Prostatectomy For Localized Prostate Cancer Research Articles

Effects of Short-Term Finasteride on Apoptotic Factors and Androgen Receptors in Prostate Cancer Cells

We explored the molecular correlates of the effect of finasteride on prostate tissue in patients undergoing radical prostatectomy. Patients undergoing radical prostatectomy for localized prostate cancer were eligible for study. After providing informed consent patients were randomized to receive 5 mg finasteride or placebo daily for at least 30 days before surgery. At surgery prostate tissue was harvested from the surgical specimen and sent for analysis. Tissue samples were analyzed for the pro-apoptotic factors caspase-3, caspase-7 and IGFBP-3. Samples were also analyzed for the tumor suppressor/proto-oncoproteins bcl-2, p53 and p21. Finally, tissues were analyzed for androgen receptor density and insulin growth factor-1. A total of 22 study and 20 placebo samples were collected and analyzed. Negligible staining for bcl-2 or caspase-3 was noted in each group. Statistical differences were not observed for bcl-2, p53, p21 or insulin growth factor-1 between the groups. There was a statistically significant difference in caspase-7 and IGFBP-3. A mean of 77% and 99.9% of cells stained for caspase-7 in the treatment and placebo groups, respectively (p = 0.007). In 3 patients caspase-7 staining disappeared completely and it was decreased by 70% and 50% in 1 patient each. Mean intensity staining for IGFBP-3 was 1.03 in the treatment group and 1.54 in the placebo group (p = 0.005). The staining intensity of nuclear androgen receptors on benign and cancerous cells was not significantly different between the treatment and placebo groups. However, there was a significant difference in androgen receptor staining between benign and cancer cells in the 2 populations. Mean nuclear androgen receptor staining intensity in all cancer and all benign tissue samples was 119.3 and 151.8, respectively (0.001). Finasteride administered 30 days before surgery appears to decrease the apoptotic factors caspase-7 and IGFBP-3 in cancer cells, while having little to no effect on caspase-3, insulin growth factor-1, bcl-2, p53 and p21. This short-term study may have interesting implications for interpreting Prostate Cancer Prevention Trial data on the molecular level. No differences were noted between the treatment and placebo groups in the expression of nuclear androgen receptor. However, decreased expression of androgen receptors was present in cancer cells compared to that in benign prostate cells in the 2 groups.

Nomogram Predicting the Probability of Early Recurrence After Radical Prostatectomy for Prostate Cancer

We developed a nomogram predicting the probability of early biochemical recurrence after radical prostatectomy because early recurrence predisposes to distant metastasis and prostate cancer related mortality. Identifying patients at risk for early recurrence may improve prognosis as early institution of adjuvant therapy may reduce the risk of progression. From January 1992 to December 2005, 2,911 patients underwent radical prostatectomy for localized prostate cancer. Cox regression models addressing biochemical recurrence after radical prostatectomy were used to identify significant predictors. Age, prostate specific antigen, pathological Gleason sum, surgical margin, extracapsular extension, seminal vesicle invasion and lymph node invasion were considered. A nomogram predicting the probability of biochemical recurrence-free survival within 2 years after radical prostatectomy was developed. Data from an independent center were used for external validation (2,875). In both cohorts combined during the first 2 years 11.0% (639) of all patients experienced relapse which accounted for 58.5% of all observed biochemical recurrence. In the development cohort except for age all covariates represented significant predictors of biochemical recurrence after radical prostatectomy. Pathological Gleason sum 7 or greater, seminal vesicle invasion and lymph node invasion were the most powerful predictors of biochemical recurrence. The accuracy (c-index) of the nomogram predicting biochemical recurrence-free survival within 2 years after radical prostatectomy was 0.82 in the external validation cohort. Two-thirds of all instances of relapse occur during the first 2 years after radical prostatectomy. Those patients can be highly accurately identified with our nomogram. They might benefit the most from adjuvant treatment and could be the ideal candidates for adjuvant treatment trials.

