Better patient counseling needed on post-RP erectile function

There appears to be a substantial difference between what patients expect of recovery of erectile function following radical prostatectomy and what they actually experience.

The difference may put severe strain on physician-patient relationships, say researchers from Memorial Sloan-Kettering Cancer Center, New York.

First author Christian J. Nelson, PhD, reported yesterday that only 13% of men with erections sufficient for penetration before the procedure returned to that status without using medications such as phosphodiesterase type-5 inhibitors. Dr. Nelson stressed the need for appropriate pre-procedure counseling.

"It is better to give patients this information before the procedure than to try to explain it to them following the procedure," Dr. Nelson told Urology Times. He acknowledged that much of the published literature reports significantly higher recovery rates, some as high as 90%.

Acting on anecdotal evidence, Dr. Nelson and his co-authors, Peter Scardino, MD, and John P. Mulhall, MD, assessed the erectile function of 250 men (average age, 59±8 years) pre- and post-radical prostatectomy. Of the men with baseline erectile function scores ≥24 (mild to no dysfunction), about one-third (32%) regained function; however, well over half (60%) required medication to do so. Only 13% of men reporting mild to no dysfunction prior to prostatectomy reported returning to full baseline function at 24 months without medication.

Dr. Nelson stressed that these findings should be clarified with patients prior to the procedure. He observed that prior to undergoing radical prostatectomy, patients were focused on their cancer, and paid little attention to the operation’s side effects. Following the procedure, when the idea of cancer no longer occupied their minds, they would begin to express disappointment about their erectile function.

He also noted that information on the Internet and from marketing presentations of nerve-sparing procedures tended to inflate recovery of function rates.