BERKELEY, CA (UroToday.com) - Radical prostatectomy (RP) is the treatment of choice for patients with organ-confined disease and a life expectancy of more than 10 years. Generally, an age of 70 is used as a relative cutoff for strongly recommending surgery and 75 years is certainly the upper limit of acceptance for surgery. The goals of the patient are cure of his cancer (survival), preservation of potency, and preservation of continence. Elucidating the long-term impact of RP on health-related quality of life (HRQOL) is important for men choosing surgical treatment of localized prostate cancer. In our paper, we assessed long-term, patient-reported HRQOL changes and outcomes during a later phase in prostate cancer survivors who underwent RP via open retropubic approach. The present study is a second follow-up of the original 5-year longitudinal follow-up performed since 2002. A total of 120 Japanese men with prostate cancer were included in this study at follow-up of more than 5 years. Of the 120 subjects, 91 (73%) responded at a median follow-up time of 102 months (range, 85-123). Among general HRQOL domains, mental and role composite summary score remained stable throughout follow-up. At the final survey, no significant differences were observed in any of the domains compared with age-matched average scores of the general Japanese population. Although a slight tendency toward decreased urinary outcomes beyond 5 years postoperatively was observed compared with 5 years, the differences were not significant. Sexual function showed a substantially lower score just after RP and remained at a deteriorated level (p < 0.001).
This study indicates that physicians and patients involved in deciding who should undergo RP have done very well at identifying men with prostate cancer who have a great chance of benefiting from surgery. With regard to long-term disease-specific function, urinary function decreases immediately after surgery, followed by a variable recovery phase within the first 2 years. Interestingly, beyond this time, another slight age-dependent decrease in urinary function can be observed after 8 years. Potency results for identical patients showed the same initial drop, but opposite to continence, recovery of erectile function can extend beyond 2 years, again significantly associated with patient age. The decision to treat prostate cancer should be based on disease risk, life expectancy, and patient preferences. This study did not examine disease characteristics, so no comment can be made on whether patients selected for RP were appropriate based on prostate cancer risk category. In individual pre- and postoperative patient counseling, individual risk factors for postoperative
Shunichi Namiki, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
Tohoku University Graduate School of Medicine
1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
Department of Urology
Japan Community Health care Organization Sendai Hospital
3-16-1, Tsutsumi-machi, Aoba-ku, Sendai 981-8501, Japan