Preoperative counseling incorporating the best-case, worst-case, and most-likely outcome scenarios aid patients' decision making. This information is not readily available for prostate cancer counseling because most patient reported outcomes are presented as averages, which minimize individual patient experiences. Using the Expanded Prostate Index Composite (EPIC), we present data to characterize the best and worst-case after prostatectomy.
EPIC bowel, urinary irritation and continence, and sexual function scores were measured among 1418 men (stratified by baseline function) undergoing prostatectomy. Patient-level functional trajectories were modeled using a Bayesian hierarchical model. The 5-year best and worst-case outcomes were defined as the upper 95th percentile and lower 5th percentile.
At 5 years after surgery, among those with good baseline urinary continence, the best-case was a score of 100.0 (95% CrI; 100.0 - 100.0) and worst-case was 54.4 (42.2 - 63.7). Among men with good baseline sexual function undergoing nerve sparing surgery, best-case was 83.9 points (74.1 - 93.1) and worst-case was 17.6 (7.5 - 26.1). The differences between best and worst-case for bowel and urinary irritation were relatively small (11.4 and 13.6 points respectively).
Prostatectomy exerted minimal negative impact on urinary irritation and bowel function with minimal variability. There was a larger range in patient experience for urinary continence and sexual function with most patients experiencing significant functional decline. Future studies reporting best and worst-case outcomes for multiple treatment modalities may provide valuable information for shared decision making in prostate cancer treatment.
The Journal of urology. 2018 Oct 23 [Epub ahead of print]
Christopher Martin, Benjamin Haaland, Alexander E Tward, Christopher Dechet, Will Lowrance, Robert A Stephenson, Heidi Hanson, Brock O'Neil
Huntsman Cancer Institute, Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT., Division of Biostatistics, Department of Population Health Sciences, University of Utah Health, Salt Lake City, UT., Huntsman Cancer Institute, Genitourinary Malignancies Disease-Oriented Team, University of Utah Health, Salt Lake City UT., Huntsman Cancer Institute, Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT., Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT; Population Health Sciences, Huntsman Cancer Institute, Salt Lake City, UT.