Nerve-grafting surgery after resection of neuro-vascular bundles during radical prostatectomy is one of the promising resolutions for dilemma between cancer control and functional preservation. The objective of this study is to evaluate the effect of nerve-grafting surgery on health-related quality of life (HRQOL) in localized prostate cancer patients with special interest in the influence of sexual dysfunction on mental status.
A total of 88 patients followed for a minimum of 12 months after surgery with a median follow-up of 48 months were enrolled in this study. Of those, 24 patients underwent unilateral nerve-sparing with contralateral nerve-grafting or bilateral nerve-grafting and 64 patients underwent prostatectomy without nerve-sparing procedure. HRQOL assessed with the Japanese version of Extended Prostate Cancer Index Composite (EPIC) and Medical Outcomes Study 8 Items Short Form Health Survey (SF-8) was analyzed cross-sectionally.
Patients in nerve-grafting group who recovered potency demonstrated higher sexual function scores compared with those without nerve-sparing procedure (P = 0.022 and 0.001 in 25-48 and 49 months or later, respectively). However, sexual bother scores in nerve-grafting group who recovered potency were lower than those without nerve-sparing procedure throughout the observation periods (P = 0.012 in 49 months or later).
Cavernous nerve reconstruction provided recovery of erectile dysfunction in substantial proportion of patients, which resulted in favorable physical HRQOL. Majority of these patients, however, did not seem to be satisfied with their sexual function, which caused sustained sexual bother feeling.