Despite advances in prostate cancer outcomes, significant treatment regret exists largely based on the disparity between the expected and the actual functional outcome achieved. This requires an increased focus on cancer survivorship following RP. We aimed to evaluate care at our institution, implement a new survivorship focused pathway for the first two years and then evaluate it.

We conducted an RP care audit at our institution until 12 months post-operatively in 2017 assessing primarily care associated with continence and sexual dysfunction. We then introduced a new cancer survivorship focused pathway in January 2020 with continence and andrology specialists leading care from 3 months post-operatively working with oncological surgeons, psychotherapists and physiotherapists, and included pre-operative and post operative seminars. Currently, over 1000 patients are enrolled with patients completing prospective PROMs, pad assessment and erection hardness score at 5 time points from baseline until two years after surgery on physical and mental wellbeing, continence and sexual dysfunction. Also, we measure compliance with management. We evaluated this with the Client Satisfaction Questionnaire-8 (CSQ-8) and our own tailored likert scale experience measure. Both projects were registered according to local governance protocols.

In the audit, 293 patients (mean age 60 (Range 44-76) years) had a RP. Only 8/293 (2.7%) patients had PROM assessment of erectile dysfunction (ED) or 49 (16.7%) patients for continence. Post-operatively, 97% were informally asked about ED and 98% for continence but no PROM assessment performed. There was inconsistent use of PDE5i and poor access to the vacuum erection device (VED) across the entire cohort. Only 2% patients interacted with a functional or andrological surgeon within the first 12 months.

Following introduction of the new pathway, 81% patients have completed PROMs at 12 months. Every patient has seen a continence or andrology specialist more than once in their first year. All patients leave the hospital with a VED and, if relevant, a daily PDE5i. 150/236 patients, who have completed the 2-year pathway, have completed the CSQ-8 with a median score 32/32 (IQR 27-30), where a higher score means a higher satisfied client. 234 patients have completed our tailored patient-reported experience measure with 91% patients reporting their holistic care needs were being met. Our patient experience data shows 83% and 86% patients report being well-informed about ED and continence before surgery and 90% and 93% being better informed about their ED and continence management after their first rehabilitation appointment. Importantly, 95% patients felt as involved as they wanted in their management.

We have shown high patient satisfaction for our new pathway, aiming to improve the experience of RP patients.

This new pathway is the first step to put cancer survivorship at the centre of RP care. We look forward to reporting our outcomes in future work