title: Achieving optimal outcomes after radical prostatectomy.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: Jeffery W
authors.initials: JW
authors.lastname: Saranchuk
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Elena
authors.initials: E
authors.lastname: Elkin
authors.forename: A Karim
authors.initials: AK
authors.lastname: Touijer
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen