EAU 2019: Higher Free Testosterone Predicts Faster Potency Recovery After Robot-Assisted Radical Prostatectomy

Barcelona, Spain (UroToday.com) Hypogonadism and sexual dysfunction are closely related, such that men with low testosterone are at increased risk of erectile dysfunction. In a cohort of men undergoing radical prostatectomy and in consideration of its attendant side effect of decreased sexual function, preoperative low testosterone is of significant concern. 

Ms. Linda Huynh, a clinical research coordinator at the University of California, Irvine, presented a single surgeon retrospective cohort study of 442 patients undergoing radical prostatectomy with prospectively screened free and total testosterone levels. Complimentary to the groups three other abstracts, they stratified the 442 patients into three quartiles, based on preoperative testosterone levels. Thresholds of 5.1 and 7 were used to create three groups, of which erectile function was tracked via the erections sufficient for intercourse questionnaire at 3, 9 and 15 months post-radical prostatectomy. 

Huynh and colleagues found a stepwise detriment to sexual function as free testosterone levels decreased. In particular, the group with free testosterone less than 5.1 had a significantly decreased rate of sexual function recovery at 24 months – nearly 15% lower than those with free testosterone levels between 5.1 and 7 or greater than. 

While the current study is limited in its sample size in regards to multivariate analysis, the three groups did not differ significantly in regards to clinicodemographic characteristics. Even further, the IIEF-5 scores mirrored rates of recovery of erections sufficient for intercourse. These two points lend strength to the study and suggest the need to consider testosterone replacement therapy for men undergoing radical prostatectomy. 

Written by: Linda My Huynh, a Senior Clinical Research Coordinator (Department of Urology, University of California-Irvine)  at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.