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Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W, Salner AL, Zelefsky MJ, Aragon-Ching JB, Slovin SF, Wittmann DA, Hoyt MA, Sinibaldi VJ, Chodak G, Pratt-Chapman ML, Cowens-Alvarado RL. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin 2014; 64:225-49. [PMID: 24916760 DOI: 10.3322/caac.21234] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.
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Affiliation(s)
- Ted A Skolarus
- Assistant Professor of Urology, Department of Urology, University of Michigan, Research Investigator, HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Barocas DA, Chen V, Cooperberg M, Goodman M, Graff JJ, Greenfield S, Hamilton A, Hoffman K, Kaplan S, Koyama T, Morgans A, Paddock LE, Phillips S, Resnick MJ, Stroup A, Wu XC, Penson DF. Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study. J Comp Eff Res 2014; 2:445-60. [PMID: 24236685 DOI: 10.2217/cer.13.34] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While randomized controlled trials represent the highest level of evidence we can generate in comparative effectiveness research, there are clinical scenarios where this type of study design is not feasible. The Comparative Effectiveness Analyses of Surgery and Radiation in localized prostate cancer (CEASAR) study is an observational study designed to compare the effectiveness and harms of different treatments for localized prostate cancer, a clinical scenario in which randomized controlled trials have been difficult to execute and, when completed, have been difficult to generalize to the population at large. METHODS CEASAR employs a population-based, prospective cohort study design, using tumor registries as cohort inception tools. The primary outcome is quality of life after treatment, measured by validated instruments. Risk adjustment is facilitated by capture of traditional and nontraditional confounders before treatment and by propensity score analysis. RESULTS We have accrued a diverse, representative cohort of 3691 men in the USA with clinically localized prostate cancer. Half of the men invited to participate enrolled, and 86% of patients who enrolled have completed the 6-month survey. CONCLUSION Challenging comparative effectiveness research questions can be addressed using well-designed observational studies. The CEASAR study provides an opportunity to determine what treatments work best, for which patients, and in whose hands.
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153
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Chung E, Gillman M. Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy. Med J Aust 2014; 200:582-5. [DOI: 10.5694/mja13.11028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eric Chung
- St Andrew's Pelvic Medicine Centre, St Andrew's War Memorial Hospital, Brisbane, QLD
- Department of Surgery, University of Queensland, Brisbane, QLD
| | - Michael Gillman
- St Andrew's Pelvic Medicine Centre, St Andrew's War Memorial Hospital, Brisbane, QLD
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154
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Gómez-Veiga F, Silmi-Moyano Á, Günthner S, Puyol-Pallas M, Cózar-Olmo J. Reference values for the CAVIPRES-30 questionnaire, a global questionnaire on the health-related quality of life of patients with prostate cancer. Actas Urol Esp 2014; 38:304-12. [PMID: 24183473 DOI: 10.1016/j.acuro.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/08/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Define and establish the reference values of the CAVIPRES-30 Questionnaire, a health related quality of life questionnaire specific for prostate cancer patients. MATERIAL AND METHODS The CAVIPRES-30 was administered to 2,630 males with prostate cancer included by 238 Urologist belonging to the Spanish National Healthcare System. Descriptive analysis on socio-demographic and clinical data were performed, and multivariate analyses were used to corroborate that stratification variables were statistically significantly and independently associated to the overall score of the questionnaire. RESULTS The variables Time since diagnosis of the illness, whether the patient had a Stable partner or not, if he was, or not, undergoing Symptomatic treatment were statistically significantly and independently associated (P < .001) to the overall score of the questionnaire. The reference values table of the CAVIPRES-30 questionnaire is made up of different kinds of information of each patient profile: sample size, descriptive statistics with regard to the overall score, Cronbach's alpha value (between .791 and .875) and the questionnaire's values are reported by deciles. CONCLUSIONS The results of this study contribute new proof as to the suitability and usefulness of the CAVIPRES-30 questionnaire as an instrument for assessing individually the quality of life of prostate cancer.
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155
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Counseling the post-radical prostatectomy patients about functional recovery: high predictiveness of current status. Urology 2014; 84:158-63. [PMID: 24824411 DOI: 10.1016/j.urology.2014.02.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To develop prediction models to help counsel post-radical prostatectomy patients about functional recovery. METHODS The study included 2162 patients undergoing radical prostatectomy at a major cancer center, who reported urinary and erectile function at 1 year or at 2 years and at least 1 prior follow-up at 3, 6, 9, or 12 months. We created logistic regression models predicting function at one or 2 years on the basis of function at 3, 6, 9, and 12 months (2 years only), with the additional predictors of age, stage, grade, prostate-specific antigen levels, nerve-sparing status and baseline functional score. RESULTS No variable other than current functional score had a consistent statistically significant relationship with outcome. The area under the curves for predicting function at 2 years based on current function alone at 3, 6, 9, and 12 months were respectively 0.796, 0.831, 0.882, and 0.885 for erectile function and 0.789, 0.862, 0.869, and 0.876 for urinary function. Patients using 1 pad at 6 months had only a 50% probability of being pad free at 2 years; this dropped to 36% for patients using 2 pads. This suggests that there is an opportunity for early identification and possible referral of patients likely to have long-term urinary dysfunction. CONCLUSION Assessment of urinary and erectile function in the first postoperative year is strongly predictive of long-term outcome and can guide patient counseling and decisions about rehabilitative treatments.
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156
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Kirby MG, White ID, Butcher J, Challacombe B, Coe J, Grover L, Hegarty P, Jackson G, Lowndes A, Payne H, Rees J, Sangar V, Thompson A. Development of UK recommendations on treatment for post-surgical erectile dysfunction. Int J Clin Pract 2014; 68:590-608. [PMID: 24188207 PMCID: PMC4279873 DOI: 10.1111/ijcp.12338] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM To develop a management strategy (rehabilitation programme) for postsurgical erectile dysfunction (ED) among men experiencing ED associated with treatment of prostate, bladder or rectal cancer that is suitable for use in a UK NHS healthcare context. METHODS PubMed literature searches of ED management together with a survey of 13 experts in the management of ED from across the UK were conducted. RESULTS Data from 37 articles and completed questionnaires were collated. The results discussed in this study demonstrate improved objective and subjective clinical outcomes for physical parameters, sexual satisfaction, and rates of both spontaneous erections and those associated with ED treatment strategies. CONCLUSION Based on the literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for postsurgical ED.
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Affiliation(s)
- M G Kirby
- The Prostate Centre, London and the University of Hertfordshire, London, UK
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Resnick MJ, Barocas DA, Morgans AK, Phillips SE, Chen VW, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hoffman KE, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Koyama T, Penson DF. Contemporary prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction: Defining the population at risk for harms of prostate cancer treatment. Cancer 2014; 120:1263-71. [PMID: 24510400 PMCID: PMC4930672 DOI: 10.1002/cncr.28563] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND The authors investigated the prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction in a contemporary, population-based prostate cancer cohort. They also explored the associations between baseline function and age, comorbidity, and timing of baseline survey completion with respect to treatment. METHODS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a population-based, prospective cohort study that enrolled 3691 men with incident prostate cancer during 2011 and 2012. Pretreatment function was ascertained using the Expanded Prostate Cancer Index-26 (EPIC-26). Data were stratified by age, comorbidity, and timing of baseline survey completion with respect to treatment. Unadjusted and multivariable linear regression analyses were performed to evaluate the relations between exposures and pretreatment function. RESULTS After applying exclusion criteria, the study cohort comprised 3072 men. A strikingly high proportion of men reported inability to obtain erections satisfactory for intercourse (45%) and some degree of urinary incontinence (17%) at baseline. Sexual function was particularly age-sensitive, with patients aged ≤60 years reporting summary scores in excess of 30 points higher than patients aged ≥75 years (P < .001). Compared with the healthiest men, highly comorbid patients reported less favorable function in each domain, including urinary incontinence (summary score, 89.5 vs 74.1; P < .001) and sexual function (summary score, 70.8 vs 32.9; P < .001). Although statistically significant differences in summary scores were identified between patients who completed the baseline questionnaire before treatment (52%) versus after treatment (48%), the absolute differences were small (range, 1-3 points). CONCLUSIONS Patients with newly diagnosed prostate cancer exhibit a wide distribution of pretreatment function. The current data may be used to redefine the population "at risk" for treatment-related harms.
