Urinary and Sexual Function After Radical Prostatectomy for Clinically Localized Prostate Cancer

Stanford, Janet L.; Feng, Ziding; Hamilton, Ann S.; Gilliland, Frank D.; Stephenson, Robert A.; Eley, J. William; Albertsen, Peter C.; Harlan, Linda C.; Potosky, Arnold L.

doi:10.1001/jama.283.3.354

Cited by 1,058 publications

(645 citation statements)

References 19 publications

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“…After RP alone patients regain urinary continence at varying times with 22% reporting no problem with urinary incontinence at 6 months, 37% at 12 months and 38% at 24 months. 20 A prospective randomized study comparing 48 patients who were treated with AXRT within 16 weeks after RP and 52 who had RP alone showed similar incontinence rates (23 vs 17%) at a mean 24 months follow-up post-RP. 19 Our increased incidence of urinary incontinence and erectile dysfunction may be explained by our long follow-up.…”

Section: Discussionmentioning

confidence: 95%

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Petroski¹,

Warlick

Herring

et al. 2004

Prostate Cancer Prostatic Dis

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Introduction and Objectives: The efficacy of adjuvant and salvage external beam radiation (AXRT þ SXRT) for prostate cancer after radical prostatectomy (RP) has been debated because of the inability to rule out systemic occult metastasis, uncertainty that radiation eradicates residual local disease and the potential of exacerbating impotency and incontinence. To characterize the effectiveness and treatment morbidity a retrospective review was performed. Methods: In all, 38 patients received AXRT and 91 received SXRT. The SXRT group was stratified by PSA level, age, race, pathologic stage, margin status, worst Gleason sum, radiation dose and pelvic field. Complications evaluated were impotence and incontinence. Median follow-up was 60.2 months. Results: The 5-y disease-free survival (DFS) rate was 61.3% for AXRT and 36.3% for SXRT. Multivariate analysis of the SXRT cohort showed Gleason score, pathologic stage and pre-XRT PSA to be predictors of disease recurrence. After XRT 26% had worsened continence. Conclusions: Patients who recur after RP whose pathologic stage is pT2 or pT3c, Gleason score of 8 or higher or pre-XRT PSA is 42.0 ng/dl may have microscopic metastatic disease and a decreased chance of cure with SXRT alone. Continence was further impaired after XRT.

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Section: Discussionmentioning

confidence: 95%

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Petroski¹,

Warlick

Herring

et al. 2004

Prostate Cancer Prostatic Dis

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“…In literature the achieved continence rates vary between 31 and 98.5% of all patients. [1][2][3][4][5] Also the time to reach the final continence status differs from a few days up to 2 y. An explanation for these discrepancies may be various definitions of continence and differences in physician vs assessment of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

Randenborgh

Paul

Kübler

et al. 2004

Prostate Cancer Prostatic Dis

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Purpose: To improve the rate of full continence in our patients, we performed, since June 1997, a careful preparation of the distally intraprostatic part of the membranous urethra to obtain a long urethral stump for the vesicourethral anastomosis. Patients and methods: In all, 610 patients without (group 1) and 403 patients with (group 2) a long intraprostatic stump of the urethra were asked by a selfadministered questionnaire about their continence status. The rate of positive surgical margins were compared as a marker of local tumour control. Results: Full continence (no pads) was achieved in 76.02% in group 1 and in 88.84%, of all patients in group 2. Stress incontinence (SIC) I1 was found in 12.46% and 7.44% respectiveley, SIC II1 was noted in 8.69 and 3.72% and complete incontinence was seen in 2.79% in group 1 and in two patients (0.5%) in group 2. Also the time to reach the final continence status was statistically and highly significantly (Po0.001) shortened. The rate of positive margins decreased in group 2, despite intraprostatic preparation. Conclusions: The preparation of a long, partially intraprostatic portion of the membranous urethra for vesicourethral anastomosis in radical retropubic prostatectomy leads to a statistically highly significant improvement of full continence and earlier continence in prostate cancer patients without compromising local tumour control.

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“…[1][2][3][4][5][6][7][8] Because the prognosis associated with localized prostate carcinoma is excellent (5-year relative survival rate nearly 100% 9 ), quality-of-life issues become a key factor in decision making regarding the choice of treatment.…”

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confidence: 99%

“…3,[5][6][7]13,15 Reported levels of incontinence range from 30% to 70% 1 year after diagnosis and treatment. [3][4][5][6][7]11,15 Bowel dysfunction has been noted to occur in approximately 30 -45% of patients treated with external beam radiation, 4,7,16 and to a lesser degree with other types of treatment. 4,6,7,15 Most studies of treatment outcomes in men with prostate carcinoma have emphasized sexual, urinary, and bowel symptoms with the assumption that they have an impact on quality of life.…”

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confidence: 99%

The association of treatment‐related symptoms with quality‐of‐life outcomes for localized prostate carcinoma patients

Bacon

Giovannucci

Testa³

et al. 2002

Cancer

142

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BACKGROUNDMost studies of treatment outcomes in men with localized prostate carcinoma have emphasized sexual, urinary, and bowel symptoms with the assumption that they have an impact on quality of life. However, very few studies have directly examined and compared the impact of these symptoms on overall and cancer specific quality of life.METHODSThe authors examined 783 incident cases of localized prostate carcinoma, diagnosed from 1993 to 1998, and 1928 age‐matched healthy controls from the Health Professionals Follow‐Up Study cohort. Information on frequency of ejaculation and urinary symptoms were collected before cancer diagnosis. After cancer diagnosis, the authors mailed a questionnaire including the Medical Outcomes Study Short Form–36 Health Status Survey (SF‐36), the Cancer Rehabilitation Evaluation System–Short Form (CARES‐SF), and the University of California at Los Angeles Prostate Cancer Index in 1998.RESULTSCases had slightly lower scores on most of the SF‐36 scales and reported much more bother from sexual, urinary, and bowel symptoms compared with healthy controls. Among prostate carcinoma patients, bowel symptoms had the greatest negative impact on quality of life, followed by sexual and urinary symptoms. As expected, treatment‐related symptoms were associated with the physical domains of quality of life, but psychosocial domains were just as strongly affected.CONCLUSIONSPatients and health care providers need to consider the potential mental quality‐of‐life impacts associated with prostate carcinoma treatment symptoms when making treatment decisions. Even after patients have completed cancer treatment, significant health impairments may remain. Health care providers should continue to address the mental and physical well‐being of prostate carcinoma patients in follow‐up care. Cancer 2002;94:862–71. © 2002 American Cancer Society.DOI 10.1002/cncr.10248

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Urinary and Sexual Function After Radical Prostatectomy for Clinically Localized Prostate Cancer

Abstract: Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.

Cited by 1,058 publications

References 19 publications

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

The association of treatment‐related symptoms with quality‐of‐life outcomes for localized prostate carcinoma patients

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