Five year Expanded Prostate cancer Index Composite‐based quality of life outcomes after prostatectomy for localized prostate cancer

• Published in: BJU international 2011-02, Vol.107 (4), p.585-590
• Main Authors: Parker, Walter R., Wang, Rou, He, Chang, Wood Jr, David P.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; EPIC; Epidemiologic Methods; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; prostate cancer; Prostatectomy - adverse effects; Prostatectomy - rehabilitation; Prostatic Neoplasms - psychology; Prostatic Neoplasms - rehabilitation; Prostatic Neoplasms - surgery; Quality of Life; Recovery of Function; Sexual Dysfunction, Physiological - etiology; Sexual Dysfunction, Physiological - psychology; sexual recovery; Tumors; Tumors of the urinary system; Urinary Incontinence - etiology; Urinary Incontinence - psychology; urinary recovery; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09579.x

Study Type – Therapy (outcomes research) Level of Evidence 2c What’s known on the subject? and What does the study add? Previous studies typically assessed early outcomes (≤2 years) after prostatectomy often without individual pre‐operative scores for comparison. Our study followed patients and provides long term results, five years post‐operatively, and compared results to patients own baseline scores across all domains within EPIC. OBJECTIVE To document the Expanded Prostate cancer Index Composite (EPIC) results for men followed for 5 years after radical prostatectomy. PATIENTS AND METHODS EPIC and demographic information were prospectively obtained from 434 patients who received questionnaires preoperatively and 1, 4, 12, 24, 36, 48 and 60 months postoperatively. Paired t‐tests compared scores at individual time points. Percentage return to baseline was calculated at all postoperative time points and multivariate analyses evaluated postoperative trends. RESULTS The mean age of patients was 63.4 years. Mean urinary function and incontinence worsen after prostatectomy, with recovery stable 12 months after surgery. Mean urinary bother returned to baseline by 4 months post‐prostatectomy. Some 55.8% and 77.5% of patients return to their urinary function and bother baselines, respectively, 1 year after surgery. Mean sexual function and bother both declined after surgery, with new stable baselines achieved by 24 and 36 months post‐prostatectomy, respectively. Of the patients, 24.2% returned to their sexual function baseline by 24 months. No postoperative improvement was noted in mean sexual bother until the 12 months post‐prostatectomy. Of the patients, 36.8% returned to their sexual bother baseline by 36 months. Minimal change was noted in the bowel and hormonal domains. CONCLUSIONS Mean urinary function and incontinence did not recover to preoperative baseline after prostatectomy, although it did not add distress because mean urinary bother returned to pre‐prostatectomy levels. Mean sexual function declined post‐prostatectomy, with continued recovery up to 24 months. Sexual bother recovered later but, once it reached a new baseline, the distress does not lessen with time, probably indicating an inability to adjust to their functional loss.