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Affiliation(s)
- Matthew J. Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alicia K. Morgans
- Department of Medical Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon E. Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vivien W. Chen
- Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Matthew R. Cooperberg
- Department of Urology, University of California San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California Irvine, Irvine, California
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherri H. Kaplan
- Health Policy Research Institute, University of California Irvine, Irvine, California
| | | | | | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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Pisansky TM, Pugh SL, Greenberg RE, Pervez N, Reed DR, Rosenthal SA, Mowat RB, Raben A, Buyyounouski MK, Kachnic LA, Bruner DW. Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial. JAMA 2014; 311:1300-7. [PMID: 24691606 PMCID: PMC4669050 DOI: 10.1001/jama.2014.2626] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Tadalafil is used to treat erectile dysfunction after prostate cancer treatment, but its role as a preventive agent is undefined. OBJECTIVES To determine primarily whether tadalafil preserved erectile function in men treated with radiotherapy for prostate cancer, and secondarily to determine whether participant- or partner-reported overall sexual function and sexual and marital satisfaction were affected. DESIGN, SETTING, AND PARTICIPANTS Stratified, placebo-controlled, double-blind, parallel-group study with 1:1 randomization at 76 community-based and tertiary medical sites in the United States and Canada. Two hundred forty-two participants with intact erectile function scheduled to receive radiotherapy for prostate cancer were recruited between November 2009 and February 2012 with follow-up through March 2013. INTERVENTIONS One hundred twenty-one participants were assigned 5 mg of tadalafil daily and 121 were assigned placebo for 24 weeks starting with external radiotherapy (63%) or brachytherapy (37%). Participant-reported International Index of Erectile Function response before radiotherapy and at weeks 2 and 4, between weeks 20 and 24, between weeks 28 and 30, and 1 year thereafter. Participants and partners could respond also to the Sexual Adjustment Questionnaire and to the Locke Marital Adjustment Test before radiotherapy, between weeks 20 and 24 and weeks 28 and 30, and at 1 year. MAIN OUTCOMES AND MEASURES Primary outcome was off-drug spontaneous erectile function 28 to 30 weeks after radiotherapy started. Secondary end points were spontaneous erection at 1 year; overall sexual function and satisfaction; marital adjustment; and partner-reported satisfaction and marital adjustment at 28 to 30 weeks and 1 year, predictors of tadalafil response; and adverse events. RESULTS Among 221 evaluable participants, 80 (79%; 95% CI, 70%-88%) assigned to receive tadalafil retained erectile function between weeks 28 and 30 compared with 61 (74%; 95% CI, 63%-85%) assigned to receive placebo (P = .49); an absolute difference of 5% (95% CI, -9% to 19%). A significant difference was also not observed at 1 year (72%; 95% CI, 60%-84% vs 71%; 95% CI, 59%-84%; P = .93). Tadalafil was not associated with significantly improved overall sexual function or satisfaction; a significant difference was not observed in any domain subscale. Partners of men assigned tadalafil noted no significant effect on sexual satisfaction, and marital adjustment was not significantly improved in participants or partners. CONCLUSIONS AND RELEVANCE Among men undergoing radiotherapy for prostate cancer, daily use of tadalafil compared with placebo did not result in improved erectile function. These findings do not support daily use of tadalafil to prevent erectile dysfunction in these patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00931528.
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Affiliation(s)
| | | | | | | | | | | | - Rex B Mowat
- Toledo Community Hospital Community Clinical Oncology Program, Toledo, Ohio
| | - Adam Raben
- Christiana Care Health Service Community Clinical Oncology Program, Newark, Delaware
| | | | - Lisa A Kachnic
- Boston Medical Center Minority-Based Community Clinical Oncology Program, Boston, Massachusetts
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160
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Gacci M, Baldi E, Tamburrino L, Detti B, Livi L, De Nunzio C, Tubaro A, Gravas S, Carini M, Serni S. Quality of Life and Sexual Health in the Aging of PCa Survivors. Int J Endocrinol 2014; 2014:470592. [PMID: 24744780 PMCID: PMC3976934 DOI: 10.1155/2014/470592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/02/2014] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Beatrice Detti
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Lorenzo Livi
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
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161
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Abstract
Elderly men comprise a large percentage of men diagnosed with prostate cancer (PrCa). Although localized PrCa is often indolent, older men tend to be diagnosed with higher-stage disease and are more likely to die from PrCa than younger men. Multiple factors other than age play an important role in determining who will benefit from active treatment, such as comorbid conditions, life expectancy, and tumor characteristics. Careful consideration of such factors can help prevent the overtreatment of elderly men with low-risk disease and undertreatment of elderly men with high-risk disease. Management decisions should be individualized by weighing the benefits of treatment against potential risks and side effects pertinent to the elderly population, whether evaluating for surgery, radiation, or androgen deprivation.
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Affiliation(s)
- Shelly X Bian
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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162
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Brajtbord JS, Punnen S, Cowan JE, Welty CJ, Carroll PR. Age and baseline quality of life at radical prostatectomy--who has the most to lose? J Urol 2014; 192:396-401. [PMID: 24582539 DOI: 10.1016/j.juro.2014.02.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Although younger men have better health related quality of life scores after radical prostatectomy, many have higher baseline function with more to lose than older men. We examined the impact of age on sexual and urinary function and bother during the first 2 years after radical prostatectomy. MATERIALS AND METHODS Participants enrolled in CaPSURE™ reported sexual and urinary scores before and after radical prostatectomy using UCLA-PCI. Repeated measures mixed models were used to compare the change in health related quality of life with time between men who were younger (age 60 years or less) and older (age greater than 60 years). Logistic regression models were used to assess associations between age and clinically meaningful health related quality of life decreases (worsening). Models were adjusted for clinical characteristics. RESULTS Of 1,806 patients younger men reported higher sexual and urinary function scores at each time point and higher sexual function decrease rates at 1 year than older men (81% vs 75%, p<0.01). Younger men also had higher sexual bother decrease rates 1 year (74% vs 61%, p<0.01) and 2 years (62% vs 56%, p=0.02) after radical prostatectomy. On multivariate analysis age was associated with changes in sexual function and bother from baseline through 2 years (each p<0.01). Younger men had higher adjusted odds of sexual function decreases at 1 year (OR 1.15/5 years, 95% CI 1.01-1.30, p=0.03) but not at 2 years. Younger age was associated with lower odds of worsening sexual bother at 2 years (OR 0.79/5 years, 95% CI 0.67-0.94, p<0.01). Urinary function and bother decrease rates were similar by age. Secondary analyses of the age/health related quality of life interaction showed that men were at greater risk for health related quality of life decreases if baseline scores were above average regardless of age. CONCLUSIONS Younger men reported higher sexual and urinary function overall, and experienced greater decreases in sexual function immediately after radical prostatectomy than older men. While the 2 groups experienced similar relative sexual function decreases at 2 years, younger men had worse interim decreases at 1 year. Providers should consider these findings when discussing treatment timing, particularly with younger men diagnosed with early stage, low grade disease.
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Affiliation(s)
- Jonathan S Brajtbord
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | - Sanoj Punnen
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | - Janet E Cowan
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | - Christopher J Welty
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | - Peter R Carroll
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California.
