(015) The Association Between Prostate Volume and Erectile Function Recovery Following Radical Prostatectomy

Abstract

Abstract Introduction The relationship between prostate volume (PV) and erectile function recovery (EFR) after radical prostatectomy (RP) has not been well studied. Objective We aimed to evaluate PV as a predictor of EFR 24 months after RP. Methods We included men who underwent RP with surgeon-reported nerve-sparing score (NSS) and 2-year follow up who had documentation of pre-RP PV on MRI and baseline functional erections (pre-RP IIEF-EFD scores ≥ 24). Demographics, ED-related comorbidities, pathological features, PDE5i use, and total testosterone (T) levels were recorded. At 12 months post-RP, patients scored PDE5i use 0-3; 0 never, 1 sometimes, 2 regularly, 3 routinely. NSS on each side (R/L) was scored on a 1-4 scale: 1 complete preservation, 2 near-complete preservation, 3 partial resection, 4 complete resection. Scores of 1 or 2 indicate nerve-sparing and scores of 3 or 4 indicate non-nerve-sparing. We then classified overall NS status as bilateral, unilateral, or non-spared. At 24 months post-RP, EFD score ≥ 24 defined functional erections, ≤ 10 severe ED. Multivariable analysis (MVA) evaluated predictors of EFD score ≥ 24 as well as EFD ≤ 10 after RP; patient age, number of comorbidities, baseline EF, NSS, PDE5i use, and PV were analyzed. Results 1741 men were included. Median age was 60 (55, 65) years. 36% had ≥ 2 comorbidities. Median PV was 33 (26, 44) mL with 12% having PV ≥ 60 mL. Median pre-RP IIEF-EFD score was 29 (27, 30). Grade group 1, 2, 3, 4 and 5 comprised 12%, 68%, 15%, 2%, and 3% of the cohort, respectively. NSS: bilateral (82%), unilateral (15%), non-spared (3%). Median PDE5i use score within 4 weeks of the 12 month post-RP visit was 1 (0, 1); reported PDE5i use was 44% never, 39% sometimes, 13% regularly, and 4% routinely. At 24 months post-RP, median EFD was 22 (9, 28), and 56% had EFD < 24. Men with post-RP EFD < 24 had greater PV (41 ± 26 mL) vs men with EFD ≥ 24 (36 ± 17 mL, p<0.001). 67% of the men with EFD < 24 had a PV ≥ 60 mL vs 33% of men with EFD ≥ 24 (p=0.02). On MVA, predictors of EFD ≥ 24 included bilateral NS, age and PV. Predictors of EFD ≤ 10 included bilateral NS and age. At 24 months post-RP, neither routine PDE5i use nor a higher comorbidity index were predictive of EF outcome. Conclusions Among men with functional erections pre-RP, larger PV is associated with a poorer EFR at 24m post-RP independent of degree of nerve-sparing, age, and PDE5i use. Disclosure No.