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Quality of life, sexual function and decisional regret after Prostate surgery

BERKELEY, CA (UroToday.com) - Newswise — Sexual function is one of the most important factors impacting quality of life (QoL) after radical prostatectomy (RP).

Along with other potential factors, sexual function after RP influences whether a patient regrets their decision to have had surgery. Joyce Davison and colleagues at the University of British Columbia studied these issues and report the findings in the online version of the BJU International.

The study group consisted of 155 consecutive men undergoing RP for clinically localized CaP. Of these, 130 completed baseline demographic, social, and clinical assessment prior to RP and one year afterwards. Sexual function, QoL, and decisional regret were measured and scored. Neoadjuvant androgen deprivation was given to 39 patients.

Mean patient age was 62 years, 71% had a high school education or higher, 85% were married, and 56% were employed either part- or full-time.

An active role in treatment decision-making with their physician was reported by 84%, 11% reported a collaborative role, and 5% a passive role. Using SHIM scores 77% reported having moderate to severe erectile dysfunction one year after surgery although, 24% reported this pre-operatively. Men who received neoadjuvant androgen deprivation reported significantly lower SHIM scores than men who did not received it.

Although scores showed no decrease in sexual interest after RP many men felt less masculine, were less sexually active, had significantly less sexual enjoyment, had difficulty in getting and maintaining an erection, reported ejaculation problems, and being more uncomfortable being sexually intimate. 4% of men expressed decisional regret over having had surgery. This was correlated with changes in QoL, decreased social functioning, increased pain and financial difficulties. In multivariate analysis, the effect on decisional regret scores was not impacted by role assumed in treatment decision making, age, educational attainment, SHIM score, treatment-related symptoms, sexuality, and neoadjuvant androgen deprivation therapy.

In conclusion, few patients regretted their decision to have RP one year after surgery although most men had moderate to severe ED.

Davison BJ, So AI and Goldenberg SL

BJU Int. ePub, June 19, 2007
doi: 10.1111/j.1464-410X.2007.07043.x