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Singh BP, Prakash J, Sankhwar SN, Dhakad U, Sankhwar PL, Goel A, Kumar M. Retrograde intrarenal surgery vs extracorporeal shock wave lithotripsy for intermediate size inferior pole calculi: a prospective assessment of objective and subjective outcomes. Urology 2014; 83:1016-22. [PMID: 24560970 DOI: 10.1016/j.urology.2013.12.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/16/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess objective and subjective outcomes of retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (SWL) for the treatment of intermediate size (1-2 cm) inferior calyceal (IC) stones in a prospective randomized fashion. METHODS Between March 2011 and January 2013, 70 symptomatic adults who had isolated IC stone between 10 and 20 mm underwent RIRS or SWL by computer-generated pseudorandom assignment (1:1). Success rate, mean procedure time, hospital stay, pain score on day 1 and 2 using visual analog scale, analgesic requirement after discharge, complications, retreatment rate, auxiliary procedure, and patient-reported outcomes (using self-made nonvalidated questionnaire) were compared. RESULTS Baseline parameters and mean stone size (SWL 16.45 ± 2.28 mm, RIRS 15.05 ± 3.56 mm; P = .0542) were comparable. Success rate was significantly higher after a single session of RIRS compared with 3 sessions of SWL (85% vs 54%; P = .008). Retreatment rate (65% vs 5.7%; P = .0001) and auxiliary procedure (45% vs 8%; P = .0009) were significantly higher in SWL. Pain score on postoperative day 1 and 2 was significantly higher in RIRS, but patients with SWL required significantly more analgesics afterward. Most of the complications were of Clavien grade I and/or II in both groups. Average time to return to normal activity and voiding symptoms were significantly higher in RIRS. Overall satisfaction score (2.17 ± 1.24 vs 2.82 ± 1.17; P = .026) was significantly higher in RIRS than SWL. CONCLUSION For the treatment of intermediate size IC calculi, RIRS is superior to SWL in terms of objective and subjective outcomes.
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Affiliation(s)
| | - Jai Prakash
- Department of Urology, King George Medical University, Lucknow, India.
| | | | - Urmila Dhakad
- Department of Rheumatology, King George Medical University, Lucknow, India
| | - Pushp Lata Sankhwar
- Department of Obstetrics and Gynecology, King George Medical University, Lucknow, India
| | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George Medical University, Lucknow, India
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Drazer MW, Prasad SM, Huo D, Schonberg MA, Dale W, Szmulewitz RZ, Eggener SE. National trends in prostate cancer screening among older American men with limited 9-year life expectancies: Evidence of an increased need for shared decision making. Cancer 2014; 120:1491-8. [DOI: 10.1002/cncr.28600] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/23/2013] [Accepted: 12/25/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Michael W. Drazer
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Sandip M. Prasad
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Dezheng Huo
- Department of Health Studies; University of Chicago Medical Center; Chicago Illinois
| | - Mara A. Schonberg
- Department of Medicine; Harvard Medical School; Boston Massachusetts
| | - William Dale
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | | | - Scott E. Eggener
- Section of Urology; University of Chicago Medical Center; Chicago Illinois
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Kerns SL, Ostrer H, Rosenstein BS. Radiogenomics: using genetics to identify cancer patients at risk for development of adverse effects following radiotherapy. Cancer Discov 2014; 4:155-65. [PMID: 24441285 DOI: 10.1158/2159-8290.cd-13-0197] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED Normal-tissue adverse effects following radiotherapy are common and significantly affect quality of life. These effects cannot be accounted for by dosimetric, treatment, or demographic factors alone, and evidence suggests that common genetic variants are associated with radiotherapy adverse effects. The field of radiogenomics has evolved to identify such genetic risk factors. Radiogenomics has two goals: (i) to develop an assay to predict which patients with cancer are most likely to develop radiation injuries resulting from radiotherapy, and (ii) to obtain information about the molecular pathways responsible for radiation-induced normal-tissue toxicities. This review summarizes the history of the field and current research. SIGNIFICANCE A single-nucleotide polymorphism–based predictive assay could be used, along with clinical and treatment factors, to estimate the risk that a patient with cancer will develop adverse effects from radiotherapy. Such an assay could be used to personalize therapy and improve quality of life for patients with cancer.
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Affiliation(s)
- Sarah L Kerns
- Departments of 1Radiation Oncology and 2Dermatology, Preventive Medicine and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai; 3Department of Radiation Oncology, New York University School of Medicine, New York; Departments of 4Pathology, and 5Genetics and Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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Storås AH, Sanda MG, Ferrer M, Loge JH, Dahl AA, Steinsvik EAS, Guedea F, Cvancarova M, Fosså SD. Localized prostate cancer in Norway, the United States, and Spain: between-country differences of variables before treatment among patients eligible for curative treatment. Clin Genitourin Cancer 2014; 12:e117-25. [PMID: 24524968 DOI: 10.1016/j.clgc.2013.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In men with PCa, large variations of PROs after RP or high-dose RAD might be related to between-country differences of medical and sociodemographic variables, and differences in PROs before treatment in the sexual and urinary domains. PATIENTS AND METHODS In 1908 patients with localized PCa from Norway, the United States, or Spain, the relation between medical (prostate-specific antigen, Gleason score, cT-category) and sociodemographic variables (age, education, marital status) before treatment was investigated. Using the Expanded Prostate Cancer Index Composite questionnaire, PROs before treatment within the sexual and urinary domains were also considered. RESULTS Compared with the European patients, American patients were younger, fewer had comorbid conditions, and more had a high education level. Fifty-three percent of the US men eligible for RP had low-risk tumors compared with 42% and 31% among the Norwegian and the Spanish patients, respectively. Among the Spanish RAD patients, 54% had had low-risk tumors compared with 34% of the American and 21% of the Norwegian men planned for RAD, respectively. Compared with the European patients, significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups, the number of patients with sexual or urinary dysfunction exceeded that of patients with bother related to the reported dysfunction. CONCLUSION Statistically significant between-country differences were observed in medical and sociodemographic variables, and in PROs before treatment within the sexual and urinary domains. Large differences between reported dysfunction and related problems within the sexual and urinary domains indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, might in part explain the large variation of side effects after treatment evident in the medical literature.
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Affiliation(s)
- Anne Holck Storås
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Martin G Sanda
- Department of Urology, Emory University Hospital, Atlanta, GA
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Jon Håvard Loge
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alv A Dahl
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eivind A S Steinsvik
- Department of ENT, Division of Surgery, Akershus University Hospital, Lorenskog, Norway
| | - Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Milada Cvancarova
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Sophie D Fosså
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
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Kerns SL, de Ruysscher D, Andreassen CN, Azria D, Barnett GC, Chang-Claude J, Davidson S, Deasy JO, Dunning AM, Ostrer H, Rosenstein BS, West CML, Bentzen SM. STROGAR - STrengthening the Reporting Of Genetic Association studies in Radiogenomics. Radiother Oncol 2014; 110:182-8. [PMID: 23993398 PMCID: PMC4786020 DOI: 10.1016/j.radonc.2013.07.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/16/2013] [Accepted: 07/29/2013] [Indexed: 01/14/2023]
Abstract
Despite publication of numerous radiogenomics studies to date, positive single nucleotide polymorphism (SNP) associations have rarely been reproduced in independent validation studies. A major reason for these inconsistencies is a high number of false positive findings because no adjustments were made for multiple comparisons. It is also possible that some validation studies were false negatives due to methodological shortcomings or a failure to reproduce relevant details of the original study. Transparent reporting is needed to ensure these flaws do not hamper progress in radiogenomics. In response to the need for improving the quality of research in the area, the Radiogenomics Consortium produced an 18-item checklist for reporting radiogenomics studies. It is recognised that not all studies will have recorded all of the information included in the checklist. However, authors should report on all checklist items and acknowledge any missing information. Use of STROGAR guidelines will advance the field of radiogenomics by increasing the transparency and completeness of reporting.
