Healthy Lifestyle Improves Sexual Function Post-Prostatectomy

Patients with prostate cancer can expect better sexual function after a robotic-assisted radical prostatectomy (RARP) if they maintain a healthy lifestyle, researchers reported at the American Urological Association 2012 Annual Scientific Meeting held May 19-23 in Atlanta, Georgia.

The study also showed that a novel index that uses a scoring system to categorize health behaviors known to have an effect on erectile function and vascular health can predict sexual function post-RARP.

“Our results suggest that patients who live healthier lifestyles have better erectile function outcomes after prostate surgery,” said Michael A. Poch, MD, urologic oncology fellow at Roswell Park Cancer Institute in Buffalo, New York.

The group examined the impact of lifestyle behaviors on quality-of-life outcomes in 409 men who underwent RARP at their institution for localized prostate cancer over a recent 6-year period.

Despite the availability of improved surgical techniques and knowledge about prostate anatomy, RARP can potentially cause impairments in urinary, bowel, and erectile function, Poch noted. However, few studies have explored preoperative patient-specific behaviors that may influence postoperative health-related quality-of-life outcomes.

Modifiable lifestyle behaviors, including cigarette smoking, alcohol consumption, and physical activity, have been shown to affect overall genitourinary health in men, he added. While the relationship between post-prostatectomy health-related quality-of-life outcomes and lifestyle behaviors has not been evaluated, the impact of lifestyle behaviors on vascular health, wound healing, and overall genitourinary health has been well established.

Patients enrolled in the present study completed the validated University of California Los Angeles Prostate Cancer Index (UCLA-PCI) at standard postoperative time points. Lifestyle information was obtained from the medical center’s data bank, which routinely gathers data on dietary, social, and health practices at the time of cancer diagnosis.

The investigators used the novel composite Lifestyle Index of Vascular and Erectile (LIVE) Health to assign values to behaviors that have been shown to affect erectile function and vascular health, including current smoking status, cigarette pack-year history, physical activity level, and body mass index. A LIVE score ≤2 was categorized as low, a score of 3-4 was considered average, and a score >4 was categorized as high.

Of those patients with adequate preoperative sexual function, 76 (24%) and 101 (32%) reported adequate postoperative sexual function at 6 and 12 months, respectively. Patients with average or high LIVE scores had higher sexual function scores across all time points except at 6 weeks. Overall, 180 (44%) patients returned to their baseline sexual bother score by 12 months.

Better erection quality (P = .02) and orgasmic function (P = .01) at 12 months were positively associated with higher LIVE scores after adjustments for age, preoperative sexual function, and receipt of nerve-sparing technique. LIVE scores were not associated with urinary function or bother.

“Using the LIVE index, we were able to demonstrate that healthy lifestyle behaviors are associated with improved postoperative sexual function for patients undergoing RARP,” Poch said. He recommended that the LIVE score be used for preoperative counseling for men undergoing prostatectomy.

Poch MA, Mehedint DC, O’Malley RL, et al. The effect of lifestyle behaviors on postprostatectomy health related quality of life outcomes. Presented at the American Urological Association Annual Meeting; May 19-23, 2012; Atlanta, GA. Abstract 165.