Urinary and Sexual Function After Radical Prostatectomy for Clinically Localized Prostate Cancer: The Prostate Cancer Outcomes Study | Oncology | JAMA | JAMA Network
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Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999.  CA Cancer J Clin.1999;9:8-31.Google Scholar
Stanford JL, Stephenson RA, Coyle LM.  et al.  Prostate Cancer Trends 1973-1995. Bethesda, Md: SEER Program, National Cancer Institute; 1999. National Institutes of Health publication 99-4543.
Steiner MS, Morton RA, Walsh PC. Impact of anatomical radical prostatectomy on urinary continence.  J Urol.1991;145:512-515.Google Scholar
Leandri P, Rossignol G, Gautier J-R, Ramon J. Radical retropubic prostatectomy: morbidity and quality of life: experience with 620 consecutive cases.  J Urol.1992;147:883-887.Google Scholar
Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1870 consecutive radical retropubic prostatectomies.  J Urol.1999;162:433-438.Google Scholar
Fowler FJ, Barry MJ, Lu-Yao G, Roman A, Wasson J, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy.  Urology.1993;42:622-629.Google Scholar
Murphy GP, Mettlin C, Menck H, Winchester DP, Davidson AM. National patterns of prostate cancer treatment by radical prostatectomy: results of a survey by the American College of Surgeons Commission on Cancer.  J Urol.1994;152:1817-1819.Google Scholar
Jonler M, Messing EM, Rhodes PR, Bruskewitz RC. Sequelae of radical prostatectomy.  Br J Urol.1994;74:352-358.Google Scholar
Braslis KG, Santa-Cruz C, Brickman AL, Soloway MS. Quality of life 12 months after radical prostatectomy.  Br J Urol.1995;75:48-53.Google Scholar
Litwin MS, Hays RD, Fink A.  et al.  Quality-of-life outcomes in men treated for localized prostate cancer.  JAMA.1995;273:129-135.Google Scholar
Fowler FJ, Barry MJ, Lu-Yao G, Wasson J, Roman A, Wennberg JE. Effect of radical prostatectomy for prostate cancer on patient quality of life: results from a Medicare survey.  Urology.1995;45:1007-1015.Google Scholar
Talcott JA, Rieker P, Clark JA.  et al.  Patient-reported symptoms after primary therapy for early prostate cancer: results of a prospective cohort study.  J Clin Oncol.1998;16:275-283.Google Scholar
Potosky AL, Harlan LC, Stanford JL.  et al.  Measuring quality of life following prostate cancer: a key consideration for assessing burden and progress.  J Natl Cancer Inst.1999;91:1719-1724.Google Scholar
Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure.  Med Care.1998;36:1002-1012.Google Scholar
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models.  Biometrika.1986;73:13-22.Google Scholar
 SUDAAN [computer program]. Release 7.5. Research Triangle Park, NC: Research Triangle Institute; 1997.
Litwin MS, Lubeck DP, Henning JM, Carroll PR. Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the CaPSURE database.  J Urol.1998;159:1988-1992.Google Scholar
Osoba D. Lessons learned from measuring health-related quality of life in oncology.  J Clin Oncol.1994;12:608-616.Google Scholar
Talcott JA, Rieker P, Propert KJ.  et al.  Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy.  J Natl Cancer Inst.1997;89:1117-1123.Google Scholar
Lim AJ, Brandon AH, Fiedler J.  et al.  Quality of life: radical prostatectomy versus radiation therapy for prostate cancer.  J Urol.1995;154:1420-1425.Google Scholar
Original Contribution
January 19, 2000

Urinary and Sexual Function After Radical Prostatectomy for Clinically Localized Prostate Cancer: The Prostate Cancer Outcomes Study

Author Affiliations

Author Affiliations: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center (Drs Stanford and Feng) and Department of Epidemiology, University of Washington (Dr Stanford), Seattle, Wash; Department of Preventive Medicine, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles (Drs Hamilton and Gilliland); New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque (Dr Gilliland); Utah Cancer Registry and Division of Urology, University of Utah School of Medicine, Salt Lake City (Dr Stephenson); Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta (Dr Eley); Division of Urology, University of Connecticut Health Sciences Center, Farmington (Dr Albertsen); National Cancer Institute, Division of Cancer Control and Prevention, Bethesda, Md (Drs Harlan and Potosky).

JAMA. 2000;283(3):354-360. doi:10.1001/jama.283.3.354

Context Patients with prostate cancer and their physicians need knowledge of treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patients.

Objective To measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer.

Design The Prostate Cancer Outcomes Study, a population-based longitudinal cohort study with up to 24 months of follow-up.

Setting Population-based cancer registries in 6 geographic regions of the United States.

Participants A total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease.

Main Outcome Measures Distribution of and change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis.

Results At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after surgery varied according to whether the procedure was nerve sparing (65.6% of non–nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve–sparing). At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age (39.0% of men aged <60 years vs 15.3%-21.7% of older men were potent at ≥18 months [P<.001]; 13.8% of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at ≥18 months [P = .03]), and sexual function also varied by race (38.4% of black men reported firm erections at ≥18 months vs 25.9% of Hispanic and 21.3% of white men; P = .001).

Conclusions Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.