Post-RP recovery of erectile function: better data needed!


Our knowledge about the rate of recovery of erectile function after radical prostatectomy really isn’t very good. Rates of recovery seem to vary greatly based on how erectile function and dysfunction are defined, how data are collected, how much time elapses between surgery and measurement of erectile function, and even the specific population studied.

Tal et al. set out to conducted a carefully structured meta-analysis and review of all available, published data on recovery of erectile function after radical prostatectomy (RP). They searched through all published literature between 1985 and 2007. Strict inclusion criteria were set for any article to be considered as meeting appropriate criteria for inclusion in the meta-analysis:

  • It had to report data on rate of recovery of erectile function  post-RP.
  • The study population needed to be ≥ 50 patients who were followed for at least 1 year after surgery.
  • The nerve-sparing status of the surgical procedure had to be declared.
  • Patients could not have ED prior to surgery, and they could not have received any other form of prostate cancer therapy.

The results of the meta-analysis can be described as follows:

  • A total of 212 relevant studies were identified.
  • Only 22/212 (10%) met the inclusion criteria and were analyzed (9,965 RPs; erectile function recovery data on 4,983 subjects).
  • The mean study population size in the 22 studies was 226.5 with a standard deviation of  384.1 (range: 17-1,834).
  • The overall rate of recovery of erectile function was 58 percent.
  • The 19 single-center series publications reported a significantly higher rate of recovery of erectile function than the 3 multicenter series publications (60 vs. 33 percent, RR = 1.82).
  • Studies in which patients were followed for ≥ 18 months reported a slightly higher rate  of recovery of erectile function vs. studies with < 18-month follow-up (60 vs. 56 percent, RR = 1.07).
  • Studies reporting data from series of open RPs and laparoscopic RPs had similar rates of recovery of erectile function (57 vs. 58 percent),
  • Studies reporting data from series of robot-assisted laparoscopic RPs had higher rates of recovery of erectile function (73 percent) compared with these other approaches.
  • Patients < 60 years of age had a significantly higher rate of recovery of erectile function compared to patients ≥ 60 years (77 vs. 61 percent, RR = 1.26).

The authors draw the following conclusions from this analysis:

  • Most of the published literature does not meet strict criteria for reporting post-RP recovery of rates of erectile function.
  • Single and multiple surgeon series have comparable rates of recovery of erectile function, but single center studies have a higher rate.
  • Younger men have higher rate of recovery of erectile function.
  • There is no evident difference in rates of recovery of erectile function between open and non-robotic, laparoscopic forms of RP (based on data in the available literature).

The “New” Prostate Cancer InfoLink noted some days ago how carefully a recent study had attempted to assess pre- and post-surgical erectile function in a trial of high-intensity focused ultrasound (even though we criticized the criteria used to assess potency). We would argue that that paper set a minimal standard by which future studies of post-treatment analysis of erectile function should be assessed.

We also note that there is no mention in the abstract of Tal et al.’s meta-analysis about the use of potential methods to improve recovery of erectile function (e.g., 5-alpha-reductase inhibitors), and we assume that the meta-analysis did not discriminate between patients who did or did not use such products in ther attempt to enhance their erectile function.

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