Mp14-09 Unexpected Long-Term Improvements in Urinary and Erectile Function in a Large Cohort of Men With Self-Reported Outcomes Following Radical Prostatectomy

Abstract

For both treatment groups, the rate of complications peaked within two years of treatment, but continued at a steady rate for the next 10 years.CONCLUSIONS: Complications are common following prostate cancer treatment and occur many years after treatment. The type of primary treatment (radiotherapy versus prostatectomy) is an important predictor of complication rates for all categories.INTRODUCTION AND OBJECTIVES: It is often assumed that there is little improvement in incontinence and erectile dysfunction (ED) beyond 12 to 24 mos after radical prostatectomy. There is sparse data addressing this issue. We sought to determine the probability of achieving good urinary function (UF) and erectile function (EF) up to 48 mos post-operatively based on patient reported functional status at 12 mos. METHODS: We identified 2537 patients who underwent radical prostatectomy (RP) between 2007e2012 at a tertiary institution with self-reported UF and EF scores at 12 mos and beyond. Our main outcome was good EF as defined by IIEF 22 (range 1e30) or good UF as defined by a validated urinary questionnaire score of 17 (range 0e21). Kaplan-Meier analyses and multivariable Cox proportional hazards models were used to determine the probability of achieving continence and functional erections in patients that had not achieved good UF and EF by 12 mos. Patients with preoperative incontinence or ED were excluded. RESULTS: At 12 mos post-operatively, 629 (30%) and 897 (66%) patients had not achieved good UF and EF, respectively. Of those who were incontinent at 12 mos, there was increasing probability of achieving good UF at 24, 36, and 48 mos (33%, 49%, and 61%, respectively). To account for the possibility of adapting to urinary symptoms, we used pad free status as the outcome and found lower probabilities of UF recovery but a similar rising trend at the same time points (29%, 40%, and 47%, respectively). In patients who had ED at 12 mos, there was also an increasing probability of recovering EF at 24, 36, and 48 mos (21%, 32%, and 42%, respectively).CONCLUSIONS: In this large cohort with self-reported outcomes, men continue to achieve improvement in UF and EF with increasing time from surgery, despite having incontinence or ED at 12 mos. The probabilities of achieving good function were considerably higher than initially anticipated. These findings may represent natural history, but the effect of informative censoring, patients' response biases, and rehabilitative interventions are being investigated.