MP62-15 MAY OUTCOMES OF RALP PERFORMED AFTER AN INITIAL AS STRATEGY DIFFER FROM THOSE FROM IMMEDIATE SURGERY? A PROPENSITY SCORES MATCHED ANALYSIS ON 388 PATIENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-15 MAY OUTCOMES OF RALP PERFORMED AFTER AN INITIAL AS STRATEGY DIFFER FROM THOSE FROM IMMEDIATE SURGERY? A PROPENSITY SCORES MATCHED ANALYSIS ON 388 PATIENTS Bernardo Rocco, Maria Chiara Sighinolfi, Marcio Covas Moschovas, Sandri Marco, Alessandra Cassani, Luca Sarchi, Simone Assumma, Salvatore Micali, and Vipul Patel Bernardo RoccoBernardo Rocco More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Sandri MarcoSandri Marco More articles by this author , Alessandra CassaniAlessandra Cassani More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Simone AssummaSimone Assumma More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is recommended as an initial treatment strategy for low-risk PCa patients to reduce overtreatment and to avoid possible side effects. Indications to AS are currently extending also to intermediate-risk PCa with low rate of pattern 4 (<10%). In case of disease progression, an active treatment is necessary, and robotic radical prostatectomy (RALP) could be an option. Our study compares peri-operative, oncological, and functional outcomes between patients who underwent RALP after AS strategy and patients who opted for immediate surgical treatment in a referral center. METHODS: Data from patients undergoing RALP following AS were prospectively collected in a single center and compared to patients who underwent an immediate RALP after propensity score (PS) matching. The PS analysis was performed using the covariates age, BMI, CCI, pre-op Sexual Health Inventory for Men (SHIM) score, prostate size, PSA, cT, date of surgery, length of follow up. ISUP score at the time of AS indication was matched with ISUP at RALP for the control group. Peri-operative performance, functional and oncological outcomes were compared between groups at early and intermediate follow up. RESULTS: 388 patients were included (194 RALP after AS and 194 immediate RALP). Median time of AS was 35.4 months (IQR 22-60). Median follow up was 24 and 20 months for AS and controls, respectively (p=0.1). Median console time was significantly higher in the AS group than in the control group (80 vs 75 min; p=0.03), there was no significant difference in EBL and complication rate. At final pathology, the AS group had a lower rate of ISUP 1 but a significantly higher rate of ISUP ≥ 4 (p=0.002). Lymphovascular invasion and EPE was higher in AS group (26% vs 9%, p=0.004; 38% vs 28%, p=0.05, respectively), there was no significant difference in PSM rate. The initial AS strategy improved the risk of biochemical recurrence (HR 4.2; 95%CI 1.2-14.8; p=0.02) whereas potency and continence rate did not differ significantly between groups at each interval point. In the subgroup of patients with a pre-op SHIM < 17, AS was associated with a decreased risk of potency (HR 0.4, 95% CI 0.19-0.88, p=0.02) and a higher time for recovery of erection (190 days in AS vs 92 days in immediate RALP, p=0.06). CONCLUSIONS: RALP performed after an initial AS strategy is likely to impair early and intermediate oncological outcomes maybe due to higher chances of EPE and lymphovascular invasion. In addition, the percentage of ISUP≥ 4 in AS patients was double in the final pathology. Functional outcomes (continence, potency) are similar between groups. Patients with a pre-operative moderate degree of erectile dysfunction should be informed that potency recovery could be adversely affected by a delayed surgical treatment. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1098-e1098 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernardo Rocco More articles by this author Maria Chiara Sighinolfi More articles by this author Marcio Covas Moschovas More articles by this author Sandri Marco More articles by this author Alessandra Cassani More articles by this author Luca Sarchi More articles by this author Simone Assumma More articles by this author Salvatore Micali More articles by this author Vipul Patel More articles by this author Expand All Advertisement Loading ...