Androgen replacement therapy in patients with age-related hypogonadism after radical retropubic prostatectomy for localized prostate cancer

Background The aim was to estimate the efficacy and safety of androgen replacement therapy (ART) in a retrospective cohort study of a group of patients with signs and symptoms of hypogonadism who had undergone radical retropubic prostatectomy (RRP) for localized prostate cancer (PCa). Methods The results of treatment in 16 patients who had undergone RRP for localized PCa at stage pT2N0M0 during the years 2001–2005 were analyzed. Both prior to and following the ART, serum total testosterone (T), and prostate-specific antigen (PSA) levels were evaluated, and signs and symptoms were assessed using the Aging Male Symptoms (AMS) Scale. Results With a mean ART duration of 15 months, the mean test level increased from 6.5 ± 1.98 nmol/l to 19.2 ± 5.1 nmol/l (from 188 ± 57 ng/dl to 555 ± 198 ng/dl) ( p < 0.01), while the AMS symptom score decreased from 40.4 ± 5.4 to 20.8 ± 3.8 points. None of the patients had evidence indicative of biochemical or clinical progression of localized PCa. Conclusion Our experience of the treatment of 16 patients and the relevant literature data suggest that in the carefully selected patients with the signs and symptoms of hypogonadism following RRP, the safe use of ART with a good clinical effect is feasible. To formulate the clinical guidelines on ART in patients who have been surgically cured of PCa, prospective, multicenter studies with large numbers of patients are required.

High surgical volume is associated with a lower rate of secondary therapy after radical prostatectomy for localized prostate cancer

To assess the relationship between surgical volume (SV), defined as the number of radical prostatectomies (RPs) within a calendar year, and the time to secondary therapy (ST) after RP, as this might represent an important determinant of cancer control. The study included 7937 men treated with RP by 130 urologists between 1989 and 2000. Radiotherapy or any form of hormonal manipulation represented ST. Univariable and multivariable Cox regression analyses was used to evaluate the time to ST after RP. SV was an independent (P = 0.02) predictor of ST-free survival after RP, and the multivariable rate of ST sharply decreased with increasing SV. The use of ST is inversely proportional to SV of up to 24 RPs per year. A higher annual SV might be indicative of less restrictive use of RP in high-risk patients who eventually require combined treatments.

Significance of micrometastases in prostate cancer

Pelvic lymph node metastases have been considered the most potent factor associated with disease recurrence in patients undergoing radical prostatectomy for localized prostate cancer. Routine pathological examination, however, can miss micrometastatic tumor foci in the lymph nodes of patients with prostate cancer, resulting in confused tumor staging and clinical decision-making. Accordingly, intensive efforts have been made to develop a procedure for efficaciously detecting micrometastases in pelvic lymph nodes using several kinds of molecular and histopathological techniques targeting genes specifically expressed in the prostate, such as prostate-specific antigen and prostate-specific membrane antigen. Although some of these techniques have been shown to achieve significantly higher sensitivity for detecting micrometastatic prostate cancer cells in surgically removed pelvic nodes during radical prostatectomy than conventional pathological examination, there have not been any methods introduced into clinical practice. In this review, we attempted to summarize recent advances in the field of "micrometastases" in prostate cancer in order to clarify the clinical significance of micrometastases in patients undergoing radical prostatectomy and to suggest limitations to be overcome before developing a reliable model for clinical application.

Effect of socioeconomic status and race on outcome after radical prostatectomy for localized prostate cancer

