Predicting erectile function outcome in men after radical prostatectomy for prostate cancer

Abstract

What's known on the subject? and What does the study add? Over the last decade, the surgical treatment of prostate cancer has evolved towards minimal access surgery, particularly via a robot‐assisted technique. However, there is still debate regarding the true benefit for patients with respect to a functional outcome such as erectile function. The present prediction model provides a reliable estimation of the likelihood of regaining erectile function after prostatectomy. OBJECTIVE To identify the reported rates of potency after prostatectomy in the recent literature for men without preoperative erectile dysfunction (ED) and to develop a statistical model for predicting the expected potency after prostatectomy. MATERIALS AND METHODS A Medline search was conducted with the keywords ‘potency’ and ‘prostatectomy’ from 2003 to 2009. In total, 33 studies in the English language reporting pre‐ and postoperative erectile function were identified. Data from studies reporting outcome after open, laparoscopic and robot‐assisted prostatectomy were analyzed separately. Only data obtained from potent men before surgery were included in the analysis. RESULTS In potent men before surgery, the main predictors of post‐treatment erectile function are age and time after treatment. The cumulative range of potency rates at 48 months for all ages (45–75 years) was 49–74% for open, 58–74% for laparoscopic and 60–100% for robotic prostatectomy. The predicted outcome differs by type of operation and patient age. CONCLUSIONS Men aged <60 years have a significant likelihood of regaining erectile function after radical prostatectomy. The reported statistical model provides a reliable estimation of erectile function outcome after prostatectomy for men with localized prostate cancer and intact erectile function.