Sexual Satisfaction in Population With ED After Robot-Assisted Radical Prostatectomy May Take Time to Improve

It may take a long time for satisfaction with sexual life to improve among men with erectile dysfunction (ED) due to robot-assisted radical prostatectomy that was utilized to treat localized prostate cancer, according to results from an observational study published in The Journal of Sexual Medicine.

Patients without ED at baseline had mean overall satisfaction score was 8.2 (range 2-10). Overall, patients with ED following RARP had a mean overall satisfaction of 4.8 at 6 months, 4.8 at 12 months, 4.9 at 24 months, and 4.6 at 36 months (range 2-10; P = .2) compared with mean overall satisfaction scores of 8.4, 8.4, 8.1, and 8.2 at 6, 12, 24, and 36 months (range 3-10; P = .2), respectively, for patients without ED after RARP.

“Satisfaction with sexual life in men with ED due to RARP did not improve between 6 and 36 months [of] follow-up, indicating improvement of satisfaction might take a long time,” the investigators wrote. “One could counsel patients that sexual satisfaction is based on individual baseline sexual satisfaction and the return of sexual desire after RARP.”

Patients were treated for localized prostate cancer with RARP at a single treatment center between 2006 and 2019 were included in the observational study. Patients filled out questionnaires prior to RARP, as well as at 6, 12, 24, and 36 months time points after the procedure. Several questionnaires were used in the study, including the EORTC core quality of life questionnaire (QLQ-C30), International Index of Erectile Function 15 (IIEF-15), International Prostate Symptom Score (IPSS), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).

The study’s primary objective was analyzing sexual life satisfaction for patients without ED before RARP and investigating any improvement in sexual life satisfaction for patients with ED after RARP over time.

A total of 2808 patients underwent RARP, 884 of whom were included in the analysis. The median patient age was 63 years. Data were available for 467 patients with ED due to RARP at 6 months follow-up, 381 patients at 12 months, 333 patients at 24 months, and 189 patients at 36 months.

At 24 months, patients with ED satisfied with sexual life had significantly higher satisfaction scores at baseline, QoL scores, IIEF-5 scores, and sexual desire scores than patients who reported being not satisfied. More, overall satisfaction at baseline (OR, 1.4; 95% CI, 1.1-1.8; P = .01) and sexual desire scores (OR, 1.7; 95% CI, 1.4-2.1; P <.01) were found to be independent predictors of overall satisfaction at 24 months. a\After 36 months of follow-up, overall satisfaction at baseline (OR, 2.3; 95% CI, 1.13-4.88; P = .02) and sexual desire scores at 36 months (OR, 2.1; 95% CI, 1.20-3.75; P = .09) were found to be independent predictors, as they were at 24 months.

Of note, the research population is limited to only patients treated with RARP, which suggests that these data may not be generalizable to other treatment modalities. Moreover, the potential negative impact of adjuvant or salvage radiotherapy and androgen deprivation therapy were not considered in this research.

“It is vital to present realistic, individualized expectations regarding both sexual satisfaction and recovery after RARP,” the investigators concluded.

Reference

Albers LF, Tillier CN, van Muilekom E, et al. Sexual satisfaction in men suffering from erectile dysfunction after robot-assisted radical prostatectomy for prostate cancer: an observational study. J Sex Med. 2021;18(2):339-346. doi:10.1016/j.jsxm.2020.11.011