5061 Background: In the US, profound social disparities in cancer diagnosis, treatment and mortality have been demonstrated in various cancers. We sought to evaluate the impact of socioeconomic status (SES) on utilization and cancer specific survival (CSS) after radical prostatectomy (RP) for Gleason <7, localized prostate cancer. Methods: The California Cancer Registry (CCR) is a population-based registry that has collected cancer incidence data for the entire population of California since 1988. We evaluated the association between SES and CSS for men who underwent initial RP for localized, Gleason score <7 prostate cancer in California from 1996 to 2005. SES status was defined using a residential block group method and ranked into quintiles. Survival was analyzed using Cox proportional hazards models. Results: Between 1996 and 2005, 123,836 men were diagnosed with localized, Gleason score <7 prostate cancer. Of these men, 39,192 (32%) underwent RP as initial therapy. Men of lower SES were less likely to undergo RP for localized prostate cancer than men of higher SES. For men who underwent RP (n = 39,192), the risk of death from prostate cancer declined 51% from the lowest quartile of SES to the highest quartile of SES (P for linear trend = 0.0003). Adjustment for race produced nearly identical results. (see table) Conclusions: Men of lower SES are less likely to undergo RP in the management of localized prostate cancer. Even when RP is performed, men with lower SES still have an increased cancer specific mortality when compared to men of higher SES. Quintile of SES Percent of patients undergoing RP HR for death from prostate cancer HR for death from prostate cancer–adjusted for race 1 (lowest) 27.4 1.00 (referent) 1.00 (referent) 2 29.2 0.74(0.46–1.18) 0.67(0.42–1.08) 3 30.1 0.72(0.46–1.13) 0.63(0.40–0.99) 4 32.2 0.48(0.30–0.76) 0.40(0.25–0.66) 5 (highest) 35.3 0.49(0.32–0.76) 0.41(0.26- 0.65) No significant financial relationships to disclose.

Prostatectomie radicale avec conservation du col vésical : marges chirurgicales et continence urinaire

To evaluate the functional and cancer results of radical prostatectomy with bladder neck preservation in the treatment of localized prostate cancer. From January 2000 to March 2006, 194 consecutive patients underwent open retropubic radical prostatectomy for localized prostate cancer. The bladder neck was technically preserved in 180 patients (93%). The mean age of these 180 patients was 63.2+/-6.1 years. The mean preoperative PSA was 9.38+/-6 ng/ml. The 180 patients were classified according to the Amico prognostic classification as low risk: 52.2%, intermediate risk: 37.8% and high risk: 10%. Operative specimens were examined by the same pathologist according to the Stanford technique. Positive surgical margin was defined as tumour tissue in contact with the ink of the operative specimen. For analysis of the functional results, patients were classified into three categories: continent without protection, stress incontinent, totally incontinent. Continence was evaluated at D10, one month, six months, one, two, three, four and five years. The mean follow-up was 44+/-25 months. This series of 180 operative specimens comprised 64 (35.6%) cases of positive surgical margins and 112 (62.2%) pT3 cancers. No positive margins were observed in the bladder neck, either alone or associated with another positive margin. Seventy-one percent of patients were continent on D10 and at one month, 85% were continent at six months and 89% were continent at one year. Two cases of anastomotic stenosis were observed (1.2%). Bladder neck preservation during open retropubic radical prostatectomy allows early continence in more than 70% of cases without increasing the risk of positive surgical margins.

A phase I trial of pre-operative radiotherapy for prostate cancer: Clinical and translational studies

Background and purpose Selected patients undergoing radical prostatectomy for localized prostate cancer can be at high-risk for pT3 disease and require subsequent radiotherapy. In a phase I trial, we investigated the feasibility of pre-operative radiotherapy for this patient subset. Materials and methods Eligibility criteria were: T1/T2N0M0 tumors plus (i) Gleason ⩾ 7, PSA > 10 ng/ml and <35 ng/ml, or (ii), PSA >15 ng/ml and less <35 ng/ml (any Gleason). Patients received 25 Gy in five fractions of radiotherapy followed by radical prostatectomy. Trial endpoints included intra-operative morbidity and late toxicity following combined treatment. We also stained pre- and post-radiotherapy prostate samples for DNA damage response proteins. Results Between 2001 and 2004, 15 patients were entered on trial. Thirteen patients completed combined-modality treatment. Only one patient had signs of intra-operative inflammation. No patient had post-operative complication. There was no severe late gastrointestinal toxicity. Late genitourinary toxicity consisted of severe urinary incontinence in 2 of 13 patients. From a translational standpoint, irradiated prostate tumor tissues had long-term activation of the CDK-inhibitor p21 WAF associated with reduced cell proliferation. Conclusion Intra-operative morbidity is low following short-course, pre-operative radiotherapy. A phase II trial is planned to fully document biochemical response with this combined-modality approach.

The Impact of Prostate Size on Urinary Quality of Life Indexes Following Laparoscopic Radical Prostatectomy

We assessed the effects of prostate size on long-term health related quality of life and functional outcomes after laparoscopic radical prostatectomy. A total of 729 consecutive patients who underwent laparoscopic radical prostatectomy for localized prostate cancer were stratified by pathological prostate gland weight, including group 1--less than 35 gm, group 2--35 to 70 gm and group 3--greater than 70 gm. Urinary health related quality of life was assessed preoperatively and at regular intervals following laparoscopic radical prostatectomy using the validated Expanded Prostate Cancer Index Composite questionnaire. A total of 613 evaluable patients were studied with a mean age of 57.7 years, a preoperative prostate specific antigen of 6.0 ng/ml, a median preoperative and postoperative Gleason score of 6, and a mean pathological gland weight of 51.3 gm (range 13.4 to 145.7). Patients with the largest glands had significantly worse baseline urinary function, as demonstrated by Expanded Prostate Cancer Index Composite urinary domain summary (p <0.001) and subscale scores, including scores for urinary bother (p <0.001), urinary irritative/obstructive (p = 0.001) and urinary incontinence (p = 0.03). Patients in group 3 also had significantly older age, a higher body mass index, longer operative time and more blood loss (each p <0.05). Despite preoperative differences and possible confounders all groups approached similar urinary health related quality of life outcomes at all time points postoperatively. At 12 months patients with the largest glands had improved Expanded Prostate Cancer Index Composite urinary irritative/obstructive and urinary bother subscale scores compared to their baseline scores (p <0.05). In laparoscopic radical prostatectomy despite preoperative differences increasing prostatic size is not associated with delayed or worse postoperative urinary health related quality of life. Furthermore, in patients with large glands an improvement in urinary irritative/obstructive and bother symptoms from baseline may be seen 12 months postoperatively.

Prostate Cancer Volume at Biopsy Predicts Clinically Significant Upgrading

A significant proportion of patients with prostate cancer with Gleason score 6 disease at biopsy is upgraded to Gleason score 7 or higher after radical prostatectomy, increasing the risk of adverse outcome. We identified clinical and pathological parameters that predict pathological upgrading in this population. A total of 268 patients with biopsy Gleason score 6 prostate cancer who underwent biopsy and radical prostatectomy between October 1999 and January 2007 were included in the study. Pretreatment characteristics were used to identify predictors of pathological upgrading. Upgrading significance was established by comparing radical prostatectomy pathology between cases that were and were not upgraded. A total of 134 patients (50%) were upgraded postoperatively to Gleason score 7 or higher. Preoperative prostate specific antigen greater than 5.0 ng/ml (p = 0.036), prostate weight 60 gm or less (p = 0.004) and more cancer volume at biopsy, defined by cancer involving greater than 5% of the biopsy tissue (p = 0.002), greater than 1 biopsy core (p <0.001) or greater than 10% of any core (p = 0.014), were associated with pathological upgrading. Upgraded patients were more likely to have extraprostatic extension and positive surgical margins at radical prostatectomy (p <0.001 and 0.001, respectively). Prostate specific antigen, prostate volume and biopsy cancer volume predict clinically significant upgrading in patients diagnosed with Gleason score 6 disease. These parameters may be valuable in the pretreatment risk assessment of this patient population.

Significance of Tertiary Gleason Pattern 5 in Gleason Score 7 Radical Prostatectomy Specimens

