Gandaglia G, Lista G, Fossati N, Suardi N, Gallina A, Moschini M, Bianchi L, Rossi M S, Schiavina R, Shariat S F, Salonia A, Montorsi F, Briganti A
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Università Vita-Salute San Raffaele, Milan, Italy.
Prostate Cancer Prostatic Dis. 2016 Jun;19(2):185-90. doi: 10.1038/pcan.2016.1. Epub 2016 Feb 9.
Erectile dysfunction (ED) represents one of the most common long-term side effects in prostate cancer (PCa) patients treated with bilateral nerve-sparing radical prostatectomy (BNSRP). The aim of our study was to assess the influence of non-surgically related causes of ED in patients treated with BNSRP.
Overall, 716 patients treated with BNSRP were retrospectively identified. All patients had complete data on erectile function (EF) assessed by the Index of Erectile Function-EF domain (IIEF-EF) and depressive status assessed by the Center for Epidemiologic Studies-Depression (CES-D) questionnaire. EF recovery was defined as an IIEF-EF of ⩾22. Kaplan-Meier analyses assessed the impact of preoperative IIEF-EF, depression and adjuvant radiotherapy (aRT) on the time to EF recovery. Multivariable Cox regression models were used to test the impact of aRT on EF recovery after accounting for depression and baseline IIEF-EF.
Median follow-up was 48 months. Patients with a preoperative IIEF-EF of ⩾22 had substantially higher EF recovery rates compared with those with a lower IIEF-EF (P<0.001). Patients with a CES-D of <16 had significantly higher EF recovery rates compared to those with depression (60.8 vs 49.2%; P=0.03). Patients receiving postoperative aRT had lower rates of EF compared with their counterparts left untreated after surgery (40.7 vs 59.8%; P<0.001). These results were confirmed in multivariable analyses, where preoperative IIEF-EF (P<0.001), depression (P=0.04) and aRT (P=0.03) were confirmed as significant predictors of EF recovery.
Preoperative functional status and depression should be considered when counseling PCa patients regarding the long-term side effects of BNSRP. Moreover, the administration of aRT has a detrimental effect on the probability of recovering EF after BNSRP. This should be taken into account when balancing the potential benefits and side effects of multimodal therapies in PCa patients.
勃起功能障碍（ED）是接受双侧神经保留根治性前列腺切除术（BNSRP）治疗的前列腺癌（PCa）患者最常见的长期副作用之一。我们研究的目的是评估BNSRP治疗患者中与手术无关的ED病因的影响。
总体而言，对716例接受BNSRP治疗的患者进行了回顾性分析。所有患者均有通过勃起功能指数-EF领域（IIEF-EF）评估的勃起功能（EF）完整数据，以及通过流行病学研究中心抑郁量表（CES-D）问卷评估的抑郁状态数据。EF恢复定义为IIEF-EF≥22。Kaplan-Meier分析评估了术前IIEF-EF、抑郁和辅助放疗（aRT）对EF恢复时间的影响。多变量Cox回归模型用于检验在考虑抑郁和基线IIEF-EF后aRT对EF恢复的影响。
中位随访时间为48个月。术前IIEF-EF≥22的患者与IIEF-EF较低的患者相比，EF恢复率显著更高（P<0.001）。CES-D<16的患者与有抑郁的患者相比，EF恢复率显著更高（60.8%对49.2%；P=0.03）。接受术后aRT的患者与术后未接受治疗的患者相比，EF恢复率较低（40.7%对59.8%；P<0.001）。这些结果在多变量分析中得到证实，其中术前IIEF-EF（P<0.001）、抑郁（P=0.04）和aRT（P=0.03）被确认为EF恢复的显著预测因素。
在向PCa患者咨询BNSRP的长期副作用时，应考虑术前功能状态和抑郁情况。此外，aRT的应用对BNSRP术后EF恢复的可能性有不利影响。在权衡PCa患者多模式治疗的潜在益处和副作用时应考虑到这一点。