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Affiliation(s)
- Sarah L Kerns
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, USA; Department of Pathology, Albert Einstein College of Medicine, New York, USA; Department of Genetics, Albert Einstein College of Medicine, New York, USA
| | - Dirk de Ruysscher
- Department of Radiation Oncology, University Hospitals Leuven/KU Leuven, Belgium
| | | | - David Azria
- Montpellier Cancer Institute, Montpellier University, France
| | - Gillian C Barnett
- Department of Oncology, Cambridge University Hospital NHS Foundation Trust, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susan Davidson
- Department of Clinical Oncology, Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | | | - Harry Ostrer
- Department of Pathology, Albert Einstein College of Medicine, New York, USA; Department of Genetics, Albert Einstein College of Medicine, New York, USA
| | - Barry S Rosenstein
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, USA
| | | | - Søren M Bentzen
- Department of Human Oncology, University of Wisconsin, Madison, USA.
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Isgoren AE, Saitz TR, Serefoglu EC. Erectile Function Outcomes after Robot‐Assisted Radical Prostatectomy: Is It Superior to Open Retropubic or Laparoscopic Approach? Sex Med Rev 2014; 2:10-23. [DOI: 10.1002/smrj.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Marina O, Warner J, Ye H, Grills IS, Shah C, Wallace M, Gustafson GS, Brabbins DS, Martinez AA, Krauss DJ. An age-corrected matched-pair study of erectile function in patients treated with dose-escalated adaptive image-guided intensity-modulated radiation therapy vs. high-dose-rate brachytherapy for prostate cancer. Brachytherapy 2013; 13:163-8. [PMID: 24295963 DOI: 10.1016/j.brachy.2013.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 10/04/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare erectile dysfunction (ED) after adaptive dose-escalated image-guided intensity-modulated radiotherapy (IG-IMRT) and high-dose-rate interstitial brachytherapy (HDR) monotherapy. METHODS AND MATERIALS Low- and intermediate-risk prostate cancer patients treated with IG-IMRT or HDR were matched on pretreatment ED, age, Gleason score, T-stage, and prostate specific antigen. Patients who received androgen deprivation therapy were excluded. ED was graded by Common Terminology Criteria for Adverse Events v4. Actuarial rates of ED were computed by the Kaplan-Meier method. RESULTS There were 384 patients with median followup of 2.0 years (0.5-6.1) for IG-IMRT and 2.0 years (0.5-8.7) for HDR. The median IG-IMRT dose was 75.6 Gy and HDR dose 38 Gy in four fractions. For patients with no pretreatment ED, actuarial rates of requiring intervention (Grade ≥2 ED) at 3 years were 31% for IG-IMRT and 19% for HDR (p=0.23), and impotence despite medical intervention (Grade 3) were 0% for IG-IMRT and 6% for HDR (p=0.06). For patients with Grade 1 pretreatment ED, Grade ≥2 ED at 3 years were 47% for IG-IMRT and 34% for HDR (p=0.79), and Grade 3 ED were 15% in both groups (p=0.59). For patients with Grade 2 pretreatment ED, Grade 3 ED at 3 years were 22% for IG-IMRT and 37% for HDR (p=0.70). No variables were predictive of Grade ≥2 ED following treatment. CONCLUSIONS Rates of ED requiring medical intervention for both IG-IMRT and HDR are low and equivalent. Even patients with ED before treatment are likely to maintain potency with medication use at 3 years following treatment.
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Affiliation(s)
- Ovidiu Marina
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | | | - Hong Ye
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Chirag Shah
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Michelle Wallace
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Gary S Gustafson
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Donald S Brabbins
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Alvaro A Martinez
- Michigan HealthCare Professionals/21st Century Oncology, Farmington Hills, MI
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
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Keyes M, Crook J, Morton G, Vigneault E, Usmani N, Morris WJ. Treatment options for localized prostate cancer. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:1269-1274. [PMID: 24336537 PMCID: PMC3860921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe treatment options for clinically localized prostate cancer: radical prostatectomy, prostate brachytherapy, external beam radiation, and active surveillance. QUALITY OF EVIDENCE Prostate-specific antigen (PSA) outcomes presented are from non-randomized, cohort, and other comparisons trials (level II evidence). We describe PSA outcomes from Canadian centres when they are available. One small randomized controlled trial (level I evidence) in localized prostate cancer is available to compare radical prostatectomy with brachytherapy. MAIN MESSAGE Treatment choice in prostate cancer is based on initial PSA level, clinical stage of disease, and Gleason score, together with baseline urinary function, comorbidities, and patient age. In this article, we describe patients' eligibility for and the common side effects of all treatment options. Prostate brachytherapy and active surveillance have evolved as new standard treatments of localized prostate cancer. We give a brief overview of the brachytherapy procedure, side effects, and PSA outcomes across Canada, as well as active surveillance guidelines. CONCLUSION Prostate cancer treatment requires a multidisciplinary approach, with input from both urology and radiation oncology. Input from family physicians is often as important in helping guide patients through the treatment decision process.
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Affiliation(s)
- Mira Keyes
- Prostate Brachytherapy Program, BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6.
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171
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Obayomi-Davies O, Chen LN, Bhagat A, Wright HC, Uhm S, Kim JS, Yung TM, Lei S, Batipps GP, Pahira J, McGeagh KG, Collins BT, Kowalczyk K, Bandi G, Kumar D, Suy S, Dritschilo A, Lynch JH, Collins SP. Potency preservation following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2013; 8:256. [PMID: 24180317 PMCID: PMC4228383 DOI: 10.1186/1748-717x-8-256] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Erectile dysfunction after prostate radiation therapy remains an ongoing challenge and critical quality of life issue. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT impotency would be higher than conventional radiation therapy approaches. This study sought to evaluate potency preservation and sexual function following SBRT for prostate cancer. METHODS Between February 2008 and March 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. Potency was defined as the ability to have an erection firm enough for intercourse with or without sexual aids while sexual activity was defined as the ability to have an erection firm enough for masturbation and foreplay. Patients who received androgen deprivation therapy (ADT) were excluded from this study. Ninety-seven hormone-naïve men were identified as being potent at the initiation of therapy and were included in this review. All patients were treated to 35-36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Prostate specific antigen (PSA) and total testosterone levels were obtained pre-treatment, every 3 months for the first year and every 6 months for the subsequent year. Sexual function was assessed with the Sexual Health Inventory for Men (SHIM), the Expanded Prostate Index Composite (EPIC)-26 and Utilization of Sexual Medication/Device questionnaires at baseline and all follow-up visits. RESULTS Ninety-seven men (43 low-, 50 intermediate- and 4 high-risk) at a median age of 68 years (range, 48-82 years) received SBRT. The median pre-treatment PSA was 5.9 ng/ml and the minimum follow-up was 24 months. The median pre-treatment total serum testosterone level was 11.4 nmol/L (range, 4.4-27.9 nmol/L). The median baseline SHIM was 22 and 36% of patients utilized sexual aids prior to treatment. Although potency rates declined following treatment: 100% (baseline); 68% (6 months); 62% (12 months); 57% (18 months) and 54.4% (24 months), 78% of previously potent patients had erections sufficient for sexual activity at 24 months post-treatment. Overall sexual aid utilization increased from 36% at baseline to 49% at 24 months. Average EPIC sexual scores showed a slow decline over the first two years following treatment: 77.6 (baseline); 68.7 (6 months); 63.2 (12 months); 61.9 (18 months); 59.3 (24 months). All sexual functions including orgasm declined with time. Prior to treatment, 13.4% of men felt their sexual function was a moderate to big problem which increased to 26.7% two years post treatment. Post-treatment testosterone levels gradually decreased with a median value at two year follow-up of 10.7 nmol/L. However, the average EPIC hormonal scores did not illustrate a statistically significant difference two years post-treatment. Review of the radiation doses to the penile bulb in this study, a potential marker of post-treatment sexual function, revealed that the dose was relatively low and at these low doses the percentage of the penile bulb receiving 29.5 Gy did not correlate with the development of ED. CONCLUSIONS Men undergoing SBRT monotherapy for prostate cancer report sexual outcomes comparable to those reported for conventional radiation modalities within the first 24 months after treatment. Longer follow-up is required to confirm the durability of these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
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172
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Five-year potency preservation after iodine-125 prostate brachytherapy. Int J Clin Oncol 2013; 19:940-5. [PMID: 24170247 DOI: 10.1007/s10147-013-0632-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We aimed to evaluate long-term erectile function following prostate brachytherapy, based on patient characteristics and treatment factors. METHODS Between 2003 and 2006, 665 men with localized prostate cancer were treated with (125)I permanent seed implantation. None was given adjuvant hormone therapy. Erectile function was assessed before treatment, and at 6 months, 1, 2, 3, 4 and 5 years after implantation using the Mount Sinai Erectile Function Score (MSEFS) of 0-3 (0 = no erections, 1 = erections insufficient for intercourse, 2 = suboptimal erections but sufficient for intercourse, 3 = normal erectile function). Potency was defined as score 2 or 3, and 382 men were potent before treatment. Univariate and multivariate analyses were performed on the data from these 382 patients to identify variables associated with potency preservation. RESULTS In patients who were potent before treatment, the actuarial potency preservation rate fell to 46.2 % at 6 months after brachytherapy, and then slowly recovered reaching 52.0 % at 5 years after brachytherapy. In multivariate logistic regression analysis, patient age (p = 0.04) and pre-treatment MSEFS (p < 0.001) were predictors of 5-year potency preservation. Neoadjuvant hormone therapy affected potency preservation only at 6 months after brachytherapy. CONCLUSIONS Patient age at implantation and pre-treatment erectile function are predictive factors for the development of erectile dysfunction following prostate brachytherapy.