The Gleason grading system in reporting prostate cancer accounts for the primary and secondary Gleason pattern. The clinical significance of a higher tertiary (third most prevalent) grade is largely unrecognized. Radical prostatectomy specimens from 300 patients with Gleason score 7 (3 + 4 or 4 + 3) prostate cancer were pathologically reexamined for the presence of a tertiary grade 5 pattern as well as the association with pathological stage and biochemical recurrence-free survival. A total of 214 patients met study inclusion criteria. Patients with Gleason score 7 and tertiary grade 5 cancer had significantly higher pathological stage disease than patients with Gleason score 7 without tertiary grade 5 cancer (p <0.001). Gleason score 7 + tertiary pattern 5 tumors were significantly associated with adverse pathological features such as seminal vesicle invasion, extraprostatic extension and lymphovascular invasion compared to Gleason score 7 tumors (p <0.05). The relative effects of a tertiary grade 5 component on all pathological parameters analyzed was greater for Gleason score 7 tumors with a lower primary Gleason pattern 3 vs a higher primary Gleason pattern 4. Patients with Gleason score 7 + tertiary pattern 5 tumors had significantly decreased biochemical recurrence-free survival (54 months) compared to patients with Gleason score 7 tumors (121 months) (p = 0.0005). Preoperative prostate specific antigen, lymphovascular invasion and positive surgical margin status were shown to be independent predictors of prostate specific antigen recurrence on multivariate analysis. Small percentages of tertiary grade 5 patterns in Gleason score 7 radical prostatectomy specimens are associated with aggressive pathological features predictive of advanced pathological stage and biochemical recurrence-free survival.

Androgen Deprivation Therapy for Localized Prostate Cancer and the Risk of Cardiovascular Mortality

We investigated whether androgen deprivation therapy (ADT) use is associated with an increased risk of death from cardiovascular causes in patients treated for localized prostate cancer. From the Cancer of the Prostate Strategic Urologic Research Endeavor database, data on 3262 patients treated with radical prostatectomy and 1630 patients treated with external beam radiation therapy, brachytherapy, or cryotherapy for localized prostate cancer were included in this analysis. Competing risks regression analyses were performed to assess whether use of ADT was associated with a shorter time to death from cardiovascular causes after controlling for age (as a continuous variable) and the presence of baseline cardiovascular disease risk factors. All tests for statistical significance were two-sided. The median follow-up time was 3.8 years (range = 0.1-11.3 years). Among the 1015 patients who received ADT, the median duration of ADT use was 4.1 months (range = 1.0-32.9 months). In a competing risks regression analysis that controlled for age and risk factors for cardiovascular disease, both ADT use (adjusted hazard ratio [HR] = 2.6; 95% confidence interval [CI] = 1.4 to 4.7; P = .002) and age (adjusted HR = 1.07; 95% CI = 1.02 to 1.1; P = .003) were associated with statistically significantly increased risks of death from cardiovascular causes in patients treated with radical prostatectomy. Among patients 65 years or older treated with radical prostatectomy, the 5-year cumulative incidence of cardiovascular death was 5.5% (95% CI = 1.2% to 9.8%) in those who received ADT and 2.0% (95% CI = 1.1% to 3.0%) in those who did not. Among patients 65 years or older treated with external beam radiation therapy, brachytherapy, or cryotherapy, ADT use was associated with a higher cumulative incidence of death from cardiovascular causes, but the difference did not reach statistical significance. The use of ADT appears to be associated with an increased risk of death from cardiovascular causes in patients undergoing radical prostatectomy for localized prostate cancer.

MP-18.21: Comparative study of health-related quality of life in patients underwent brachytherapy, external beam radiation therapy combined with brachytherapy and radical prostatectomy for localized prostate cancer

MP-18.21: Comparative study of health-related quality of life in patients underwent brachytherapy, external beam radiation therapy combined with brachytherapy and radical prostatectomy for localized prostate cancer

Cancer aggressiveness is country-specific

The geographical continent in which a patient resides is a strong predictor of lymph-node invasion (LNI) in patients undergoing radical prostatectomy for localised prostate cancer (BJU International 2007; 100: 528–32).

POS-01.119: Risk factors for postprostatectomy incontinence in a country with low incidence of prostate cancer

The rate of urinary incontinence after radical prostatectomy is difficult to assess from the literature. We identified risk factors associated with urinary incontinence from one year longitudinal survey in men after radical prostatectomy for localized prostate cancer in Taiwan.

Association of cysteine-rich secretory protein 3 and beta-microseminoprotein with outcome after radical prostatectomy.

