Article Data

  • Views 842
  • Dowloads 136

Original Research

Open Access

The effect of the discrepancy between pre- and post-operative staging on decision-making and quality of life in men undergoing a radical prostatectomy

  • Álvaro Martínez-Bordajandi1
  • Ana Patricia Puga-Mendoza2
  • Gonzalo Granero-Heredia3
  • Cayetano Fernández-Sola3,4,*,
  • Tomás Fernández-Aparicio5
  • Iria Dobarrio-Sanz3
  • José Manuel Hernández-Padilla3

1Departament of Anaesthesiology and Surgical Intensive Care, Torrecardenas Universitary Hospital, 04009 Almeria, Spain

2Community Health Centre Retamar, Sanitary District of Almeria, 04131 Almeria, Spain

3Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain

4Faculty of Health Sciences, Universidad Autónoma de Chile, 7500000 Santiago, Chile

5Department of Urology, Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain

DOI: 10.22514/jomh.2023.059 Vol.19,Issue 7,July 2023 pp.77-85

Submitted: 28 December 2022 Accepted: 22 March 2023

Published: 30 July 2023

*Corresponding Author(s): Cayetano Fernández-Sola E-mail:


Prostate cancer is the most prevalent cancer and the second leading cause of oncological mortality in men. Its prognosis is estimated by normograms based on statistical methods. However, it is still a challenge to accurately determine the pathological stage from clinical data. Our aim is to describe and analyze the relationship between sociodemographic, quality-of-life and clinical variables in patients undergoing a radical prostatectomy. A cross-sectional observational study was carried out and included 51 patients undergoing a radical prostatectomy in a general hospital in southeastern Spain. The normality of all variables was studied. A descriptive and association/correlation analysis of the most relevant variables of the study was carried out. In addition, a multivariate analysis was performed to study the intergroup differences between variables with significant correlation. Age was related to a higher occurrence of erectile dysfunction (f = 10.594, p = 0.09) and to a lower percentage of consultations for this reason (x2 = 6.996, p = 0.012). Overweight/obese patients had a more aggressive result on the Gleason score (w = 151.5, p = 0.019). Differences were found between ultrasound and surgical specimen prostate volume (f = 10.324, p = 0.004). There were differences between the Gleason score result obtained from the biopsy and the surgical specimen (f = 23.330, p = 0.00001). Our results suggest that older age could be related to increased erectile dysfunction, that obesity could be related to more aggressive prostate cancer, and that there can be differences in the Gleason score between the biopsy and the final specimen. These findings suggest that the Gleason score results should be interpreted cautiously.


Prostate cancer; Prostatectomy; Staging; Gleason score

Cite and Share

Álvaro Martínez-Bordajandi,Ana Patricia Puga-Mendoza,Gonzalo Granero-Heredia,Cayetano Fernández-Sola,Tomás Fernández-Aparicio,Iria Dobarrio-Sanz,José Manuel Hernández-Padilla. The effect of the discrepancy between pre- and post-operative staging on decision-making and quality of life in men undergoing a radical prostatectomy. Journal of Men's Health. 2023. 19(7);77-85.


[1] American Cancer Society. Cancer facts & figures 2020. 2020. Available at: (Accessed: 27 July 2022).

[2] Mucci LA, Wilson KM, Giovannucci EL. Epidemiology of prostate cancer. Pathology and Epidemiology of Cancer. 2017; 349: 107–125.

[3] Sociedad Española de Oncologia Médica (SEOM). The cancer numbers in Spain. 2020. Available at: (Accessed: 25 May 2022).

[4] Etxeberria J, Guevara M, Moreno-Iribas C, Burgui R, Delfrade I, Floristan Y, et al. Prostate cancer incidence and mortality in Navarre. Anales del Sistema Sanitario Navarra. 2018; 41: 9–15. (In Spain)

[5] Rodriguez-Sanchez L, Fernández-Navarro P, López-Abente G, Nuñez O, De Larrea-Baz NF, Jimenez-Moleón JJ, et al. Different spatial pattern of municipal prostate cancer mortality in younger men in Spain. PLOS ONE. 2019; 14: e0210980.