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Gay HA, Michalski JM, Hamstra DA, Wei JT, Dunn RL, Klein EA, Sandler HM, Saigal C, Litwin M, Kuban D, Hembroff L, Chang P, Sanda MG. Neoadjuvant androgen deprivation therapy leads to immediate impairment of vitality/hormonal and sexual quality of life: results of a multicenter prospective study. Urology 2013; 82:1363-8. [PMID: 24139340 DOI: 10.1016/j.urology.2013.06.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 06/13/2013] [Accepted: 06/21/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the immediate effects of neoadjuvant androgen deprivation therapy (NADT) on health-related quality of life (HRQOL) among patients undergoing radiation therapy (RT) for newly diagnosed prostate cancer. METHODS The Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium is a prospective multi-institutional study. HRQOL is measured with the Expanded Prostate Cancer Index Composite-26 questionnaire. Differences in patient-reported HRQOL were observed between pretreatment and 2 months after NADT start (and before definitive RT) with significant differences evaluated by paired t test. RESULTS From among 450 patients who completed the Expanded Prostate Cancer Index Composite-26 before and 2 months after NADT start, 71 received NADT before proceeding with definitive RT. Patients receiving NADT experienced significant impairment in vitality/hormonal (P <.0001) and sexual (P <.0001) HRQOL after NADT initiation. The mean ± standard deviation vitality/hormonal score fell from an average of 94.1 ± 9.7 before NADT to 78.7 ± 16.3 two months after NADT initiation; and sexual HRQOL fell from a mean of 51.7 ± 31.1 pretreatment to 32.3 ± 26.1 after NADT initiation. Both these HRQOL domain changes exceeded the thresholds for clinical significance. Patients receiving NADT also experienced a significant impairment in urinary continence (P = .024), although this difference did not meet the criteria for clinical significance. CONCLUSION In this analysis, patients receiving NADT experience significant impairment in sexual and vitality/hormonal HRQOL even before starting definitive RT. The significant effect of this therapy on HRQOL needs to be considered before initiating NADT in men where there is no clear evidence of clinical benefit.
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Affiliation(s)
- Hiram Alberto Gay
- Department of Radiation Oncology, Washington University in Saint Louis, MO.
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Katoh H, Tsuji H, Ishikawa H, Kamada T, Wakatsuki M, Hirasawa N, Suzuki H, Akakura K, Nakano T, Shimazaki J, Tsujii H. Health-related quality of life after carbon-ion radiotherapy for prostate cancer: A 3-year prospective study. Int J Urol 2013; 21:370-5. [DOI: 10.1111/iju.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/04/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroyuki Katoh
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
- Gunma Heavy-ion Medical Center; Gunma University; Maebashi Gunma Japan
| | - Hiroshi Tsuji
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Hitoshi Ishikawa
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
- Gunma Heavy-ion Medical Center; Gunma University; Maebashi Gunma Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Masaru Wakatsuki
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Naoki Hirasawa
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Hiroyoshi Suzuki
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Koichiro Akakura
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Takashi Nakano
- Gunma Heavy-ion Medical Center; Gunma University; Maebashi Gunma Japan
| | - Jun Shimazaki
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
| | - Hirohiko Tsujii
- Research Center for Charged Particle Therapy; National Institute of Radiological Sciences; Inage Chiba Japan
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Chipman JJ, Sanda MG, Dunn RL, Wei JT, Litwin MS, Crociani CM, Regan MM, Chang P. Measuring and predicting prostate cancer related quality of life changes using EPIC for clinical practice. J Urol 2013; 191:638-45. [PMID: 24076307 DOI: 10.1016/j.juro.2013.09.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We expanded the clinical usefulness of EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) by evaluating its responsiveness to health related quality of life changes, defining the minimally important differences for an individual patient change in each domain and applying it to a sexual outcome prediction model. MATERIALS AND METHODS In 1,201 subjects from a previously described multicenter longitudinal cohort we modeled the EPIC-CP domain scores of each treatment group before treatment, and at short-term and long-term followup. We considered a posttreatment domain score change from pretreatment of 0.5 SD or greater clinically significant and p ≤ 0.01 statistically significant. We determined the domain minimally important differences using the pooled 0.5 SD of the 2, 6, 12 and 24-month posttreatment changes from pretreatment values. We then recalibrated an EPIC-CP based nomogram model predicting 2-year post-prostatectomy functional erection from that developed using EPIC-26. RESULTS For each health related quality of life domain EPIC-CP was sensitive to similar posttreatment health related quality of life changes with time, as was observed using EPIC-26. The EPIC-CP minimally important differences in changes in the urinary incontinence, urinary irritation/obstruction, bowel, sexual and vitality/hormonal domains were 1.0, 1.3, 1.2, 1.6 and 1.0, respectively. The EPIC-CP based sexual prediction model performed well (AUC 0.76). It showed robust agreement with its EPIC-26 based counterpart with 10% or less predicted probability differences between models in 95% of individuals and a mean ± SD difference of 0.0 ± 0.05 across all individuals. CONCLUSIONS EPIC-CP is responsive to health related quality of life changes during convalescence and it can be used to predict 2-year post-prostatectomy sexual outcomes. It can facilitate shared medical decision making and patient centered care.
