MP62-01 FUNCTIONAL OUTCOMES IN PATIENTS WITH CLINICALLY HIGH-RISK PROSTATE CANCER (PCA) TREATED WITH ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALP)

Abstract

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 2015MP62-01 FUNCTIONAL OUTCOMES IN PATIENTS WITH CLINICALLY HIGH-RISK PROSTATE CANCER (PCA) TREATED WITH ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALP) Firas Abdollah, Daniel Pucheril, Jesse Sammon, Akshay Sood, Dane Klett, Nicola Fossati, Giorgio Gandaglia, Nazareno Suardi, Giorgio Guazzoni, Manuela Tutolo, Craig Rogers, Hans Stricker, Wooju Jeong, James Peabody, Francesco Montorsi, Alberto Briganti, and Mani Menon Firas AbdollahFiras Abdollah More articles by this author , Daniel PucherilDaniel Pucheril More articles by this author , Jesse SammonJesse Sammon More articles by this author , Akshay SoodAkshay Sood More articles by this author , Dane KlettDane Klett More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Manuela TutoloManuela Tutolo More articles by this author , Craig RogersCraig Rogers More articles by this author , Hans StrickerHans Stricker More articles by this author , Wooju JeongWooju Jeong More articles by this author , James PeabodyJames Peabody More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , and Mani MenonMani Menon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The last decade saw a shift in treatment paradigm for PCa. Specifically, there has been increased recognition of the role for surgery as an initial treatment in patients with clinically high-risk PCa. Simultaneously, a rapid increase in the use of RALP as a substitute for open surgery has occured. In consequence, an increasing number of men with high-risk PCa are treated with RALP. We evaluated post-op functional outcomes in these individuals, focusing on post-op urinary continence (UC) and erectile function (EF) recovery. METHODS 799 men with D'Amico clinical high-risk PCa treated with RALP between 2004 and 2012 at 2 tertiary care centers were included. Uni-/multi-variable (MVA) Cox regression analyses tested the relationship between available predictors and two endpoints: 1) UC recovery (the use of 0-1 pad after surgery); 2) EF recovery (post-op International Index of Erectile Function (IIEF)-EF≥17). Covariates consisted of age, body mass index (BMI), PSA value, clinical stage, Gleason grade at biopsy, Charlson comorbidity index, nerve sparing status, pre-op IIEF-EF (for EF recovery endpoint), and pre-op IPSS (for continence recovery endpoint). All patients were instructed to start PDE-5 inhibitors, and/or penile injection to treat erectile dysfunction after surgery. RESULTS Mean (median) age, PSA value, and BMI at surgery were 62.1 yrs (63), 10.2 ng/ml (6.1), and 27.9 Kg/m2 (27), respectively. Biopsy GS was ≥8 in 56.6% of patients, and clinical stage was ≥T2c in 40.1% of patients. Mean (median) pre-op IIEF-EF was 19 points (22). Overall, 86.5% received a nerve-sparing RALP, 32.9% had positive surgical margins, and 3.4% received any adjuvant treatment. Mean (median) follow-up time was 58.5 months (56.5). At 3-, 6-, 12-, 24-, and 36-months post-op the UC recovery rate was respectively 79, 83, 86, 88, and 97%, while the EF recovery rate was respectively 14, 28, 42, 54, and 77%. At MVA, only age (HR: 0.98, p=0.005) was an independent predictor of UC recovery, while both BMI (HR: 0.94, p=0.02), and pre-op IIEF-EF (HR: 1.07, p=0.04) were independent predictors of EF recovery. CONCLUSIONS Our findings represent one of the few reports on functional outcomes in patients with D'Amico clinically high-risk PCa treated with RALP. At 3-years post-op the vast majority of patients recover urinary continence (97%), and a substantial number recover EF (77%). However, older age and higher BMI might negatively impact the recovery of functional outcomes, while a better baseline sexual function has a positive impact on post-op EF recovery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e780 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Firas Abdollah More articles by this author Daniel Pucheril More articles by this author Jesse Sammon More articles by this author Akshay Sood More articles by this author Dane Klett More articles by this author Nicola Fossati More articles by this author Giorgio Gandaglia More articles by this author Nazareno Suardi More articles by this author Giorgio Guazzoni More articles by this author Manuela Tutolo More articles by this author Craig Rogers More articles by this author Hans Stricker More articles by this author Wooju Jeong More articles by this author James Peabody More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Mani Menon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...