Dr Herbert Lepor

A/Prof Nathan Lawrentschuk: Nathan Lawrentschuk here, Talking Urology. We have the great pleasure of having Dr Herbert Lepor here with us from NYU. So, Herbert could I just start off and tell the audience really the summary of your talks here this week.

Herbert Lepor: So we’re looking at the long-term outcomes following radical prostatectomy. So, we have to keep our outcomes in perspective. The good news is the overwhelming majority of men we operate on will be alive 15 years later. And so, the outcomes that we should really focus on are the lower urinary tract symptoms, continence and potency. I think radical prostatectomy really gets a lot of bad press for all the harms and what we’ve learned is that there are actually some unrecognized benefits as far as lower urinary tract symptoms, it improves symptoms in those who are bothered at the onset and really arrests the natural history of lower urinary tract symptoms in men. In fact when you look at incontinence over time, the incontinence rate in men undergoing radical prostatectomy parallels that of the general male population 10-15 years down the road and no doubt sexual dysfunction is a big problem. What is disconcerting for us all as men age the frequency of sexual dysfunction is almost inevitable. So we may accelerate that with a radical prostatectomy but again we have to look down the road 10-15-20 years because men are actually going to survive to have to deal sort of not with the long-term consequences of their treatment but also aging.

Nathan: Sure. So, what you’re really saying is that the benchmarks that we’ve perhaps been playing against, if you like, for men with, undergoing radical prostatectomy that the benchmarks are perhaps too high and we’re not really comparing to the community at large as opposed to people who have really good function?

Herbert: You know exactly, and I think you know men when they undergo the radical prostatectomy the goal is to cure their disease right? And I think they’re balancing the cure versus all these horrific consequences and I think what this does is put into perspective, it’s not to minimize the impact of radical prostatectomy in quality of life but also to look in the long horizon and in fact the patient who is 60 years of age okay has a radical prostatectomy, if you go 15 years down the road relative to someone who’s undiagnosed at age 60, the man who has a radical prostatectomy will have no urinary symptoms, the patient without prostate cancer actually does. Incontinence about 10% and in terms of for men as they’re aging that 60-year-old man to be 75 both his counterpart and himself unfortunately very minimal sexual activity. And I guess for me as being someone who’s interested in focal therapy as a way to minimize the quality of life consequences of radical prostatectomy we have to really keep in mind that on the long horizon I think it’s not to the degree that the procedure has been characterized.

Nathan: Thank you very much Herb. Thanks for being with us.