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Affiliation(s)
- Jonathan J Chipman
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Martin G Sanda
- Department of Urology, Emory University, Atlanta, Georgia
| | - Rodney L Dunn
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - John T Wei
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Mark S Litwin
- David Geffen School of Medicine and Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California
| | - Catrina M Crociani
- Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Meredith M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Peter Chang
- Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Pavlovich CP, Levinson AW, Su LM, Mettee LZ, Feng Z, Bivalacqua TJ, Trock BJ. Nightly vs on-demand sildenafil for penile rehabilitation after minimally invasive nerve-sparing radical prostatectomy: results of a randomized double-blind trial with placebo. BJU Int 2013; 112:844-51. [PMID: 23937708 DOI: 10.1111/bju.12253] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To clarify the role of phosphodiesterase type 5 (PDE5) inhibitors in post-prostatectomy penile rehabilitation (PPPR). To compare nightly and on-demand use of PDE5 inhibitors after nerve-sparing minimally invasive radical prostatectomy (RP). PATIENTS AND METHODS We conducted a single-institution, double-blind, randomized controlled trial of nightly vs on-demand 50-mg sildenafil citrate after nerve-sparing minimally invasive RP. A total of 100 preoperatively potent men, aged <65 years, with scores on the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) ≥26, underwent nerve-sparing surgery. The patients were randomized to either nightly sildenafil and on-demand placebo (nightly sildenafil group), or on-demand sildenafil and nightly placebo (on-demand sildenafil group; maximum on-demand dose six tablets/month) for 12 months. Patients then underwent a 1-month washout period. Validated measures of erectile function (IIEF-EF score and the Expanded Prostate Cancer Index Composite [EPIC]) were compared between treatment groups over the entire 13-month time course, using multivariable mixed linear regression models. RESULTS The treatment groups were well matched preoperatively (mean age 54.3 vs 54.6 years, baseline IIEF-EF score 29.4 vs 29.3, for the nightly vs the on-demand sildenafil groups, respectively). No significant differences were found in erectile function between treatments (nightly vs on-demand sildenafil) at any single timepoint after RP, after adjusting for potential confounding factors. When evaluated over all timepoints simultaneously, no significant effects of treatment group (nightly vs on-demand sildenafil) were found on recovery of potency, as assessed by absolute IIEF-EF scores (P = 0.765), on percentage of men returning to an IIEF-EF score >21 (P = 0.830), or on IIEF-EF score recovery to a percentage of baseline value (P = 0.778). When evaluated over all timepoints simultaneously, no significant effects of treatment group were found on secondary endpoints such as assessment of potency (including EPIC item 59 response 'erections firm enough for intercourse'), attempted intercourse frequency or confidence. CONCLUSIONS Erectile recovery up to 1 year after RP does not differ between previously potent men who use sildenafil nightly compared to on-demand. This trial does not support chronic nightly sildenafil as being any better than on-demand sildenafil for use in penile rehabilitation after nerve-sparing minimally invasive RP.
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Affiliation(s)
- Christian P Pavlovich
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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177
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Eroticization as a factor influencing erectile dysfunction treatment effectiveness. Int J Impot Res 2013; 26:1-6. [PMID: 23823215 DOI: 10.1038/ijir.2013.29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 04/24/2013] [Accepted: 06/04/2013] [Indexed: 11/09/2022]
Abstract
We review both the medical and psychosocial literature on factors influencing male potency in order to better understand why erectile dysfunction (ED) treatments, PDE5 drugs in particular, are abandoned when otherwise effective. We incorporate anecdotal data from websites and list serves dedicated to helping patients deal with iatrogenic ED. Our goal is to distinguish between ED treatments that are medicalized versus eroticized, and how partner participation may influence their effectiveness. Recently it has been shown that ED treatment effectiveness is aided by the involvement of the patient's partner. This permits an erotic association between the partner and the ED 'aid'. We extend this idea to suggest that having the partner involved as early as possible in the discussion of treatment, and their presence at the time of prescription, should improve ED aid effectiveness. Eroticization of ED aids shifts the focus from a perceived disability of the patient toward the sexual pleasure provided by the partner. We further suggest that ED aids used without the partner's knowledge will undermine intimacy and ultimately the treatment's effectiveness. Unpartnered patients should be advised about the importance of informing potential partners about their use of such aids, as openness and honesty may increase intimacy in the long run.
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Glass AS, Cowan JE, Fuldeore MJ, Cooperberg MR, Carroll PR, Kenfield SA, Greene KL. Patient Demographics, Quality of Life, and Disease Features of Men With Newly Diagnosed Prostate Cancer: Trends in the PSA Era. Urology 2013; 82:60-5. [DOI: 10.1016/j.urology.2013.01.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/03/2013] [Accepted: 01/22/2013] [Indexed: 10/26/2022]
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179
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180
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Teloken PE, Mulhall JP. Erectile Function Following Prostate Cancer Treatment: Factors Predicting Recovery. Sex Med Rev 2013; 1:91-103. [PMID: 27784588 DOI: 10.1002/smrj.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer represents the most common nonskin malignancy encountered in men, and the excellent long-term survival achieved in the majority of patients has allowed more attention to be given to the side effects associated with its treatment. Erectile function is one of the main concerns of patients when considering treatment options for prostate cancer. Not surprisingly, post-treatment sexual function is closely related to outcome satisfaction and has long-lasting effects on quality of life. Radical prostatectomy is currently the most commonly employed therapy for prostate cancer. Conflicting rates of erectile dysfunction have been reported after surgery, owing not only to different surgical techniques but also because of dissimilar patient populations and definitions. Providing accurate information to individual patients in regards to their chances of recuperating the ability to have intercourse after treatment is important not only because it allows patients to make informed decisions but also because it has the potential to reduce treatment dissatisfaction. This article mainly focuses on discussing predictors of erectile function after radical prostatectomy. Patient factors, surgical aspects, including comparisons between open, laparoscopic, and robotic approaches, and postoperative management issues that impact sexual outcomes are evaluated. Prediction models combining multiple factors are described. The definition and chronology of erectile function recovery and impact of sexual function on quality of life after surgery are also discussed. Teloken PE and Mulhall JP. Erectile function following prostate cancer treatment: Factors predicting recovery. Sex Med Rev 2013;1:91-103.
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Affiliation(s)
- Patrick E Teloken
- Department of Urology, Sir Charles Gaidner Hospital, Perth, Australia
| | - John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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181
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Roach M, Thomas K. Overview of randomized controlled treatment trials for clinically localized prostate cancer: implications for active surveillance and the United States preventative task force report on screening? J Natl Cancer Inst Monogr 2013; 2012:221-9. [PMID: 23271777 DOI: 10.1093/jncimonographs/lgs039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Prostate cancer and its management have been intensely debated for years. Recommendations range from ardent support for active screening and immediate treatment to resolute avoidance of screening and active surveillance. There is a growing body of level I evidence establishing a clear survival advantage for treatment of subsets of patients with clinically localized prostate cancer. This chapter presents a review of these randomized controlled trials. We argue that an understanding of this literature is relevant not only to those considering active surveillance but also to those evaluating the merits of screening. In addition, a number of important evidence-based conclusions concerning what should and should not be done can be gleaned from these trials.
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Affiliation(s)
- Mack Roach
- UCSF-Helen Diller Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1708, USA.
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182
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Rivin del Campo E, Thomas K, Weinberg V, Roach M. Erectile dysfunction after radiotherapy for prostate cancer: a model assesing the conflicting literature on dose–volume effects. Int J Impot Res 2013; 25:161-5. [DOI: 10.1038/ijir.2013.28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/26/2013] [Accepted: 05/08/2013] [Indexed: 11/09/2022]
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A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy. Prostate Cancer 2013; 2013:810715. [PMID: 23862066 PMCID: PMC3703796 DOI: 10.1155/2013/810715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/22/2013] [Accepted: 06/05/2013] [Indexed: 11/20/2022] Open
Abstract
Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU) technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB) during robotic prostatectomy (RARP). Materials and Methods. Nine patients with normal preoperative potency and scheduled for a bilateral nerve-sparing procedure were prospectively enrolled. LDU was used to measure arterial flow at 6 anatomic locations alongside the prostate, and signal intensity was evaluated by 4 independent reviewers. Measurements were made before and after NVB dissection. Modifications in nerve-sparing procedure due to LDU use were recorded. Postoperative erectile function was assessed. Fleiss Kappa statistic was used to evaluate inter-rater agreement for each of the 12 measurements. Results. Analysis of Doppler signal intensity showed maintenance of flow in 80% of points assessed, a decrease in 16%, and an increase in 4%. Plane of NVB dissection was altered in 5 patients (56%) on the left and in 4 patients (44%) on the right. There was good inter-rater reliability for the 4 reviewers. Use of the probe did not significantly increase operative time or result in any complications. Seven (78%) patients had recovery of erections at time of the 8-month follow-up visit. Conclusions. LDU is a safe, easy to use, and effective method to identify local vasculature and anatomic landmarks during RARP, and can potentially be used to achieve greater nerve preservation.
