Svetlana Avulova1, Zhiguo Zhao2, Daniel Lee3, Li-Ching Huang2, Tatsuki Koyama2, Karen E Hoffman4, Ralph M Conwill5, Xiao-Cheng Wu6, Vivien Chen6, Matthew R Cooperberg7, Michael Goodman8, Sheldon Greenfield9, Ann S Hamilton10, Mia Hashibe11, Lisa E Paddock12, Antoinette Stroup12, Matthew J Resnick3, David F Penson3, Daniel A Barocas3. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: svetlana.avulova@vanderbilt.edu. 2. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee. 3. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas. 5. Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee. 6. School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana. 7. Department of Urology, University of California-San Francisco Medical Center, San Francisco, California. 8. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 9. Center for Health Policy Research and Department of Medicine, University of California-Irvine, Irvine, California. 10. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California. 11. Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. 12. Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
Abstract
PURPOSE: Nerve sparing contributes to the recovery of sexual and urinary function after radical prostatectomy but it may be ineffective in some patients or carry the risk of a positive surgical margin. We evaluated sexual and urinary function outcomes according to the degree of nerve sparing in patients with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: The CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study is a prospective, population based, observational study of men diagnosed with localized prostate cancer in 2011 to 2012. Patient reported sexual and urinary functions were measured using the 26-item Expanded Prostate Index Composite at baseline within 6 months after diagnosis, and 6, 12 and 36 months after enrollment. Study inclusion criteria included radical prostatectomy as primary treatment, documentation of nerve sparing status and absent androgen deprivation therapy. Nerve sparing status was defined as none, unilateral or bilateral according to the operative report. RESULTS: The final analytical cohort included 991 men. The 11 men treated with unilateral nerve sparing and the 75 treated with a nonnerve sparing procedure were grouped together. In the multivariable model there was a significant difference in the sexual function score 3 years after radical prostatectomy in the bilateral nerve sparing group compared with the unilateral and nonnerve sparing group (6.1 points, 95% CI 2.0-10.3, p = 0.004). This was more pronounced in men with high baseline sexual function (8.23 points, 95% CI 1.6-14.8, p = 0.014) but not in those with low baseline function (4.0 points, 95% CI -0.6-8.7, p = 0.090). Similar effects were demonstrated on urinary incontinence scores. CONCLUSIONS: Bilateral nerve sparing resulted in better sexual and urinary function outcomes than unilateral or nonnerve sparing but the difference was not significant in men with low baseline sexual function.
PURPOSE: Nerve sparing contributes to the recovery of sexual and urinary function after radical prostatectomy but it may be ineffective in some patients or carry the risk of a positive surgical margin. We evaluated sexual and urinary function outcomes according to the degree of nerve sparing in patients with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: The CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study is a prospective, population based, observational study of men diagnosed with localized prostate cancer in 2011 to 2012. Patient reported sexual and urinary functions were measured using the 26-item Expanded Prostate Index Composite at baseline within 6 months after diagnosis, and 6, 12 and 36 months after enrollment. Study inclusion criteria included radical prostatectomy as primary treatment, documentation of nerve sparing status and absent androgen deprivation therapy. Nerve sparing status was defined as none, unilateral or bilateral according to the operative report. RESULTS: The final analytical cohort included 991 men. The 11 men treated with unilateral nerve sparing and the 75 treated with a nonnerve sparing procedure were grouped together. In the multivariable model there was a significant difference in the sexual function score 3 years after radical prostatectomy in the bilateral nerve sparing group compared with the unilateral and nonnerve sparing group (6.1 points, 95% CI 2.0-10.3, p = 0.004). This was more pronounced in men with high baseline sexual function (8.23 points, 95% CI 1.6-14.8, p = 0.014) but not in those with low baseline function (4.0 points, 95% CI -0.6-8.7, p = 0.090). Similar effects were demonstrated on urinary incontinence scores. CONCLUSIONS: Bilateral nerve sparing resulted in better sexual and urinary function outcomes than unilateral or nonnerve sparing but the difference was not significant in men with low baseline sexual function.
Authors: Karen E Hoffman; David F Penson; Zhiguo Zhao; Li-Ching Huang; Ralph Conwill; Aaron A Laviana; Daniel D Joyce; Amy N Luckenbaugh; Michael Goodman; Ann S Hamilton; Xiao-Cheng Wu; Lisa E Paddock; Antoinette Stroup; Matthew R Cooperberg; Mia Hashibe; Brock B O'Neil; Sherrie H Kaplan; Sheldon Greenfield; Tatsuki Koyama; Daniel A Barocas Journal: JAMA Date: 2020-01-14 Impact factor: 56.272
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Authors: André N Vis; Roderick C N van den Bergh; Henk G van der Poel; Alexander Mottrie; Philip D Stricker; Marcus Graefen; Vipul Patel; Bernardo Rocco; Birgit Lissenberg-Witte; Pim J van Leeuwen Journal: BJUI Compass Date: 2021-11-09
Authors: Elin Axén; Rebecka Arnsrud Godtman; Anders Bjartell; Stefan Carlsson; Eva Haglind; Jonas Hugosson; Anna Lantz; Marianne Månsson; Gunnar Steineck; Peter Wiklund; Johan Stranne Journal: Eur Urol Open Sci Date: 2021-06-19