Introduction

First results from the ProtecT trial reported on worse functional outcomes for radical prostatectomy (RP) patients compared to their radiation or active surveillance counter partners. We investigated this question for patients undergoing RP in a tertiary high-volume center.

Methods

A total of 14016 men underwent RP between 2005 and 2013 at a tertiary high-volume center. Standardized questionnaires assessing urinary continence (UC), lower urinary tract symptoms (LUTS), erectile (EF) and bowel (BF) function as well as overall health and quality of life (QoL) were completed annually after RP. Additional data for UC and EF were available at three months after RP. UC was defined as the use of zero or 1-safety pad per 24 hours. General EF was assessed using the IIEF-5 (International Index of erectile function) score. EF was defined as a score of ≥3 points in the second question of the IIEF-5 questionnaire: &[Prime]When you had erections with sexual stimulation, how often were your erections stiff enough for penetration?&[Prime] LUTS were analyzed according to the ICSmaleSF (International Continence Society Male Short-Form) instrument. For evaluation of BF, occurrence of bloody stools was documented. Overall health and QoL was investigated using the last two questions of the EORTC-30 questionnaire.

Results

Post-RP UC rates at 3-months, 1-year UC and 3-years were 74.4%, 86.9% and 86.8% for all patients and considerably higher compared to the results of the ProtecT trial. Similar, recovery of erectile function was better at all three time points with a 3-months EF recovery rate of 26.6% and a 3-year rate of 45.4%. In patients who were potent prior to RP and had bilateral nerve sparing, EF rates were 60.4% three years after RP. LUTS and occurrence of bloody stools was comparable to the ProtecT trial with a mean voiding score of 1.83% and occurrence of bloody stools in less than 1%. Both, overall health and QoL reached a mean of 5.7 out of a total of 7.0 points.

Conclusions

Compared to the results of the ProtecT trial, functional outcomes were considerably better for patients undergoing RP in a high-volume center. Although RP is associated with UI and erectile dysfunction, most patients reported very good overall health and QoL one year after RP.

Funding

none