[6] Siegel DA, O’Neil ME, Richards TB, Dowling NF, Weir HK. Prostate cancer incidence and survival, by stage and race/ethnicity—United States, 2001–2017. Morbidity and Mortality Weekly Report. 2020; 69: 1473–1480.

[7] Hsing AW, Tsao L, Devesa SS. International trends and patterns of prostate cancer incidence and mortality. International Journal of Cancer. 2000; 85: 60–67.

[8] Zhu Y, Mo M, Wei Y, Wu J, Pan J, Freedland SJ, et al. Epidemiology and genomics of prostate cancer in Asian men. Nature Reviews Urology. 2021; 18: 282–301.

[9] Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent global patterns in prostate cancer incidence and mortality rates. European Urology. 2020; 77: 38–52.

[10] Badal S, Aiken W, Morrison B, Valentine H, Bryan S, Gachii A, et al. Disparities in prostate cancer incidence and mortality rates: Solvable or not? The Prostate. 2020; 80: 3–16.

[11] Desai K, McManus JM, Sharifi N. Hormonal therapy for prostate cancer. Endocrine Reviews. 2021; 42: 354–373.

[12] Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MJ. Prospective study of sex hormone levels and risk of prostate cancer. Journal of the National Cancer Institute. 1996; 88: 1118–1126.

[13] Watts EL, Appleby PN, Perez-Cornago A, Bueno-de-Mesquita HB, Chan JM, Chen C, et al. Low free testosterone and prostate cancer risk: a collaborative analysis of 20 prospective studies. European Urology. 2018; 74: 585–594.

[14] Haider A, Zitzmann M, Doros G, Isbarn H, Hammerer P, Yassin A. Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries. The Journal of Urology. 2015; 193: 80–86.

[15] Zhang H, Zhou Y, Xing Z, Sah RK, Hu J, Hu H. Androgen metabolism and response in prostate cancer anti-androgen therapy resistance. International Journal of Molecular Sciences. 2022; 23: 13521.

[16] Wang X, Wu Y, Guo J, Chen H, Weng X, Liu X. Oncological safety of intrafascial nerve-sparing radical prostatectomy compared with conventional process: a pooled review and meta-regression analysis based on available studies. BMC Urology. 2019; 19: 41.

[17] Boesen L. Multiparametric MRI in detection and staging of prostate cancer. Danish Medical Bulletin. 2017; 64: B5327.

[18] Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, Flanigan RC, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6630 men. The Journal of Urology. 2017; 197: S200–S207.

[19] Gordetsky J, Epstein J. Grading of prostatic adenocarcinoma: current state and prognostic implications. Diagnostic Pathology. 2016; 11: 25.

[20] Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA: A Cancer Journal for Clinicians. 2017; 67: 93–99.

[21] Martínez-Bordajandi Á, Fernández-sola C, Puga-endoza AP, López-Entrambasaguas OM, Lucas-matheu M, María I, et al. Sexual experiences after non-nerve sparing radical prostatectomy. Acta Paulista Enfermagem. 2020; 33: 1–10.

[22] Katz A, Dizon DS. Sexuality after cancer: a model for male survivors. The Journal of Sexual Medicine. 2016; 13: 70–78.

[23] Fode M, Serefoglu EC, Albersen M, Sønksen J. Sexuality following radical prostatectomy: is restoration of erectile function enough? Sexual Medicine Reviews. 2017; 5: 110–119.

[24] Bernardes MFVG, Chagas S de C, Izidoro LC de R, Veloso DFM, Chianca TCM, da Mata LRFP. Impact of urinary incontinence on the quality of life of individuals undergoing radical prostatectomy. Revista Latino-Americana de Enfermagem. 2019; 27: e3131.

[25] Kesch C, Heidegger I, Kasivisvanathan V, Kretschmer A, Marra G, Preisser F, et al. Radical prostatectomy: sequelae in the course of time. Frontiers in Surgery. 2021; 8: 684088.

[26] Nam RK, Cheung P, Herschorn S, Saskin R, Su J, Klotz LH, et al. Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapy for prostate cancer: a population-based cohort study. The Lancet Oncology. 2014; 15: 223–231.

[27] Lehto U, Tenhola H, Taari K, Aromaa A. Patients’ perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: a nationwide survey. British Journal of Cancer. 2017; 116: 864–873.

