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Nomograms May Help Physicians Counsel Prostate Cancer Patients

They worked with data from 272 men (average age 59) who had undergone radical prostatectomy. The men completed the erectile function domain of an assessment called the International Index of Erectile Function (IIEF-EFD) before their surgery and again at 12- and 24-month time points after their surgery. (Later data was not available for all men.)

Three nomograms were created:

  • Preoperative. This tool was based on data collected before surgery.
  • Early (3-month) postoperative. This nomogram considered the degree of nerve-sparing that occurred during surgery. (During prostatectomy, surgeons try to avoid damaging erectile nerves as much as possible, although some nerves cannot be spared.) The nomogram also used preoperative data.
  • Delayed postoperative. This tool used 12-month IIEF-EFD data to predict 24-month outcomes.

“Nomograms are prediction models that have been consistently shown to be better than a clinician’s guess regarding a particular outcome,” the authors explained.

To predict a man’s erectile function after surgery, a doctor considers the patient’s age, IIEF-EFD score, nerve-sparing status (if applicable), and the presence of any comorbidities – health conditions that could affect erections, like diabetes, coronary artery disease, or smoking history.

Once the information is gathered, the doctor can use the nomogram to determine the probability of specific erection outcomes 12 and 24 months after surgery.

The authors noted that the nomograms can provide information about erectile function, but not about overall sexual wellbeing or sexual satisfaction.

They added that their nomograms should be considered “best-case scenario” explanations and acknowledged that the tools have not been externally validated. The nomograms may not be appropriate for men who have more than three comorbidities.

“It is hoped that these nomograms will allow for a more accurate discussion regarding erectile function recovery after [radical prostatectomy],” the authors concluded.


The Journal of Sexual Medicine

Mulhall, John P., MD, MSc, FECSM, et al.

“Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy”

(Full-text. Published online: September 11, 2019)

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