title: Demonstration of erectile management techniques to men scheduled for radical prostatectomy reduces long-term regret: a comparative cohort study.
abstract: OBJECTIVE
  To determine whether preoperative demonstrations of intracavernosal and vacuum therapies for erectile dysfunction (ED) influence the decision of treatment choice, reducing long-term regret.
  
  
  METHODS
  In all, 82 consecutive men with localized prostate cancer, scheduled for radical prostatectomy and reporting an International Index of Erectile Function score of >21, were prospectively enrolled at a single cancer centre. Following standard preoperative counselling, half of the men were invited to attend a further consultation for intracavernosal and vacuum therapy demonstrations. All patients were evaluated pretreatment and then 3 monthly using the five-point International Index of Erectile Function score and the 14-item Hospital Anxiety and Depression scale. At 12 months treatment choice changes were recorded and patients were assessed for treatment choice regret using Clark's validated two-item regret questionnaire. Statistical analysis was performed using the Mann-Whitney and Fisher's exact tests. Results were compared with a control population of 41 men who did not undergo additional ED counselling.
  
  
  RESULTS
  In all, 8/41 men (19%) changed their treatment choice, opting for brachytherapy rather than radical prostatectomy. Only 1/41 in the control population changed their decision before surgery. At 1 year, one patient (2%) in the intervention group expressed regret at his treatment choice (radical prostatectomy) compared with eight (20%) in the control group (P= 0.03, two-sided Fisher's exact test); ED was identified as the major cause of this regret.
  
  
  CONCLUSIONS
  Preoperative demonstrations of ED therapies can optimize decision making in prostate cancer and help reduce long-term regret.
authors: Urology Centre, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, UK. Janette.Kinsella@gstt.nhs.uk
authors: Janette
authors: J
authors: Kinsella
authors: Peter
authors: P
authors: Acher
authors: Anna
authors: A
authors: Ashfield
authors: Kathryn
authors: K
authors: Chatterton
authors: Prokar
authors: P
authors: Dasgupta
authors: Declan
authors: D
authors: Cahill
authors: Rick
authors: R
authors: Popert
authors: Tim
authors: T
authors: O'Brien
mesh_terms: D015331:Cohort Studies; D003657:Decision Making; D004644:Emotions; D007172:Erectile Dysfunction / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011300:Preoperative Care; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome