Background

Although active surveillance is increasingly used for the management of low-risk prostate cancer, many eligible patients are still nonetheless subject to curative treatment. One argument for considering surgery rather than active surveillance is that the probability of postoperative recovery of erectile function is age dependent, that is, patients who delay surgery may lose the window of opportunity to recover erectile function after surgery.

Objective

To model erectile function over a 10-yr period for immediate surgery versus active surveillance.

Design, setting, and participants

Data from 1103 men who underwent radical prostatectomy at a tertiary referral center were used.

Outcome measurements and statistical analysis

Patients completed the International Index of Erectile Function (IIEF-6) pre- and postoperatively as a routine part of clinical care. Preoperative IIEF-6 scores were plotted against age to assess the natural rate of functional decline due to aging. Reported erectile scores in the 2-yr period following surgery were used to assess post-surgical recovery.

Results and limitations

Each year increase in patient age resulted in a 0.27 reduction in IIEF scores. In addition to IIEF reducing with increased age, the amount of erectile function that is recovered from presurgery to 12-mo postsurgery also decreases (−0.16 IIF points/yr, 95% confidence interval −0.27, −0.05, p = 0.006). However, delayed radical prostatectomy increased the mean IIEF-6 score over a 10-yr period compared with immediate surgery (p = 0.001), even under the assumption that all men placed on active surveillance are treated within 5 yr.

Conclusions

Small differences in erectile function recovery in younger men are offset by a longer period of time living with decreased postoperative function. Better erectile recovery in younger men should not be a factor used to recommend immediate surgery in patients suitable for active surveillance, even if crossover to surgery is predicted within a short period of time.

Patient summary

Younger men have better recovery of erectile function after surgery for prostate cancer. This has led to the suggestion that delaying surgery for low-risk disease may lead patients to miss a window of opportunity to recover erectile function postoperatively. We conducted a modeling study and found that predicted erectile recovery was far superior on delayed treatment because slightly better recovery in younger men is offset by a longer period of time living with poorer postoperative function in those choosing immediate surgery.

中文翻译：

---

根治性前列腺切除术后年轻男性勃起功能的恢复得到改善：低风险患者是否需要立即手术？

背景

尽管主动监测越来越多地用于低风险前列腺癌的治疗，但许多符合条件的患者仍然接受治疗。考虑手术而不是主动监测的一个论点是，术后勃起功能恢复的概率取决于年龄，也就是说，延迟手术的患者可能会失去术后恢复勃起功能的机会窗口。

客观的

建立 10 年期间的勃起功能模型，以进行立即手术与主动监测。

设计、设置和参与者

使用来自在三级转诊中心接受根治性前列腺切除术的 1103 名男性的数据。

结果测量和统计分析

患者在术前和术后完成国际勃起功能指数 (IIEF-6)，作为临床护理的常规部分。将术前 IIEF-6 评分与年龄作图，以评估因衰老而导致的功能衰退的自然率。术后两年内报告的勃起评分用于评估术后恢复。

结果和局限性

患者年龄每年增加导致 IIEF 评分降低 0.27。除了 IIEF 随着年龄的增长而降低外，从术前到术后 12 个月恢复的勃起功能量也会降低（-0.16 IIF 点/年，95% 置信区间 -0.27，-0.05，p  = 0.006）。然而，与立即手术相比，延迟根治性前列腺切除术在 10 年期间提高了平均 IIEF-6 评分 ( p  = 0.001)，即使假设所有接受主动监测的男性都在 5 年内接受治疗。

结论

年轻男性勃起功能恢复的微小差异被术后功能下降的较长时间所抵消。年轻男性的更好的勃起恢复不应成为建议适合主动监测的患者立即手术的因素，即使预测在短时间内会交叉手术。

患者总结

年轻男性在前列腺癌手术后勃起功能恢复得更好。这导致有人提出，延迟低风险疾病的手术可能会导致患者错过术后恢复勃起功能的机会。我们进行了一项模型研究，发现预测的勃起恢复远优于延迟治疗，因为年轻男性的恢复稍好，但选择立即手术的患者术后功能较差，较长的生活时间抵消了年轻男性的恢复稍好。