Bringing follow-up to the forefront


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Arun Sahai explains the work his team is doing to trial a patient pathway that puts cancer outcome, erectile dysfunction and incontinence equally at the forefront of care.

Over 7,000 men have radical prostatectomies each year, where the prostate is removed to treat prostate cancer. However, because of the prostate’s delicate position in the body, the operation can lead to problems like erectile dysfunction or urinary incontinence.

“These men are usually happy with how the cancer treatment has gone, but there are patients with problems with erections, which are affecting their relations, quality of life and mindset. It’s the same with incontinence – they’re embarrassed to go out and meet friends. The number of times I’ve heard ‘my hobbies are out now’ or ‘I can no longer do…’, from patients for fear of leaking,” says Arun Sahai, a former TUF scholar and consultant urological surgeon at Guy’s and St Thomas’s Hospital.

“Too many patients come back years after surgery to seek help and some we never see. We are trying hard to change that and get patients seen in a timely fashion.”

Arun is working with a team of urologists at the hospital, including Majid Shabbir, consultant urological surgeon, and Findlay MacAskill, urology specialist trainee and PhD student, to trial a patient pathway that puts cancer outcomes, erectile dysfunction and incontinence equally at the forefront of their care.

“Our cancer team have been wholeheartedly on board because their drive is exactly the same – they want to have the best functional as well as oncological outcomes for their patients. Now we have team members from functional urology, andrology and prostate cancer pro-actively involved in the ongoing follow-up of a patient from the outset, which wasn’t something we had before,” says Majid.

Over 250 men started the pathway in 2020. They are followed up at regular intervals for two years after the operation to monitor their cancer treatment and its impact on their quality of life, including questionnaires and even an interview with their partner.

“It’s about trying to get as efficiently through the rehabilitation pathway so you can go back to a normal life, rather than just living with the effects of the operation,” says Findlay.

The team hope this work will yield valuable information and to identify risk factors that may predict incontinence and erectile dysfunction. With this evidence, the team can help men to make more informed decisions about their treatment options.

“Some of these guys come to us afterwards and say, ‘If someone had told me what impact the surgery would have on my life, from a sexual function point of view, I wouldn’t have had it or I would have considered other options,’” says Majid.

“We need to say ‘you’re going to have surgery, it can have an impact, but there are things that we can do to make it better and we are here with you every step of the way.’”