Anıl ERDİK, Hacı İbrahim ÇİMEN, Deniz GÜL, Kemal DEMİRHAN, Yasir Muhammed AKÇA, Onur TAYDAŞ
Sakarya Tıp Dergisi - 2026;16(2):313-326
Objective: Sarcopenia is increasingly recognized as a marker of frailty and a predictor of adverse outcomes in surgical oncology. However, its role in patients undergoing radical prostatectomy (RP) for localized prostate cancer (PCa) remains unclear. Methods: We retrospectively analyzed 165 men who underwent RP between 2015 and 2025 at a single institution. Sarcopenia was assessed using preoperative CT-derived skeletal muscle index (SMI). Perioperative complications, pathological outcomes, urinary continence, erectile function, biochemical recurrence (BCR), and all-cause mortality (ACM) were compared between sarcopenic and non-sarcopenic patients. Statistical analyses included the Mann-Whitney U test, chi-square test, Kaplan-Meier analysis with the log-rank test, and Cox proportional hazards regression. Results: Of the cohort, 75 patients (45.5%) were sarcopenic. These patients were older (median age 69 vs. 66 years, p=0.005) and had higher comorbidity scores (CCI >=5: 56.0% vs. 32.2%, p=0.002). Major complications (Clavien-Dindo >=3) occurred more frequently in the sarcopenic group (10.7% vs. 1.1%, p=0.007), although no perioperative mortality was observed. Continence status at 12 months was comparable between the groups (p=0.373). IIEF-5 scores were lower in sarcopenic patients at 12 months (median, 10 vs. 12; p=0.021); however, baseline IIEF-5 scores also differed significantly between the groups. During a median follow-up of 37 months, 65 patients developed BCR and 11 died (7 sarcopenic). Cumulative incidence of biochemical recurrence was 44% at the median follow-up. Although sarcopenic patients showed a higher recurrence trend (?65% vs. 37%), no statistically significant difference was observed (p=0.267). In Cox Regression analysis, sarcopenia did not appear to significantly predict BCR (HR 0.75, 95% CI 0.45-1.24, p=0.272). Conclusions: Preoperative sarcopenia may be associated with increased major perioperative complications and impaired erectile function following RP. However, it was not significantly associated with BCR in this cohort. Sarcopenia may primarily serve as an indicator of surgical vulnerability rather than oncological prognosis.
