Achieving normal erectile function after radical prostatectomy (RP) is a rare event, according to new research presented at the European Association of Urology 2015 congress in Madrid, Spain.

For the study, a team led by Mikkel Fode, MD, of the Herlev Hospital in Copenhagen, Denmark, asked 210 prostate cancer patients to complete the International Index of Erectile Function questionnaire (IIEF-5) prior to RP and 23 months after. The investigators also asked an additional novel question, “Is your erectile function as good as before the surgery: yes or no?

Only 6.7% of RP patients reported that their erections were as good 2 years after RP as before. Yet 23.3% received the same IIEF-5 scores pre- and post-surgery.

“What this work shows is that having an erection as good as before surgery is a rare event, with the vast majority of men, more than 93% in our sample, experiencing some sexual problems after prostate cancer surgery,” Dr. Fode stated in a news release.“Fundamentally, we may have been asking patients the wrong question, but of course we really need bigger trials to confirm this.”

The widely used IIEF-5 has never been validated for surgery patients, the researchers noted, and it may not fully reflect patients' experience. In this study, the average IIEF-5 score prior to surgery was 21.7, and dropped to 9.9 at the time of RP.

After analysis, bilateral nerve-sparing surgery and the absence of cardiovascular disease were the only significant predictors of a return to pre-surgery erectile function.

“As the average age of patients undergoing radical prostatectomy is decreasing, maintaining the ability to have an erection after an operation is increasingly important to men facing surgery…” commented Francesco Montorsi, MD, Editor Emeritus of European Urology. “We need to look more closely at nerve sparing techniques, and ensure that good post-operative care is available for each patient.”

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