title: Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy.
abstract: BACKGROUND
  After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP).
  
  
  METHODS
  367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA <or= 0.2 ng/mL) at the follow up >or= 5 years were recruited.Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp), tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score), nerve sparing (NS) procedure, and hormonal treatment (HT).We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration.
  
  
  RESULTS
  Time since prostatectomy had a negative effect on SF and a positive effect SB (both p < 0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p < 0.001) and better SB (p < 0.001).Higher stage PCa negatively affected UB, SF, and SB (all: p <or= 0.05). NS was associated with better UB, SF and SB (all: p <or= 0.05); conversely, HT was associated with worse UF, SF and SB (all: p <or= 0.05).More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT) demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time.
  
  
  CONCLUSIONS
  Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders), subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother appear to have divergent trajectories.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. maurogacci@yahoo.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Masieri
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Michele
authors.initials: M
authors.lastname: Lanciotti
authors.forename: Annalisa
authors.initials: A
authors.lastname: Mantella
authors.forename: Mario Alberto
authors.initials: MA
authors.lastname: Rossetti
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.forename: Virginia
authors.initials: V
authors.lastname: Varca
authors.forename: Andrea
authors.initials: A
authors.lastname: Romagnoli
authors.forename: Carlo
authors.initials: C
authors.lastname: Ambruosi
authors.forename: Fabio
authors.initials: F
authors.lastname: Venzano
authors.forename: Marco
authors.initials: M
authors.lastname: Esposito
authors.forename: Tomaso
authors.initials: T
authors.lastname: Montanaro
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D011788:Quality of Life; D012725:Sexual Behavior; D017741:Survivors; D014554:Urination