Introduction: A cancer survivorship clinic (CSC) for patients undergoing radical prostatectomy (RP) was started in 2010 to facilitate quality of life related care including return of erectile function and continence. In our previous study we found that men attending a CSC are offered more options for managing erectile dysfunction (ED) and have quicker return to erectile function. We hypothesized that men attending the CSC would be offered a greater variety of treatments for ED as well as more formal care for incontinence.
Methods: A retrospective cohort study of a RP database was conducted of men undergoing surgery between Sept 2014 and Dec 2018. The primary outcomes were usage of various ED aids, time to usage of these aids, and incontinence rates based upon pads per day and need for incontinence procedure. We studied CSC attendance and rates of pelvic floor physiotherapy (PFPT) enrollment. Patients with follow-up less than 4 months were excluded. Nerve-sparing status was investigated.
Results: 404 men were identified for inclusion. Median (IQR) follow-up was 34.9 (SD 18.6) months. 160 (39.6%) men attended a CSC. The cohorts were similar in regard to age, BMI, co-morbidities, and nerve-sparing status. Men attending a CSC had higher utilization of daily tadalafil (86.9% vs. 66.4%, p<0.0001), on-demand PDE5i (73.8% vs 64.0%, P=0.04), VED (33.2% vs. 16.0%, p=0.0001), ICI (24.4% vs 14.3%, p=0.01), and IPP (6.3% vs. 2.5%, p=0.06). For men in the CSC, time to initiation of on-demand PDE5i was 6.6 months (SD 8.1), VED at 6.1 months (SD 5.8), ICI at 13.8 months (SD 8.5), and IPP at 24.2 months (SD 10.0) For men in both cohorts who pursued treatment, time to treatment was not significantly different between cohorts (p>0.05). We did not find a statistically significant difference in pad usage at 1 (p=0.12) and 3 (p=0.31) months. We found an association between CSC attendance and utilizing PFPT (OR 2.89, CI: 1.55-5.42). There was no significant difference between CSC and undergoing an incontinence procedure (OR 4.71, CI: 0.94-23.66).
Conclusions: Men attending a CSC are offered more options for managing ED including daily and on demand PDE5i, VED, and ICI, and IPP. These men are also more likely to pursue PFPT sessions. There was no increased utilization of incontinence procedures in our cohort. Attendance in a CSC should be advocated for men wishing to pursue erectile function following RP.