[28] Chambers SK, Chung E, Wittert G, Hyde MK. Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment. Translational Andrology and Urology. 2017; 6: 60–68.

[29] Nelson CJ, Lacey S, Kenowitz J, Pessin H, Shuk E, Roth AJ, et al. Men’s experience with penile rehabilitation following radical prostatectomy: a qualitative study with the goal of informing a therapeutic intervention. Psycho-Oncology. 2015; 24: 1646–1654.

[30] Bergius S, Roine RP, Taari K, Sintonen H. Health-related quality of life and survival in prostate cancer patients in a real-world setting. Urologia Internationalis. 2020; 104: 939–947.

[31] Posielski N, Frankel J, Kuo H, Ho O, Elsamanoudi S, Nousome D, et al. Impact of age and race on health-related quality of life outcomes in patients undergoing radical prostatectomy for localized prostate cancer. Urology. 2022; 163: 99–106.

[32] Naccarato AMEP, Consuelo Souto S, Matheus WE, Ferreira U, Denardi F. Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy. The Aging Male. 2020; 23: 346–353.

[33] Aoun F, Peltier A, Velthoven RV. Penile rehabilitation after pelvic cancer surgery. The Scientific World Journal. 2015; 2015: 876046.

[34] Li C, Rew L, Chen L. Factors affecting sexual function: a comparison between women with gynecological or rectal cancer and healthy controls. Nursing & Health Sciences. 2015; 17: 105–111.

[35] Wang C, Song Z, Li S, Tai S. Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Supportive Care in Cancer. 2018; 26: 1553–1560.

[36] Laidsaar-Powell R, Butow P, Bu S, Charles C, Gafni A, Fisher A, et al. Family involvement in cancer treatment decision-making: a qualitative study of patient, family, and clinician attitudes and experiences. Patient Education and Counseling. 2016; 99: 1146–1155.

[37] Fernández-Sola C, Martínez-Bordajandi, Puga-Mendoza AP, Hernández-Padilla JM, Jobim-Fischer V, López-Rodríguez MDM, et al. Social support in patients with sexual dysfunction after non-nerve-sparing radical prostatectomy: a qualitative study. American Journal of Men’s Health. 2020; 14: 155798832090697.

[38] Banegas MP, Schneider JL, Firemark AJ, Dickerson JF, Kent EE, de Moor JS, et al. The social and economic toll of cancer survivorship: a complex web of financial sacrifice. Journal of Cancer Survivorship. 2019; 13: 406–417.

[39] Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: a systematic literature review. Psycho-Oncology. 2020; 29: 1746–1760.

[40] Srigley JR, Delahunt B, Egevad L, Samaratunga H, Yaxley J, Evans AJ. One is the new six: the international society of urological pathology (ISUP) patient-focused approach to Gleason grading. Canadian Urological Association Journal. 2016; 10: 339–341.

[41] Chen MM, Jahn JL, Barber JR, Han M, Stampfer MJ, Platz EA, et al. Clinical stage provides useful prognostic information even after pathological stage is known for prostate cancer in the PSA era. PLOS ONE. 2020; 15: e0234391.

[42] Shpot EV, Chinenov DVC, Amosov AV, Chernov YN, Yurova MVY, Lerner YV. Erectile dysfunction associated with radical prostatectomy: appropriateness and methods to preserve potency. Urologiia. 2018; 2: 75–82.

[43] Blomberg K, Wengström Y, Sundberg K, Browall M, Isaksson A, Nyman MH, et al. Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer—scoping the perspectives of patients, professionals and literature. European Journal of Oncology Nursing. 2016; 21: 139–145.

[44] Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, et al. Overdiagnosis and overtreatment of prostate cancer. European Urology. 2014; 65: 1046–1055.

[45] Horrill T. Active surveillance in prostate cancer: a concept analysis. Journal of Clinical Nursing. 2016; 25: 1166–1172.

[46] McKenney JK, Simko J, Bonham M, True LD, Troyer D, Hawley S, et al. The potential impact of reproducibility of gleason grading in men with early stage prostate cancer managed by active surveillance: a multi-institutional study. The Journal of Urology. 2011; 186: 465–469.

[47] John A, O’Callaghan M, Catterwell R, Selth LA. Does Gleason score of positive surgical margin after radical prostatectomy affect biochemical recurrence and oncological outcomes? Protocol for systematic review. BMJ Open. 2020; 10: e034612.

