Post-radical prostatectomy erectile function recovery lower than reported

Key Points

New York-Post-radical prostatectomy erectile function recovery is much lower than physician-reported rates, a study from the Memorial Sloan-Kettering Cancer Center, New York, indicates.

Acting on anecdotal evidence, the authors assessed the erectile function of 250 men (average age, 59±8 years) pre- and post-radical prostatectomy. The authors found that only 18% of the entire sample reported penile rigidity sufficient for penetration at 24 months post-op. Only 13% with penetration-sufficient rigidity at baseline reported a similar rigidity at 24 months post-op.

"These figures are significantly lower than most reported erectile function recovery rates, and men pre-radical prostatectomy should be educated as to the meaning of erectile function recovery," wrote the study's authors: Christian J. Nelson, PhD, Peter Scardino, MD, and John P. Mulhall, MD.

In addition, 186 men (74%) had a baseline erectile function domain (EFD) score of ≥24. At 24 months post-op, 60 (32%) of these men attained an EFD score of ≥24. Well over half (60%) of these men used phosphodiesterase type-5 inhibitor therapy to achieve results. Only 24 men (13% of the initial study cohort) with a baseline EFD ≥24 returned to that score at 24 months post-op without therapeutic intervention.

"I think there are two aspects to the study," Dr. Nelson told Urology Times. "In terms of data, the take-home message is that only a small percentage of men are going to get back to the way they were before the surgery without therapy, especially if they are over 60.

"What is not in the data are patient expectations and the adjustments they have to make after surgery."

Dr. Nelson explained that prior to undergoing radical prostatectomy, patients were focused on the disease itself and the effects of the surgery. Following the procedure, when the idea of cancer no longer occupied their minds, they would begin to express disappointment about their erectile function.

"This study offers an opportunity to frame the issue of ED in a way that puts it in context and allows the patient to understand it. For instance, before the procedure, the patient should be told, 'What we need to do is cure your cancer. Unfortunately, there are some consequences that come with that and one of them is that there is going to be an impact on your erectile function,' " said Dr. Nelson, who presented the findings at the 2011 AUA annual meeting in Washington.