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How is the success of prostate surgery measured? What metrics are used?
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JamesMohlerMD (Physician - Urology (Verified) ) - 06 / 15 / 2012
The most important measures of the success of prostate surgery are, in this order, cancer control, urinary control and potency preservation.
Cancer control should be measured and reported two years, five years and ten years after operation. Freedom from recurrent disease is measured using PSA. Of all patients who are not cured, 50% will recur in the first two years, 80% in the first five years, and almost 100% in the first ten years. Hence, the success of prostate surgery is assessed best by long-term PSA-proven cure. Urinary control recovery is measured by pad usage. An excellent surgeon should have 99% of their patients socially continent, meaning that they wear no pads, a security minipad, one minipad, or up to two minipads per day. Various quality-of-life instruments also are available to assess urinary control and bladder function. Potency is defined by the ability to achieve vaginal penetration with or without oral agents. There are two metrics used commonly — the UCLA instrument and the Sexual Health Inventory for Males (SHIM). The recovery of erectile function is very much age-dependent. An excellent surgeon should rarely have a patient become impotent when that patient is under 50 when the surgery is performed. Men in their fifties should have a recovery-of-erection rate greater than 80%, men in their sixties a rate greater than 60% and men in their seventies a rate greater than 40%.
Cancer control should be measured and reported two years, five years and ten years after operation. Freedom from recurrent disease is measured using PSA. Of all patients who are not cured, 50% will recur in the first two years, 80% in the first five years, and almost 100% in the first ten years. Hence, the success of prostate surgery is assessed best by long-term PSA-proven cure. Urinary control recovery is measured by pad usage. An excellent surgeon should have 99% of their patients socially continent, meaning that they wear no pads, a security minipad, one minipad, or up to two minipads per day. Various quality-of-life instruments also are available to assess urinary control and bladder function. Potency is defined by the ability to achieve vaginal penetration with or without oral agents. There are two metrics used commonly — the UCLA instrument and the Sexual Health Inventory for Males (SHIM). The recovery of erectile function is very much age-dependent. An excellent surgeon should rarely have a patient become impotent when that patient is under 50 when the surgery is performed. Men in their fifties should have a recovery-of-erection rate greater than 80%, men in their sixties a rate greater than 60% and men in their seventies a rate greater than 40%.
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