JU INSIGHT Patient-Reported Functional Outcomes After Radical Prostatectomy in Historical and Contemporary Practice

By: Udit Singhal, MD, Rogel Cancer Center, University of Michigan, Ann Arbor, Mayo Clinic, Rochester, Minnesota; Brent K. Hollenbeck, MS, MD, Rogel Cancer Center, University of Michigan, Ann Arbor; Samuel D. Kaffenberger, MD, Rogel Cancer Center, University of Michigan, Ann Arbor; Simpa S. Salami, MD, MPH, Rogel Cancer Center, University of Michigan, Ann Arbor; Arvin K. George, MB, BCH, BAO, Rogel Cancer Center, University of Michigan, Ann Arbor, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Ted A. Skolarus, MD, MPH, Rogel Cancer Center, University of Michigan, Ann Arbor, University of Chicago, Illinois; Jeffrey S. Montgomery, MD, Rogel Cancer Center, University of Michigan, Ann Arbor; Daniela A. Wittmann, PhD, MSW, Rogel Cancer Center, University of Michigan, Ann Arbor; David C. Miller, MD, MPH, Rogel Cancer Center, University of Michigan, Ann Arbor; John T. Wei, MD, Rogel Cancer Center, University of Michigan, Ann Arbor; Ganesh S. Palapattu, MD, Rogel Cancer Center, University of Michigan, Ann Arbor; James E. Montie, MD, Rogel Cancer Center, University of Michigan, Ann Arbor; Rodney L. Dunn, MS*, Rogel Cancer Center, University of Michigan, Ann Arbor; Todd M. Morgan, MD*, Rogel Cancer Center, University of Michigan, Ann Arbor *Co-senior authors | Posted on: 27 Nov 2023

Singhal U, Hollenbeck BK, Kaffenberger SD, et al. Comparing patient-reported functional outcomes after radical prostatectomy in historical and contemporary practice. J Urol. 2023;210(5):771-777.

Study Need and Importance

Modifications to surgical technique, particularly the widespread adoption of robotic surgery, have been proposed to improve functional recovery after prostate cancer surgery. However, rigorous comparison of men in historical vs contemporary practice to evaluate the cumulative effect of these changes on urinary and sexual function after radical prostatectomy is lacking.

What We Found

In this study, we evaluated patient-reported urinary and sexual function recovery after radical prostatectomy in historical and contemporary practice to evaluate whether combined dynamic changes between surgical eras have resulted in improved patient outcomes. We found significant differences in baseline function, with better urinary and sexual function scores prior to treatment in historical, compared to contemporary, practice. However, men in contemporary practice had better recovery of sexual function compared to men who underwent radical prostatectomy historically (Figure). Further, we found that contemporary practice consists of men with more unfavorable demographic and clinical characteristics compared to historical practice. These findings suggest modifications to prostate cancer surgery during the past 2 decades have resulted in improvements in sexual function recovery, with no difference in pattern of recovery of urinary incontinence between groups.

Figure. Adjusted patient-reported urinary incontinence (A) and sexual function (B) in the historical (Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment [PQA] study) and contemporary (Michigan Urological Surgery Improvement Collaborative [MUSIC] registry) groups from 0 to 24 months after radical prostatectomy.

Limitations

This study is limited by its single-center nature. Further, there is a lack of granularity of the data regarding intraoperative techniques (ie, nerve sparing), postoperative adjunctive therapies (ie, adjuvant or salvage radiation, hormones, pelvic floor physical therapy, penile rehabilitation), or individual surgeon-level volume.

Interpretation for Patient Care

Advances in surgery have led to improvements in patient-reported sexual function recovery after radical prostatectomy over the last 20 years. However, urinary function recovery is similar in historical and contemporary practice.