Psychosocial predictors of urinary incontinence and sexual dysfunction in the first year post-radical prostatectomy for localised prostate cancer.

Abstract

BACKGROUND: Robot assisted radical prostatectomy (RARP) is a common treatment for localized prostate cancer. Resultant urinary incontinence (UI) and sexual dysfunction can negatively impact patient wellbeing. Patients' psychological symptoms have also been associated with quality of life outcomes post-surgery. We aimed to assess the psychosocial predictors of UI and sexual function (SF) over time, and assess distress, anxiety and depressive symptoms in the first year post-surgery. METHODS: A review of a prospectively maintained database was performed, examining consecutive RARPs conducted by 3 surgeons between May 2014 and January 2017. A series of measures were completed by 182 men pre-operatively, and at 3, 6, and 12 months post-surgery. Outcome variables were SF, UI, distress, and depression and anxiety symptoms. SF and UI were assessed by the Expanded Prostate Cancer Index-26. Mixed model analyses were used to assess changes in outcomes over time and identify predictors of SF and UI, whilst controlling for pre-operative function, partner status, comorbidity and allied health practitioner involvement,. RESULTS: Anxiety and depression levels remained consistent across time. UI improved significantly (p<.001) from 3 months (M=55.40, SD=25.56) to 6 months (M=69.24, SF=23.86), followed by a non-significant improvement from 6 to 12 months. SF improved significantly over both time periods (p<.001). Higher depressive and anxiety symptoms were associated with worse SF. Similarly, higher distress was associated with worse UI. The proportions of patients who consulted with a General Practitioner (GP), nurse, physiotherapist, and psychologist in the first year post-surgery were 48%, 39%, 59% and 8% respectively. CONCLUSION: Psychological distress may negatively impact patient-reported recovery of UI and SF. Although GPs, nurses and physiotherapists were commonly consulted, fewer men sought psychological services. It is important to educate patients pre-operatively about the potential benefit of engaging with supportive care services.