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Achieving Optimal Outcomes After Radical Prostatectomy

From the Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers; and Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to James A. Eastham, MD, Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021; e-mail: easthamj{at}mskcc.org

PURPOSE: The most favorable outcome that can be achieved after radical prostatectomy is complete tumor resection without recurrence and full recovery of continence and potency. Risks of erectile dysfunction, incontinence, and disease recurrence are well described, but in isolation, do not adequately inform patients of the possibility of becoming cancer-free while at the same time returning to their preoperative functional state. We sought to determine the frequency of optimal outcomes after radical prostatectomy and the time to such outcomes.

PATIENTS AND METHODS: Patients who underwent radical prostatectomy performed at a tertiary referral center between July 1998 and July 2003 for clinical stage T1 to T3 prostate cancer were identified. Patients were excluded if they were incontinent or impotent preoperatively, or if they had received radiotherapy or neoadjuvant androgen deprivation therapy previously. Six hundred forty-seven patients were analyzed for time to recovery of full continence and potency without cancer recurrence after surgery. Optimal outcome probability was calculated with a Markov state transition model to simulate clinical outcomes in the first 4 years following radical prostatectomy.

RESULTS: Mean patient age was 58 years, and mean pretreatment prostate-specific antigen was 6.9 ng/mL. Cancer-free status with full continence and potency was achieved in 30% of men at 12 months, 42% at 24 months, 47% at 36 months, and 53% at 48 months postoperatively.

CONCLUSION: Optimal outcomes after radical prostatectomy can be achieved in a small majority of cases. Time to full recovery is primarily dictated by recovery of erectile function. This information is helpful for patients interested in their chances of returning to their preoperative functional state.

Supported in part by funds from National Cancer Institute grant CA-92629 SPORE in prostate cancer, and by gifts from the Leon Lowenstein Foundation and the Frost Foundation. A.K.T. was supported in part by National Institutes of Health grant T32-082088.

The National Cancer Institute, the Lowenstein Foundation, the Frost Foundation, and the National Institutes of Health had no role in the design or conduct of this study; or in the management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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