed patients and provides long term results, five years post-operatively, and compared results to patients own baseline scores across all domains within EPIC.Study Type -Therapy (outcomes research) Level of Evidence 2c OBJECTIVETo document the Expanded Prostate cancer Index Composite (EPIC) results for men followed for 5 years after radical prostatectomy. PATIENTS AND METHODSEPIC and demographic information were prospectively obtained from 434 patients who received questionnaires preoperatively and 1, 4, 12, 24, 36, 48 and 60 months postoperatively. Paired t -tests compared scores at individual time points. Percentage return to baseline was calculated at all postoperative time points and multivariate analyses evaluated postoperative trends.

Background Prostate cancer gene 3 (PCA3) encodes a prostate-specific messenger RNA (mRNA) that serves as the target for a novel urinary molecular assay for prostate cancer detection. Our objective is to evaluate the ability of PCA3 in addition to serum prostate-specific antigen (PSA) to predict cancer detection by extended template biopsy. Methods From September 2006 to December 2007, whole urine samples were collected after attentive digital rectal exam from 187 men prior to ultrasound-guided 12-core prostate biopsy in a urology outpatient clinic. Urine PCA3/PSA mRNA ratio scores were measured within one month and serum PSA within six months of biopsy. These were related to cancer positivity on biopsy. Results Overall, 87/187 (46.5%) biopsies were positive for cancer. Sensitivity and specificity of PCA3 score ≥35 for positive biopsy were 52.9% and 80.0%; positive and negative predictive values were 69.7% and 66.1%. Using receiver operating characteristic curve (ROC) analysis, PSA alone resulted in an area under the curve (AUC) of 0.63 for prostate cancer detection; PSA + PCA3 score resulted in an AUC of 0.71. The likelihood of prostate cancer detection rose with increasing PCA3 score ranges (p>0.0001), providing possible PCA3 score parameters for stratification into low, moderate, high, and very high risk groups for biopsy positivity. Conclusion Adding PCA3 to serum PSA improves prostate cancer prediction. Use of PCA3 in a clinical setting may help risk-stratify patients for biopsy and cancer detection, although a large-scale validation study is needed to address assay standardization, optimal cut-off values and appropriate patient populations.