It has been suggested that cysteine-rich secretory protein 3 (CRISP-3) and beta-microseminoprotein (MSP) are associated with outcome in prostate cancer. We investigated whether these markers are related to biochemical recurrence and whether addition of the markers improves prediction of recurring disease. Tissue microarrays of radical prostatectomy specimens were analyzed for CRISP-3 and MSP by immunohistochemistry. Associations between marker positivity and postprostatectomy biochemical recurrence [prostate-specific antigen (PSA) >0.2 ng/mL with a confirmatory level] were evaluated by univariate and multivariable Cox proportional hazards regression. Multivariable analyses controlled for preoperative PSA and pathologic stage and grade. Among 945 patients, 224 had recurrence. Median follow-up for survivors was 6.0 years. Patients positive for CRISP-3 had smaller recurrence-free probabilities, whereas MSP-positive patients had larger recurrence-free probabilities. On univariate analysis, the hazard ratio for patients positive versus negative for CRISP-3 was 1.53 (P=0.010) and for MSP was 0.63 (P=0.004). On multivariable analysis, both CRISP-3 (P=0.007) and MSP (P=0.002) were associated with recurrence. The hazard ratio among CRISP-3-positive/MSP-negative patients compared with CRISP-3-negative/MSP-positive patients was 2.38. Adding CRISP-3 to a base model that included PSA and pathologic stage and grade did not enhance the prediction of recurrence, but adding MSP increased the concordance index minimally from 0.778 to 0.781. We report evidence that CRISP-3 and MSP are independent predictors of recurrence after radical prostatectomy for localized prostate cancer. However, addition of the markers does not importantly improve the performance of existing predictive models. Further research should aim to elucidate the functions of CRISP-3 and MSP in prostate cancer cells.

Long-Term Survival in Men With High Grade Prostate Cancer: A Comparison Between Conservative Treatment, Radiation Therapy and Radical Prostatectomy—A Propensity Scoring Approach

We performed a retrospective cohort study using propensity score analysis to calculate long-term survival in patients with prostate cancer with Gleason score 8 or greater who were treated with conservative therapy, radiation therapy and radical prostatectomy. Between January 1, 1980 and December 31, 1997, 3,159 patients in the Henry Ford Health System were diagnosed with clinically localized prostate cancer. Of these patients 453 had a Gleason score of 8 or greater in the biopsy specimen and they were the cohort. The end points were overall and prostate cancer specific survival. Propensity score analysis was used to more precisely compare the 3 treatments of observation, radiation and radical prostatectomy. Median patient followup was longer in the radical prostatectomy arm than in the conservative treatment and radiation therapy arms (68 months vs 52 and 54, respectively). Of the 453 patients 197 (44%) were treated conservatively, 137 (30%) received radiation therapy and 119 (26%) underwent radical prostatectomy. Using propensity scoring analysis median overall survival for conservative therapy, radiation and radical prostatectomy was 5.2, 6.7 and 9.7 years, respectively. Median cancer specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. The risk of cancer specific death following radical prostatectomy was 68% lower than for conservative treatment and 49% lower than for radiation therapy (p<0.001 and 0.053, respectively). Survival of men with high grade prostate cancer can be improved by radical prostatectomy or radiation therapy.

Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study

To prospectively compare health-related quality of life (HRQOL), patient-reported treatment-related symptoms, and costs of iodine-125 permanent implant interstitial brachytherapy (IB) with those of radical prostatectomy (RP) during the first 2 years after these treatments for localized prostate cancer. A total of 435 men with localized low-risk prostate cancer, from 11 French hospitals, treated with IB (308) or RP (127), were offered to complete the European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire QLQ-C30 version 3 (EORTC QLQ-C30) and the prostate cancer specific EORTC QLQ-PR25 module before and at the end of treatment, 2, 6, 12, 18, and 24 months after treatment. Repeated measures analysis of variance and analysis of covariance were conducted on HRQOL changes. Comparative cost analysis covered initial treatment, hospital follow-up, outpatient and production loss costs. Just after treatment, the decrease of global HRQOL was less pronounced in the IB than in the RP group, with a 13.5 points difference (p < 0.0001). A difference slightly in favor of RP was observed 6 months after treatment (-7.5 points, p = 0.0164) and was maintained at 24 months (-8.2 points, p = 0.0379). Impotence and urinary incontinence were more pronounced after RP, whereas urinary frequency, urgency, and urination pain were more frequent after IB. Mean societal costs did not differ between IB (8,019 euros at T24) and RP (8,715 euros at T24, p = 0.0843) regardless of the period. This study suggests a similar cost profile in France for IB and RP but with different HRQOL and side effect profiles. Those findings may be used to tailor localized prostate cancer treatments to suit individual patients' needs.

