Erectile function recovery after radical prostatectomy in men with high risk features Journal Article


Authors: Recabal, P.; Assel, M.; Musser, J. E.; Caras, R. J.; Sjoberg, D. D.; Coleman, J. A.; Mulhall, J. P.; Parra, R. O.; Scardino, P. T.; Touijer, K.; Eastham, J. A.; Laudone, V. P.
Article Title: Erectile function recovery after radical prostatectomy in men with high risk features
Abstract: Purpose: We describe the efficacy of radical prostatectomy to achieve complete primary tumor excision while preserving erectile function in a cohort of patients with high risk features in whom surgical resection was tailored according to clinical staging, biopsy data, preoperative imaging and intraoperative findings. Materials and Methods: In a retrospective review we identified 584 patients with high risk features (prostate specific antigen 20 ng/ml or greater, clinical stage T3 or greater, preoperative Gleason grade 8-10) who underwent radical prostatectomy between 2006 and 2012. The probability of neurovascular bundle preservation was estimated based on preoperative characteristics. Positive surgical margin rates and erectile function recovery were determined in patients who had some degree of neurovascular bundle preservation. Results: The neurovascular bundles were resected bilaterally in 69 (12%) and unilaterally in 91 (16%) patients. The remaining patients had some degree of bilateral neurovascular bundle preservation. Preoperative features associated with a lower probability of neurovascular bundle preservation were primary biopsy Gleason grade 5 and clinical stage T3 disease. Among the patients with some degree of neurovascular bundle preservation 125 of 515 (24%) had a positive surgical margin, and 75 of 160 (47%) men with preoperatively functional erections and available erectile function followup had recovered erectile function within 2 years. Conclusions: High risk features should not be considered an indication for complete bilateral neurovascular bundle resection. Some degree of neurovascular bundle preservation can be done safely by high volume surgeons in the majority of these patients with an acceptable rate of positive surgical margins. Nearly half of high risk patients with functional erections preoperatively recover erectile function after radical prostatectomy.
Keywords: radiotherapy; prostatic neoplasms; prostatectomy; erectile dysfunction; therapy; mri; positive surgical margins; extracapsular extension; international index; tool; select; cancer; mortality outcomes
Journal Title: Journal of Urology
Volume: 196
Issue: 2
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2016-08-01
Start Page: 507
End Page: 512
Language: English
ACCESSION: WOS:000379266400095
DOI: 10.1016/j.juro.2016.02.080
PROVIDER: wos
PMCID: PMC4969139
PUBMED: 26905018
Notes: Article -- Source: Wos
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MSK Authors
  1. Jonathan Coleman
    349 Coleman
  2. Vincent Laudone
    140 Laudone
  3. Peter T Scardino
    671 Scardino
  4. John P Mulhall
    604 Mulhall
  5. Karim Abdelkrim Touijer
    260 Touijer
  6. Daniel D. Sjoberg
    234 Sjoberg
  7. Melissa Jean Assel
    113 Assel