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184
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Chambers SK, Schover L, Nielsen L, Halford K, Clutton S, Gardiner RA, Dunn J, Occhipinti S. Couple distress after localised prostate cancer. Support Care Cancer 2013; 21:2967-76. [PMID: 23756617 DOI: 10.1007/s00520-013-1868-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/21/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND The experience of the diagnosis of prostate cancer is distressing for both men and their partners. The present study describes the prevalence of psychological distress in men with prostate cancer and their partners, and the predictors of adjustment outcomes. METHODS/DESIGN A cross-sectional survey of 189 prostate cancer patients who were scheduled for or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic variables, masculine self-esteem and social intimacy, psychological adjustment and quality of life. RESULTS Overall, patients and partners reported low distress; however, female partners were more anxious with 36 % reporting mild to severe anxiety. For men, masculine self-esteem and time since diagnosis were most strongly related to mental health status; urinary bother most influenced physical quality of life. For female partners, the man's psychological distress and his sexual bother were most strongly related to her mental health status; higher social intimacy was most strongly associated with physical quality of life. CONCLUSION The correlates of distress after the diagnosis of prostate cancer differ between patients and female partners. For men, masculine self-esteem may be most crucial, whereas for women, her partner's level of distress may matter most. Research to better understand these interactions is needed.
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185
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Del Mar CB, Glasziou PP, Hirst GH, Wright RG, Hoffmann TC. Should we screen for prostate cancer? A re‐examination of the evidence. Med J Aust 2013; 198:525-7. [DOI: 10.5694/mja12.11576] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 03/19/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Chris B Del Mar
- Bond University, Gold Coast, QLD
- Royal Australian College of General Practitioners Red Book Committee, Melbourne, VIC
| | | | - Geoffrey H Hirst
- Department of Urology and Continence, Mater Health Services, Brisbane, QLD
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186
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The “PROCAINA (PROstate CAncer INdication Attitudes) Project” (Part II) — A survey among Italian radiation oncologists on radical radiotherapy in prostate cancer. Radiol Med 2013; 118:1220-39. [DOI: 10.1007/s11547-013-0925-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/27/2012] [Indexed: 01/01/2023]
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187
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Hennequin C, Cormier L, Richaud P, Bastide C, Beuzeboc P, Fromont G, Mongiat-Artus P, Peyromaure M, Ploussard G, Renard-Penna R, Rozet F, Soulié M, Salomon L. Curiethérapie exclusive du cancer de la prostate par implants permanents : indications et résultats. Revue du CC-AFU. Prog Urol 2013; 23:378-85. [DOI: 10.1016/j.purol.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 11/27/2022]
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188
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Dietary supplements and prostate cancer: a systematic review of double-blind, placebo-controlled randomised clinical trials. Maturitas 2013; 75:125-30. [PMID: 23567264 DOI: 10.1016/j.maturitas.2013.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 03/07/2013] [Accepted: 03/10/2013] [Indexed: 11/22/2022]
Abstract
Dietary supplements are popular among patients with prostate cancer (PC). The objective of this systematic review was to critically examine double-blind, placebo-controlled randomised clinical trials (RCTs) of non-herbal dietary supplements and vitamins (NHDS) for evidence that prostate specific antigen (PSA) levels were reduced in PC patients. Five databases were searched from their inception through December 2012 to identify studies that met our inclusion criteria. Methodological quality was independently assessed by two reviewers using the Cochrane tool. Eight RCTs met the eligibility criteria and were of high methodological quality. The following supplements were tested: isoflavones (genistein, daidzein, and glycitein), minerals (Se) or vitamins (vitamin D) or a combination of antioxidants, bioflavonoids, carotenoids, lycopenes, minerals (Se, Zn, Cu, and Mg), phytoestrogens, phytosterols, vitamins (B2, B6, B9, B12, C, and E), and other substances (CoQ10 and n-acetyl-l cysteine). Five RCTs reported no significant effects compared with placebo. Two RCTs reported that a combination of antioxidants, isoflavones, lycopenes, minerals, plant oestrogens and vitamins significantly decreased PSA levels compared with placebo. One RCT did not report differences in PSA levels between the groups. In conclusion, the hypothesis that dietary supplements are effective treatments for PC patients is not supported by sound clinical evidence. There are promising data for only two specific remedies, which contained a mixture of ingredients, but even for these supplements, additional high quality evidence is necessary before firm recommendations would be justified.
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189
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Huyghe E, Delaunay B, Njomnang Soh P, Delannes M, Walschaerts M, Delavierre D, Soulie M, Bachaud JM. Proposal for a predictive model of erectile function after permanent 125I prostate brachytherapy for localized prostate cancer. Int J Impot Res 2013; 25:121-6. [DOI: 10.1038/ijir.2013.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 11/23/2012] [Accepted: 01/16/2013] [Indexed: 11/09/2022]
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190
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Harris CR, Punnen S, Carroll PR. Men with low preoperative sexual function may benefit from nerve sparing radical prostatectomy. J Urol 2013; 190:981-6. [PMID: 23410984 DOI: 10.1016/j.juro.2013.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We determined the effect of nerve sparing radical prostatectomy on sexual and urinary function in men at various levels of pretreatment sexual function. MATERIALS AND METHODS Men in the CaPSURE™ (Cancer of the Prostate Strategic Urologic Research Endeavor) database who underwent radical prostatectomy and had baseline and 2-year posttreatment UCLA-PCI sexual function and urinary function scores were selected. Nerve sparing was categorized as bilateral, unilateral or none and the level of pretreatment sexual function was divided into quartiles. The cohort was divided into subgroups of nerve sparing technique and pretreatment sexual function. Differences between sexual function and urinary function among subgroups were determined. A test of interaction was performed between preoperative sexual function and degree of nerve sparing on postoperative sexual function and urinary function scores. RESULTS A total of 1,322 patients met the study inclusion criteria. Median patient age was 61 years (range 41 to 79). Bilateral, unilateral and no nerve sparing procedures were performed in 899, 200 and 223 men, respectively. The effects of nerve sparing on sexual function differed among the quartiles of preoperative sexual function (p <0.01). Nerve sparing did not have an effect on the sexual function of men in the lowest quartile of preoperative sexual function score (p = 0.15) but did have a significant beneficial effect on sexual function in the higher 3 quartiles (p = 0.04, p <0.01 and p <0.01, respectively). Alternatively, nerve sparing improved urinary function in men in the lowest quartile of baseline sexual function. CONCLUSIONS Nerve sparing radical prostatectomy results in better sexual function outcomes than no nerve sparing in most men except those with little baseline function. Urinary function was positively impacted in all men. Men who are suitable candidates for nerve preservation may benefit from nerve sparing surgery. Poorer baseline sexual function should not exclude these men from such surgery.
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Affiliation(s)
- Catherine R Harris
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-1695, USA.
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191
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Chung E, Brock G. Sexual Rehabilitation and Cancer Survivorship: A State of Art Review of Current Literature and Management Strategies in Male Sexual Dysfunction Among Prostate Cancer Survivors. J Sex Med 2013; 10 Suppl 1:102-11. [DOI: 10.1111/j.1743-6109.2012.03005.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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192
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Prabhu V, Lee T, McClintock TR, Lepor H. Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer. Rev Urol 2013; 15:161-177. [PMID: 24659913 PMCID: PMC3922321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many clinically localized prostate cancers that are diagnosed today are low risk, and prevention of disease-specific mortality may only be realized decades after treatment. Radical prostatectomy (RP) may adversely impact health-related quality of life (HRQOL) by causing both transient or permanent urinary incontinence and erectile dysfunction. In contrast, RP may also improve HRQOL via relief of lower urinary tract symptoms in men suffering from these symptoms prior to surgery. Because the average man treated for prostate cancer has a life expectancy of approximately 14 years, it is imperative to consider the long-term impact of RP on both survival and HRQOL in treatment decision making. This comprehensive literature review examines short-, intermediate-, and long-term HRQOL following RP. In addition, the long-term results of RP are compared with other treatment modalities for treating clinically localized prostate cancer.
