Dr. Singhal discusses sexual and urinary function after radical prostatectomy

In this video, Udit Singhal, MD, shares the take-home messages from the recent Journal of Urology study “Comparing patient-reported functional outcomes after radical prostatectomy in historical and contemporary practice.” Singhal is a urologic oncology fellow at Mayo Clinic in Rochester, Minnesota.

Transcription:

Based on these results, are you likely to change how you counsel patients undergoing radical prostatectomy?

I think it's just another tool that we have another piece of information to be able to counsel our patients. If a patient were to ask, how have we gotten better at prostate cancer surgery over time? Or does robotic surgery help us improve compared to an open approach to radical prostatectomy? It allows us to give them some objective information that we can use to counsel them. We can tell them, "We may have gotten better at preserving your sexual function, but we may not have gotten any better at improving your urinary incontinence after surgery overall." And so it just gives us another piece of information that we can back up using data. And so I think it doesn't necessarily provide us with really significant information that we can really point to, to say, "This has really improved our ability to do prostate cancer surgery." But overall, I think it's just another piece of information that's important for us to be able to use when patients ask us simple questions. I think that's important.

What is the take-home message for the practicing urologist?

I think there are a couple of take-home messages from this. One is that, over time, we saw that men in the contemporary era were actually men that had more unfavorable characteristics overall, so unfavorable patient-related characteristics, such as age, so they were operating more on older patients, were operating on more obese patients. And then also, their disease characteristics were different compared with the historical era. And so we're more likely now to operate on patients that have higher risk disease characteristics, such as higher Gleason grade, higher PSA, higher overall NCCN risk. And so that's I would say, one big takeaway is that we're more willing, potentially, to operate on more unfavorable characteristics, both from a patient-related standpoint, as well as a disease-related standpoint. A second take-home would be that, despite all the changes that have occurred to prostate cancer surgery over time, we really haven't improved our ability to maintain patients' urinary function, but we have potentially improved upon our ability to preserve their sexual function over time.

Is there anything you would like to add?

I would just say that there are some limitations to the paper overall. We had a small historical cohort of a little bit over 200 patients compared with a contemporary cohort of over 1000 patients. We're not really able to answer the question as to why we found what we found, why are we able to now better preserve sexual function over time compared with the historical cohorts, but that's something that needs to be studied further, but generally speaking, all the different changes that have occurred in prostate cancer surgery over time, have allowed us potentially to improve the ability to preserve sexual function. Now, it's really important to understand what specific reason allows us to do that and so, then you're able to really isolate that specific reason. And then obviously, that helps us be more vigilant moving forward to potentially improve sexual function across the board after prostate cancer surgery.

This transcript was edited for clarity.