The Effect of Nerve Sparing Status On Sexual and Urinary Function: 3-Year Results from the CEASAR Study

Nerve sparing (NS) contributes to recovery of sexual and urinary function after radical prostatectomy (RP) but may be ineffective in some patients or risk positive surgical margin. We evaluated sexual and urinary function outcomes in prostate cancer (PCa) patients treated with RP, according to degree of NS.

The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study of men who were diagnosed with localized PCa in 2011-2012. Patient-reported sexual and urinary functions were measured using the 26-item Expanded Prostate Index Composite (EPIC) at baseline (within 6 months after diagnosis), 6, 12, and 36 months after enrollment. Inclusion criteria included RP as primary treatment, documentation of NS status and absence of androgen deprivation therapy. NS status was defined as none (NNS), unilateral (UNS) or bilateral (BNS), according to the operative report.

Final analytic cohort included 991 men. Men who had UNS (n=111) and NNS (n=75) were grouped together. In the multivariable model, there was a significant difference in sexual function scores (6.1 points [2.0, 10.3, p=0.004) 3 years after RP between BNS and UNS/NNS groups, which was more pronounced in men with high baseline sexual function (8.23 points [1.6, 14.8, p=0.014]) but not with low baseline function (4.0 points [-0.6, 8.7, p=0.090]). Similar effects were demonstrated on urinary incontinence scores.

Bilateral nerve sparing results in better sexual and urinary function outcomes than UNS or NNS, but the difference is not significant in men with low baseline sexual function.

The Journal of urology. 2017 Dec 15 [Epub ahead of print]

Svetlana Avulova, Zhiguo Zhao, Daniel Lee, Li-Ching Huang, Tatsuki Koyama, Karen E Hoffman, Ralph M Conwill, Xiao-Cheng Wu, Vivien Chen, Matthew R Cooperberg, Michael Goodman, Sheldon Greenfield, Ann S Hamilton, Mia Hashibe, Lisa E Paddock, Antoinette Stroup, Matthew J Resnick, David F Penson, Daniel A Barocas

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: ., Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN., School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana., Department of Urology, University of California, San Francisco Medical Center, San Francisco, California., Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia., Center for Health Policy Research and Department of Medicine, University of California, Irvine, California., Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California., Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah., Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.