PRE-RADICAL PROSTATECTOMY (RP) ANDROGEN DEPRIVATION THERAPY (ADT) IS ASSOCIATED WITH POORER POSTOPERATIVE ERECTILE FUNCTION OUTCOMES

  • Deveci S
  • Heck M
  • Parker M
  • et al.
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Abstract

INTRODUCTION AND OBJECTIVES: adt is associated with reduced erectile function (EF) in patients receiving radiation therapy for prostate cancer. Despite, little evidence supporting its use, some patients continue to receive adt prior to RP. This analysis was undertaken to define the impact of pre-RP ADT on EF recovery. METHODS: Patients presenting after RP for ED evaluation and treatment within 6 months of RP who underwent duplex Doppler penile ultrasound (DUS) were compared to a contemporaneous group of men evaluated and followed identically but who did not receive ADT preoperatively Age, comorbidity and EF data were obtained from a prospectively constructed database. Specifically, we analyzed the incidence of venous leak (VL), mean IIEF EF domain score and proportion of men with EF domain scores ≥24 at 18 months post-RP. RESULTS: 38 patients received ADT (Group 1) while 94 who had not received ADT constituted Group 2. Mean age of the total cohort was 66 years with no significant difference between the 2 groups. The mean time to evaluation post-RP was similar for both groups at 3.2±1.4 months. Comorbidity profiles were similar also with 58%, 20%, 22% of Group 1 having 1, 2 and 3 vascular risk factors respectively. In Group 2, these figures were 50%, 25%, 25%. Median Gleason score (7) and pre-treatment PSA level (6 ng/ml) were similar between the two groups. In Group 1, 60%, 8%, 32% had bilateral, unilateral and non-nerve sparing surgery. For Group 2 these figures were 74%, 13%, 13%. The incidence of VL within 6 months of surgery was 60% for G1 and 20% for G2 (p<0.001). When comparing VL incidence based on nerve sparing status, all G1 groups had a higher incidence of VL compared to G2 (see Table). Likewise, the EF domains scores and proportion of men with EF domain scores ≥24 at 18 months were lower in G1 even when controlled for nerve sparing status. CONCLUSIONS: ADT used preoperatively is associated with higher rates of venous leak after RP as well poor erectile function outcomes even when controlled for nerve sparing status. In the absence of convincing data supporting the benefit of pre-RP ADT, its use should be avoided.

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Deveci, S., Heck, M., Parker, M., Guhring, P., & Mulhall, J. P. (2009). PRE-RADICAL PROSTATECTOMY (RP) ANDROGEN DEPRIVATION THERAPY (ADT) IS ASSOCIATED WITH POORER POSTOPERATIVE ERECTILE FUNCTION OUTCOMES. Journal of Urology, 181(4S), 525–525. https://doi.org/10.1016/s0022-5347(09)61482-8

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