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Affiliation(s)
- Vinay Prabhu
- Department of Urology, New York University School of Medicine, New York, NY
| | - Ted Lee
- Department of Urology, New York University School of Medicine, New York, NY
| | - Tyler R McClintock
- Department of Urology, New York University School of Medicine, New York, NY
| | - Herbert Lepor
- Department of Urology, New York University School of Medicine, New York, NY
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193
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Keyes M, Crook J, Morris WJ, Morton G, Pickles T, Usmani N, Vigneault E. Canadian prostate brachytherapy in 2012. Can Urol Assoc J 2013; 7:51-8. [PMID: 23671495 PMCID: PMC3650818 DOI: 10.5489/cuaj.218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy.
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Affiliation(s)
- Mira Keyes
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC
| | - Juanita Crook
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Kelowna, BC
- Department of Radiation Oncology, Princes Margaret Hospital, Toronto, ON
| | - W. James Morris
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Toronto, ON
| | - Tom Pickles
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC
| | - Nawaid Usmani
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - Eric Vigneault
- Quebec University Hospital l’Hotel-Dieu de Quebec, Quebec City, QC
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194
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Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy. Curr Opin Urol 2013; 23:88-94. [DOI: 10.1097/mou.0b013e32835b6602] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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195
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Schroeck FR, Jacobs BL, Hollenbeck BK. Understanding variation in the quality of the surgical treatment of prostate cancer. Am Soc Clin Oncol Educ Book 2013:278-83. [PMID: 23714522 PMCID: PMC7010404 DOI: 10.14694/edbook_am.2013.33.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
More than 80% of men with prostate cancer undergo active treatment, which can be associated with significant morbidity. Outcomes of surgical treatment vary widely depending on who treated the patient and where the patient was treated, implying that there is room for improvement. Factors influencing outcomes include patient characteristics as well as some measure of procedure volume. Although relationships between volume and outcomes for prostatectomy can most likely be explained by differences between surgeons (e.g., experience, technical skill), the hospital environment (e.g., team communication, safety culture) has the potential to either amplify or dampen the effects. Although most patient factors are immutable, these other aspects of surgical care and the delivery environment provide opportunities for quality improvement. Collaborative quality improvement initiatives may prove to be an important vehicle for achieving better prostate cancer care. These grass roots organizations, driven largely by urologists dedicated to providing prostate cancer care, have had initial successes in improving some aspects of quality in prostate cancer care, including reducing unwarranted use of imaging and perioperative morbidity. However, much of the variation in functional outcomes after prostate cancer surgery arises from differences in technical skill. Evaluating and improving intraoperative surgeon performance will inevitably be challenging, as they require acquisition and interpretation of data collected in the operating room. To this end, several methods have been described to objectively assess what happens in the operating room.
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Affiliation(s)
- Florian R Schroeck
- From the Divisions of Health Services Research and Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI
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196
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Lavery HJ, Levinson AW, Hobbs AR, Sebrow D, Mohamed NE, Diefenbach MA, Samadi DB. Baseline Functional Status May Predict Decisional Regret Following Robotic Prostatectomy. J Urol 2012; 188:2213-8. [DOI: 10.1016/j.juro.2012.08.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Hugh J. Lavery
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Adam W. Levinson
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Adele R. Hobbs
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Dov Sebrow
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Nihal E. Mohamed
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | | | - David B. Samadi
- Department of Urology, Mount Sinai Medical Center, New York, New York
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197
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Ganzer R, Stolzenburg JU, Wieland WF, Bründl J. Anatomic Study of Periprostatic Nerve Distribution: Immunohistochemical Differentiation of Parasympathetic and Sympathetic Nerve Fibres. Eur Urol 2012; 62:1150-6. [DOI: 10.1016/j.eururo.2012.03.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 03/20/2012] [Indexed: 11/30/2022]
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198
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Prabhu V, Alukal JP, Laze J, Makarov DV, Lepor H. Long-term satisfaction and predictors of use of intracorporeal injections for post-prostatectomy erectile dysfunction. J Urol 2012; 189:238-42. [PMID: 23174252 DOI: 10.1016/j.juro.2012.08.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Indexed: 01/22/2023]
Abstract
PURPOSE Intracorporeal injections have low use rates and high discontinuation rates. We examined factors associated with intracorporeal injection use, long-term satisfaction with intracorporeal injection and reasons for discontinuation in men treated with radical prostatectomy. MATERIALS AND METHODS Between October 2000 and September 2003, 731 men who underwent open radical retropubic prostatectomy were enrolled in a prospective outcomes study. The 8-year followup evaluation included the UCLA-PCI, and a survey capturing intracorporeal injection use, satisfaction and reasons for discontinuation. Logistic regression was used to determine associations between intracorporeal injection use and preoperative variables. RESULTS The 8-year self-assessment was completed by 368 (50.4%) men. Of these men 140 (38%) indicated prior or current intracorporeal injection use, with only 34 using intracorporeal injection at 8 years. Overall, 44% of the men were satisfied with intracorporeal injections. Reasons for discontinuation included dislike (47%), pain (33%), return of erection (19%), inefficacy (14%) and no partner (6%). Men trying intracorporeal injections had greater preoperative UCLA-PCI sexual function scores (75.2 vs 65.62, p = 0.00005) as well as greater decreases in this score at 3 months (p = 0.0002) and 2 years (p = 0.003). Higher preoperative sexual function scores were independently associated with the use of intracorporeal injections in a model adjusted for age, marital status, nerve sparing status and body mass index (OR 1.021, 95% CI 1.008-1.035). CONCLUSIONS Men pursuing intracorporeal injections have better baseline erectile function and experience greater deterioration in erectile function during the early postoperative period. Despite the high efficacy of injections, many men discontinue intracorporeal injections due to dislike or discomfort. Satisfaction rates for intracorporeal injections indicate their long-term role in restoring sexual function in men with post-prostatectomy erectile dysfunction.
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Affiliation(s)
- Vinay Prabhu
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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199
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Penson DF, Barocas DA, Fleshner N, Sanda MG, Greenfield S. Outcomes session. Urol Oncol 2012; 30:952-5. [DOI: 10.1016/j.urolonc.2012.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 07/20/2012] [Indexed: 10/27/2022]
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200
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The natural history of penile length after radical prostatectomy: a long-term prospective study. Urology 2012; 80:1293-6. [PMID: 23102441 DOI: 10.1016/j.urology.2012.07.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/15/2012] [Accepted: 07/07/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the penile length after radical prostatectomy (RP) in a long-term follow-up. MATERIALS AND METHODS We evaluated prospectively the penile length of 105 patients with localized prostate cancer treated by open RP. Participants using therapy for penile rehabilitation were excluded from statistical analysis. Measurements of the stretched penis were taken preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months postoperatively. The International Index of Erectile Function-Erectile Function (IIEF-EF) questionnaire was used to evaluate erectile function. The penile anthropometric measure used was the stretched length of the flaccid penis, from the pubopenile skin angle to the end of the glans, after the prepubic fat was depressed under maximum manual traction. RESULTS The mean stretched penile length 3 months after RP decreased an average of 1 cm from baseline (P <.001). This mean difference persisted until 24 months. At 36 months, the penile length differed 0.6 cm. At 48 months (-0.3 cm) and 60 months (+0.4 cm), the mean differences in penile length before and after RP were not significant (P = .080 and P = .065, respectively). Erectile function was a predictor for early return of penile length. CONCLUSION Nearly 1 cm of penile shortening after RP may be expected up to 12 months. However, a trend toward recovery of penile length occurs after 24 months of follow-up and is completely re-established after 48 months. The preserved erectile function after RP is a predictor for penile length recovery.
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