Counseling the post-radical prostatectomy patients about functional recovery: high predictiveness of current status.
OBJECTIVE
To develop prediction models to help counsel post-radical prostatectomy patients about functional recovery.


METHODS
The study included 2162 patients undergoing radical prostatectomy at a major cancer center, who reported urinary and erectile function at 1 year or at 2 years and at least 1 prior follow-up at 3, 6, 9, or 12 months. We created logistic regression models predicting function at one or 2 years on the basis of function at 3, 6, 9, and 12 months (2 years only), with the additional predictors of age, stage, grade, prostate-specific antigen levels, nerve-sparing status and baseline functional score.


RESULTS
No variable other than current functional score had a consistent statistically significant relationship with outcome. The area under the curves for predicting function at 2 years based on current function alone at 3, 6, 9, and 12 months were respectively 0.796, 0.831, 0.882, and 0.885 for erectile function and 0.789, 0.862, 0.869, and 0.876 for urinary function. Patients using 1 pad at 6 months had only a 50% probability of being pad free at 2 years; this dropped to 36% for patients using 2 pads. This suggests that there is an opportunity for early identification and possible referral of patients likely to have long-term urinary dysfunction.


CONCLUSIONS
Assessment of urinary and erectile function in the first postoperative year is strongly predictive of long-term outcome and can guide patient counseling and decisions about rehabilitative treatments.
Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: vickersa@mskcc.org.
Andrew J
AJ
Vickers
Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Matthew
M
Kent
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
John
J
Mulhall
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Jaspreet
J
Sandhu
D000368:Aged; D037001:Directive Counseling; D007172:Erectile Dysfunction / Q000209:etiology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010410:Penile Erection; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D014549:Urinary Incontinence / Q000209:etiology* / Q000534:rehabilitation*