[48] Borkenhagen JF, Eastwood D, Kilari D, See WA, Van Wickle JD, Lawton CA, et al. Digital rectal examination remains a key prognostic tool for prostate cancer: a national cancer database review. Journal of the National Comprehensive Cancer Network. 2019; 17: 829–837.

[49] Yamamoto T, Fukuta F, Masumori N. Does digital rectal examination predict prostate volume greater than 30 mL? International Journal of Urology. 2017; 24: 373–376.

[50] Okotie OT, Roehl KA, Han M, Loeb S, Gashti SN, Catalona WJ. Characteristics of prostate cancer detected by digital rectal examination only. Urology. 2007; 70: 1117–1120.

[51] Heidegger I, Klocker H, Pichler R, Pircher A, Prokop W, Steiner E, et al. ProPSA and the Prostate health index as predictive markers for aggressiveness in low-risk prostate cancer—results from an international multicenter study. Prostate Cancer and Prostatic Diseases. 2017; 20: 271–275.

[52] Novak V, Vesely S, Luksanová H, Prusa R, Capoun O, Fiala V, et al. Preoperative prostate health index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer. BMC Urology. 2020; 20: 144.

[53] Ikeda M, Amano N, Sakata Y, Honda T, Tachibana T, Hirano S, et al. Gleason pattern 5 is a possible pathologic predictor for biochemical recurrence after laparoscopic radical prostatectomy. Asian Pacific Journal of Cancer Prevention. 2019; 20: 783–788.

[54] Boesen L. Multiparametric MRI in detection and staging of prostate cancer. Danish Medical Journal. 2017; 64: B5327.

[55] Schütz V, Kesch C, Dieffenbacher S, Bonekamp D, Hadaschik BA, Hohenfellner M, et al. Multiparametric MRI and MRI/TRUS fusion guided biopsy for the diagnosis of prostate cancer. Advances in Experimental Medicine and Biology. 2018; 344: 87–98.

[56] Sahin A, Urkmez A, Haki Yuksel O, Verit A. Influence of obesity on Gleason score inconsistencies between biopsy and radical prostatectomy specimens. Journal of the College of Physicians and Surgeons Pakistan. 2018; 28: 541–545.

[57] Wu VJ, Pang D, Tang WW, Zhang X, Li L, You Z. Obesity, age, ethnicity, and clinical features of prostate cancer patients. American Journal of Clinical and Experimental Urology. 2017; 5: 1–9.

[58] Duarte MF, Luis C, Baylina P, Faria MI, Fernandes R, La Fuente JM. Clinical and metabolic implications of obesity in prostate cancer: is testosterone a missing link? The Aging Male. 2019; 22: 228–240.

[59] Matarín Jiménez TM, Fernández-Sola C, Hernández-Padilla JM, Correa Casado M, Antequera Raynal LH, Granero-Molina J. Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study. Journal of Advanced Nursing. 2017; 73: 1646–1656.

[60] Fernández-Sola C, Huancara-Kana D, Granero-Molina J, Carmona-Samper E, López-Rodríguez M del M, Hernández-Padilla JM. Sexuality throughout all the stages of pregnancy: Experiences of expectant mothers. Acta Paulista de Enfermagem. 2018; 31: 305–312.

[61] Katz A, Dizon DS. Sexuality after cancer: a model for male survivors. The Journal of Sexual Medicine. 2016; 13: 70–78.

[62] Fode M, Serefoglu EC, Albersen M, Sønksen J. Sexuality following radical prostatectomy: is restoration of erectile function enough? Sexual Medicine Reviews. 2017; 5: 110–119.

[63] Blomberg K, Wengström Y, Sundberg K, Browall M, Isaksson A, Nyman MH, et al. Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer—scoping the perspectives of patients, professionals and literature. European Journal of Oncology Nursing. 2016; 21: 139–145.

[64] Mullins B, Basak R, Broughman JR, Chen RC. Patient-reported sexual quality of life after different types of radical prostatectomy and radiation treatments: analysis of a population-based prospective cohort. Cancer. 2019; 15: 3657–3667.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus: CiteScore 0.9 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (

Submission Turnaround Time