Radical Prostatectomy: Which Quality of Life?

The aim of the present study was to evaluate quality of life in patients submitted to radical prostatectomy, by correlating the results of the post-operative condition with follow-up data at 6 and 12 months. Materials and Methods. Between october 2004 and december 2005, 68 patients - mean age 68 (range 49–76) - treated with radical retropubic prostatectomy for localized prostate cancer (T2a, T2b, No, Mo) were consecutively enrolled onto the study. All patients underwent sexual as well as urinary incontinence rehabilitation, showing good compliance. We evaluated quality of life before prostatectomy (T0), 6 (T1) and 12 (T2) months after surgery through the Short Form 36 questionnaire, for which an analysis of variance for repeated measures was carried out. Patients were interviewed by our department psychologist regarding urinary incontinence and erectile dysfunction. All patients were disease-free at the time of evaluation. Results. No significant differences were observed between physical and mental health indices. Conversely, a significant improvement (p&lt;0.001) was seen in all SF-36-questionnaire 8 scales, comparing preoperative T0 values with T1 and T2 values. Of the 68 patients, 53 (78%) no longer needed pads at the T2 follow-up, while 15 (22%) reported using 3–4 pads/day A significant worsening of the sexual function (maintenance of erection) was observed in 51 (75%) patients, who had reported having normal sexual activity preoperatively (T0). On the other hand, 17 (25%) patients reported having an adequate erection to engage in sexual intercourse. Conclusions. Despite the differences observed in physical and mental health scores during the three periods evaluated (T0, T1 and T2), overall quality of life does not appear to have been greatly compromised by surgery. At T2 follow-up, in fact, all 68 patients reported to be satisfied with having undergone radical prostatectomy because of its benefits in terms of survival and its limited effects on their quality of life. (Urologia 2007; 74: 22–9)

Radical prostatectomy: which quality of life?

The aim of the present study was to evaluate quality of life in patients submitted to radical prostatectomy, by correlating the results of the postoperative condition with follow- up data at 6 and 12 months. MATERIALS AND METHODS. Between october 2004 and december 2005, 68 patients - mean age 68 (range 49-76) - treated with radical retro-pubic prostatectomy for localized prostate cancer (T2a, T2b, No, Mo) were consecutively enrolled onto the study. All patients underwent sexual as well as urinary incontinence rehabilitation, showing good compliance. We evaluated quality of life before prostatectomy (T0), 6 (T1) and 12 (T2) months after surgery through the Short Form 36 questionnaire, for which an analysis of variance for repeated measures was carried out. Patients were interviewed by our department psychologist regarding urinary incontinence and erectile dysfunction. All patients were disease-free at the time of evaluation. RESULTS. No significant differences were observed between physical and mental health indices. Conversely, a significant improvement (p<0.001) was seen in all SF-36-questionnaire 8 scales, comparing preoperative T0 values with T1 and T2 values. Of the 68 patients, 53 (78%) no longer needed pads at the T2 follow-up, while 15 (22%) reported using 3-4 pads/day. A significant worsening of the sexual function (maintenance of erection) was observed in 51 (75%) patients, who had reported having normal sexual activity preoperatively (T0). On the other hand, 17 (25%) patients reported having an adequate erection to engage in sexual intercourse. CONCLUSIONS. Despite the differences observed in physical and mental health scores during the three periods evaluated (T0, T1 and T2), overall quality of life does not appear to have been greatly compromised by surgery. At T2 follow-up, in fact, all 68 patients reported to be satisfied with having undergone radical prostatectomy because of its benefits in terms of survival and its limited effects on their quality of life.