© 2 0 0 4 B J U I N T E R N A T I O N A L | 9 3 , 5 0 7 – 5 0 9 | doi:10.1111/j.1464-410X.2004.04658.x 507 Original Article BENEFITS AFTER RADICAL PROSTATECTOMY V. KUMAR et al. The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer V. KUMAR, H. TOUSSI*, C. MARR†, C. HOUGH† and P. JAVLE† Royal Hallamshire Hospital, Sheffield, Yorks, *Royal Liverpool Hospital, Liverpool and †Michael Heal Department of Urology, Leighton Hospital, Crewe, UK Accepted for publication 27 October 2003 measurements of urinary flow rate and postvoid residual urinary (PVR) volumes. Finally, each patient completed a self- administered continence questionnaire at 6 weeks, 3 and 6 months after surgery. RESULTS In men with moderate to severe LUTS before surgery there were significant improvements in total IPSS, symptom-associated QoL, mean peak flow rate and PVR (P < 0.05). However, in eight men with mild LUTS, although there was a 33% improvement in the total symptom score, it was not statistically significant. Thirty-eight patients reported complete continence, nine had infrequent stress leaks only on heavy physical activity, and the remaining three used <2 pads/day for protection before heavy physical activity at 3 months after surgery. CONCLUSIONS Radical prostatectomy provides major benefits to men with LUTS besides cancer control. These data are important in counselling patients about the treatment options, especially in view of the current enthusiasm for brachytherapy and conformal radiotherapy, which may worsen LUTS. KEYWORDS LUTS, IPSS, QoL, radical prostatectomy, outcome, quality of life OBJECTIVE To evaluate lower urinary tract symptoms (LUTS) and the symptom-associated quality of life (QoL) after radical prostatectomy. PATIENTS AND METHODS We carried out a prospective study (January 1999 to March 2001) of 50 consecutive men initially assessed in the nurse-led prostate assessment clinic for their LUTS and subsequently diagnosed to have localized prostate cancer. They had a radical retropubic prostatectomy and were assessed before, 3 and 6 months after surgery with a self- administered International Prostate Symptom Score (IPSS) and QoL questionnaires, and INTRODUCTION The prevalence of LUTS in men as a result of prostatic enlargement is increasing in an ageing population. At 55 years old ª 25% of men notice a decrease in their urinary stream and this increases linearly to half of those aged 75 years [1]. Despite numerous alternative treatment options, TURP remains the treatment of choice for men with severe LUTS and/or complications resulting from benign prostatic obstruction [2]. In the absence of a formal screening programme in the UK, clinical prostate cancer accounts for a significant proportion of men presenting to a prostate assessment clinic with LUTS. Radical prostatectomy (RP) is one of the preferred treatment options for clinically localized prostate cancer; developments in surgical technique have reduced the morbidity of RP [3]. Of men undergoing RP, 44% would have pre-existing moderate to severe LUTS, based on AUA symptom scores [4] and 40% would have some BOO, as defined by a flow rate of <10 mL/s [5]. Researchers investigating treatment options for prostate cancer commonly focus on cancer control and complications of therapy. As TURP alleviates LUTS in most patients it is important to ascertain the effect of RP on urinary symptoms and symptom-related quality of life (QoL) in men primarily presenting with these symptoms. PATIENTS AND METHODS In a prospective study between January 1999 and March 2001, 50 men who presented to their GP with bothersome LUTS were referred to the hospital with a suspicion of prostate cancer on the basis of a raised PSA level. Prostate cancer was established on histology and they underwent RP for clinically localized prostatic cancer. The assessment carried out before, 6 weeks, 3 and 6 months after RP included a self-administered IPSS and symptom-associated QoL questionnaire [6], uroflowmetry and a measure of postvoid residual urinary volume (PVR) by ultrasonography. The effect of RP on QoL caused by urinary symptoms was assessed by the final question in the IPSS, with seven possible responses ranging from: ‘delighted’ (0) to terrible (6) [7]. Uroflowmetry (Urodyn 1000, Dantec, Denmark) was assessed on two separate occasions (each with a voided volume of >150 mL) and the maximum flow rate (Q max ) corrected for a standard reference volume of 300 mL according to the Siroky nomogram [8]. Symptom scores of <7 were classified as mild, 8–19 as moderate and ≥ 20 as severe [7]. Clinically localized prostate cancer was diagnosed by PSA level, DRE and systematic TRUS-guided prostatic biopsies (7 MHz probe). In addition, four patients had MRI of the pelvis and a bone scan because they had poorly differentiated prostate cancer (Gleason sum score 8 in two or a PSA of > 15 ng/mL in two). Each patient was carefully counselled about the diagnosis and treatment options by a urologist and an oncology nurse specialist. This was supplemented by an information pack on prostate cancer. Anatomical retropubic RP [9] was then carried out by one