Introduction and Objectives: Modifiable lifestyle behaviors, including tobacco use, alcohol consumption, and physical activity, have been shown to affect genitourinary health in men. The goal of this study was to assess the impact of lifestyle behaviors on health-related quality of life (HRQL) outcomes for patients undergoing robotic radical prostatectomy (RARP) using a novel composite index: Lifestyle Index of Vascular and Erectile health (LIVE score).
Methods: The prospective IRB approved localized prostate cancer database at Roswell Park Cancer Institute was queried for patients who underwent RARP from 2004 to 2009. HRQL outcomes were measured using the UCLA-PCI at standard postoperative time points. Lifestyle behavior data were obtained from the Institutional Data Bank and BioRepository which collects extensive epidemiological information regarding dietary, social, and health practices at the time of cancer diagnosis. LIVE scores were generated by assigning values to smoking status, pack year history, physical activity level and body mass index (BMI). Patients with LIVE scores ≤ 2 were categorized as low, 3-4 average, and >4 high. The relationship between LIVE scores and HRQOL outcomes was assessed using ANOVA and multivariable regression analysis.
Results: 409 patients were included in the study. Mean age at operation was 60 (SD ± 6 years) with mean pre-operative PSA 6.5 ng/ml (SD ± 5.1). 130 (32%) patients reported adequate sexual function by 12 months postoperatively. 179(44%) patients returned to baseline sexual bother score by 12 months. At 6 months 359 (88%) patients were using ≤2 pads per day and (217) 53% had perfect continence. Urinary bother scores returned to baseline in 219 (53%) patients by 12 months. 77 (19%), 246 (60%) and 73 (18%) patients had high, average and low LIVE scores, respectively. Patients with average and high LIVE scores had higher sexual function scores than patients with low LIVE scores preoperatively (p <0.001), at 6 (p = 0.01), 12 (p = 0.013) and 24 months (p = 0.036). Better erection quality (p = 0.02) and orgasmic function (p = 0.01) were positively associated with LIVE scores after adjustments for age, preoperative sexual function, and receipt of nerve sparing technique. There was no difference in pad count between LIVE groups at 6 and 12 months after adjustment for age and nerve-sparing technique.
Conclusions: As demonstrated by the LIVE index, healthy lifestyle behaviors are associated with improved postoperative sexual function for patients undergoing RARP.
Available at: http://works.bepress.com/levi_ross/72/