title: Patients' desire to preserve sexual activity and final decision for a nerve-sparing approach: results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study.
abstract: BACKGROUND
  Preservation of sexual function after surgery represents a major issue for patients undergoing radical prostatectomy (RP).
  
  
  OBJECTIVE
  To investigate determinants of patients' desire to preserve sexual activity before RP and surgeons' final decision to perform a nerve-sparing RP (NSRP).
  
  
  METHODS
  Overall, 2,408 prostate cancer patients, candidates to RP, from 136 urologic departments across the Italian territory were evaluated in a multicenter prospective observational study. All patients underwent RP, according to single-center indications and procedures.
  
  
  METHODS
  Age, body mass index, previous benign prostatic hyperplasia history, preoperative tumor characteristics, quality of life through the Short Form Health Survey (SF-12), and the University of California Los Angeles Prostate Cancer Index (UCLA-PCI), erectile function through the International Index of Erectile Function (IIEF-5), desire to preserve sexual activity, NS operative outcomes, and surgical margins status were recorded.
  
  
  RESULTS
  Overall, 1,667 were interested to preserve sexual activity. Age, physical component summary of SF12 (PCS-12), sexual function score of UCLA-PCI, and IIEF-5 score were the main determinants of such interest. Only 1,246 patients were suitable for a NSRP according to guidelines. Surgeons performed a non-NSRP (NNSRP) in 1,234 patients, a unilateral NSRP in 318 and a bilateral NSRP in 856. Age, bioptical Gleason score, percentage of positive cores, PCS-12, and patient's desire to preserve sexual activity were the main determinants of final decision for a NSRP. Surgeons performed a NSRP in 424 not suitable and in 121 not interested patients. Positive surgical margins in not suitable patients submitted to NSRP were not higher if compared to that obtained after NNSRP in the same subgroup. Limits include lack of oncological and functional follow-up.
  
  
  CONCLUSIONS
  Most patients are interested to preserve sexual activity. Discrepancies exist among patients' preferences, guidelines' indications, and surgeon's final decision.
authors.affiliation: Department of Urology, University of Naples Federico II, Naples, Italy. profciroimbimbo@gmail.com
authors.forename: Ciro
authors.initials: C
authors.lastname: Imbimbo
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Creta
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.forename: Ottavio
authors.initials: O
authors.lastname: de Cobelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Fulcoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Giulio
authors.initials: G
authors.lastname: Nicita
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D011468:Prostatectomy / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D012725:Sexual Behavior / Q000523:psychology*