Longitudinal patient-reported outcomes demonstrate continued improvements in urinary and erectile function after radical prostatectomy through 30 months
Daniel M. Frendl, MD, PhD1, Wesley H. Chou, B.A.1, Matthew F. Wszolek, MD1, Francis J. McGovern, MD1, Adam S. Feldman, MD, MPH1, Michael L. Blute, MD1, Jeffrey K. Twum-Ampofo, MD1, Marcela G. del Carmen, MD, MPH2, Marilyn Heng, MD, MPH2, Rachel C. Sisodia, MD2, Douglas M. Dahl, MD1.
1Department of Urology, Massachusetts General Hospital, Boston, MA, USA, 2Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: Patient-reported outcomes measures (PROMs) are a critical component for tracking quality of life and functional outcomes in patients. Urinary incontinence and sexual dysfunction are common adverse effects many patients experience transiently or permanently after radical prostatectomy (RP). Thus, PROMs may play a role in informing patients about expected recovery trajectories after RP. We assess long-term patient-reported return of urinary and sexual function after radical prostatectomy in routine clinical practice.
MATERIALS AND METHODS: The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire was administered electronically to all patients who underwent RP at our institution in 2016 and 2017. These questionnaires were administered preoperatively and up to 30 months postoperatively. Our primary outcomes of interest were postoperative return of urinary and sexual function. We respectively defined these outcomes as either no urinary pads or use of one pad per day without overall urinary bother, as well as either erections sufficient for intercourse or erections sufficient for masturbation/foreplay without overall sexual bother. Kaplan-Meier estimators were used to evaluate time to return of these outcomes.
RESULTS: Of 634 patients who underwent RP, we included 392 (62%) who completed ≥1 questionnaire; 184/392 (47%) had both preoperative and postoperative responses. The mean age of included patients was 62.4 years (SD 6.5), with 93% of patients having undergone a nerve-sparing surgery and 38% having pathologic extracapsular (≥T3a) disease (Table 1). At 12 months, unadjusted life table estimates for the likelihood of return to urinary continence was 55%, which improved to 88% and 98% by 24 and 30 months, respectively (Fig. 1). For patients with good baseline sexual function who underwent nerve-sparing surgery, 24% reported return to sexual function by 12 months, improving to 57% at 24 months and 71% at 30 months (Fig. 2).
CONCLUSIONS: Routine electronic solicitation of PROMs in our clinical practice revealed continued improvements in continence and sexual function up to 30 months postoperatively. These findings may help inform patients regarding typical functional recovery trajectories following RP. 
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