EAU 2019: Testosterone Replacement Therapy Improves Potency Recovery Following Robot-Assisted Radical Prostatectomy

Barcelona, Spain (UroToday.com) Sexual dysfunction is a significant problem for men undergoing radical prostatectomy, regardless of surgical technique, preoperative age, or baseline sexual function. Hypogonadism (i.e. a low total or free testosterone) further prevents recovery of postoperative erectile function. 

Dr. Farouk El-Khatib, a clinical research fellow from the University of California, Irvine, presented his group’s efforts for testosterone replacement therapy and potency recovery following radical prostatectomy for local prostate cancer. The primary outcome was a recovery of erections sufficient for intercourse, assessed via two questions demonstrating erections sufficient intercourse and satisfactory for intercourse. 

Dr. El-Khatib mentions the group’s rigorous criteria: preoperative normal sexual function (as defined as an IIEF-5 score between 22 and 25), preoperative hypogonadal levels of free testosterone, and strict responses to questionnaires at 3 and 24 months postoperative. Starting from a cohort of 442 men, he isolated and matched 13 men receiving testosterone replacement therapy within one year of surgery, compared to 49 men who did not. 

His results show promising data on the benefit of testosterone replacement therapy. Although the groups had similar clinicodemographic, the patients on testosterone replacement therapy were significantly more likely to have recovered erectile function by 24 months post-radical prostatectomy. This is despite having started a much lower baseline (with less than half reporting erections sufficient for intercourse at 3 months post-surgery). 

While the study is perhaps limited by a small sample size and lack of multivariate analysis, Dr. El-Khatib states that these results have broad impact for all patients undergoing radical prostatectomy. Since free and total testosterone levels are not normally screened for in men (with prostate cancer or otherwise), screening may allow for preventative measures and/or prophylactic, preoperative therapies to reduce the impact of hypogonadism on the recovery of functional outcomes.

In the discussion, Dr. El-Khatib mentions a 40-year-old benchmark for screening men, maintaining that these men should be screened from the primary care level, rather than waiting for diagnosis by a urologic specialist. 

Presented by: Farouk el-Khatib, MD, Department of Urology, University of California, Irvine, California

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