1121 The impact of age difference between the patient and his female partner on the couple's sexual life after bilateral nerve sparing radical prostatectomy

100 Background: The clinical value of adjuvant (aRT) or salvage radiation (sRT) for patient treated with radical prostatectomy (RP) is currently controversially debated. In this study, we assessed the impact of aRT and sRT on long-term urinary continence. Methods: Overall, 15,901 patients who underwent RP in our center between 1992 and 2012 were analyzed. aRT within the first 6 months was performed in 734 (2.9%) patients, and sRT after 6 months in 1405 (8.8%) patients (median time 21.6 months), respectively. Continence rates were assessed annually after RP using a self-administrated questionnaire. Median follow-up was 48.4 months. Continence was defined as the use of no pads or one safety pad. Incontinence was categorized by the number of used pads. The impact of additional radiation therapy on continence results was analyzed by logistic regression analyses, the chi2-likelyhood test and propensity score matching. Results: In multivariate logistic regression analysis, adjusted for age, prostate volume, extend of nerve-sparing, year of surgery, the event of additive RT (OR=1.2, p=0.17) was not statistically relevant correlated with the long-term continence status whereas all other variables significantly correlated with urinary incontinence (p<0.01, each). The lacking correlation of RT and continence remained in a second logistic regression model, adjusted for tumor features (pT, pN, Gleason, PSA, margin-status). The timing of RT (aRT vs. sRT) was not statistically relevant correlated with the long-term continence status (OR=1.7, p=0.09; OR=1.2, p=0.5) In addition, a comparison of all patients received aRT with a propensity score based matched cohort of RP only patients (corrected for age, prostate volume, extend of nerve-sparing and year of surgery) revealed no statistical significant impact of RT on continence (p>0.05). In 248 patients, the continence status was available pre and post RT, again not showing a negative impact of RT (p>0.05). Conclusions: Additive radiation therapy after radical prostatectomy does not negatively affect urinary continence.

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The effect of wide resection during radical prostatectomy on surgical margins

Canadian Urological Association Journal ◽

10.5489/cuaj.3326 ◽

2016 ◽

Vol 10 (1-2) ◽

pp. 14 ◽

Cited By ~ 3

Author(s):

Luke T. Lavallée ◽

Andrew Stokl ◽

Sonya Cnossen ◽

Ranjeeta Mallick ◽

Chris Morash ◽

...

Keyword(s):

Radical Prostatectomy ◽

Multivariable Analysis ◽

Positive Margin ◽

Surgical Margins ◽

Wide Resection ◽

Nerve Sparing ◽

Positive Surgical Margin ◽

Positive Surgical Margins ◽

The Impact ◽

Nerve Spare

Introduction: The impact of nerve-sparing on positive surgical margins during radical prostatectomy (RP) remains unclear. The objective of this study was to determine the incidence of positive surgical margins with a wide resection compared to a nerve-sparing technique.Methods: A consecutive, single-surgeon patient cohort treated between August 2010 and November 2014 was reviewed. A standardized surgical approach of lobe-specific nerve-spare or wide resection was performed. Lobe-specific margin status and tumour stage were obtained from pathology reports. Univariable and multivariable associations between nerve management technique and lobe-specific positive surgical margin were determined.Results: Of 388 prostate lobes, wide resection was performed in 105 (27%) and nerve-sparing in 283 (73%). In 273 lobes without extra-prostatic extension (EPE), 0 of 52 (0%) had a positive margin when wide resection was performed compared to 20 of 221 (9%) if nerve-sparing was performed (p=0.02). In 115 lobes with EPE, 11 of 53 (21%) had a positive margin if wide resection was performed compared to 28 of 62 (45%) if nerve-sparing was performed (p=0.006). In multivariable analysis, the risk of a positive margin was decreased among patients who received wide resection as compared to nerve-spare (RR 0.43, 95% CI 0.26‒0.71; p=0.001).Conclusions: Surgical techniques to reduce positive surgical margins have become increasingly important as more patients with high-risk cancer are selecting surgery. The risk of a positive margin was greatly reduced using a standardized wide resection technique compared to nerve-sparing.

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Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center

Surgical Endoscopy ◽

10.1007/s00464-020-08177-0 ◽

2020 ◽

Author(s):

Anastasios D. Asimakopoulos ◽

Filippo Annino ◽

Camille Mugnier ◽

Laurent Lopez ◽

Jean Luc Hoepffner ◽

...

Keyword(s):

Risk Factors ◽

Radical Prostatectomy ◽

Gleason Score ◽

Surgical Margins ◽

Oncologic Outcomes ◽

Nerve Sparing ◽

Free Survival ◽

Pathologic Stage ◽

Historical Series ◽

The Impact

Abstract Background Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). Methods From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. Results In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. Conclusions PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.

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INSIGHTS INTO THE IMPACT OF NERVE-SPARING STATUS DURING RADICAL PROSTATECTOMY: VALIDATING OF A NERVE SPARING SCORING SYSTEM

The Journal of Urology ◽

10.1016/s0022-5347(09)61048-x ◽

2009 ◽

Vol 181 (4S) ◽

pp. 370-370 ◽

Cited By ~ 1

Author(s):

Christian Nelson ◽

Hannah H Alphs ◽

Farhang Rabbani ◽

James A Eastham ◽

Karim A Touijer ◽

...

Keyword(s):

Radical Prostatectomy ◽

Scoring System ◽

Nerve Sparing ◽

The Impact

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The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.1176 ◽

2013 ◽

Vol 3 (6) ◽

pp. 465 ◽

Cited By ~ 8

Author(s):

Paul Toren ◽

Shabbir M.H. Alibhai ◽

Andre Matthew ◽

Michael Nesbitt ◽

Robin Kalnin ◽

...

Keyword(s):

Radical Prostatectomy ◽

Health Utility ◽

Urinary Continence ◽

Nerve Sparing ◽

Urinary Frequency ◽

Significant Difference ◽

Patient Reported ◽

Chi Squared ◽

Dysfonction Sexuelle ◽

The Impact

Introduction: Urinary continence significantly affects quality of lifeafter radical prostatectomy (RP). The impact of nerve-sparing surgeryon continence is unclear from the current literature.Methods:We identified men with prostate cancer from the UniversityHealth Network Prostate Centre database who underwent RP.Preoperatively and at each postoperative visit, patients completedthe Patient-Oriented Prostate Utility Scale (PORPUS), a validatedpsychometric and health utility instrument. Incontinence was definedby a single questionnaire item. Patients with radiotherapy or lessthan 10 months follow-up were excluded. Chi-squared tests andANOVA were used to compare groups. Multivariable logisticregression was used to control for effects of nerve-sparing andother covariates.Results: Of the 253 eligible patients from 2003 to 2007, 159 patientshad bilateral nerve-sparing, 32 had unilateral nerve-sparing and62 had non-nerve-sparing surgery. Of these patients, 27%, 17%and 34%, respectively, were classified as incontinent at 1 year.These proportions were not significantly different between groups(p = 0.23). Multivariable logistic regression showed baseline urinarycontinence and urinary frequency to be significant predictorsof patient-reported continence at 1 year postoperatively, withodds ratios of 1.7 (95% confidence interval [CI] 1.1-2.9) and 1.5(95% CI 1.0-2.3), respectively.There was a significant difference in the proportion of PORPUSsexual function scores between nerve-sparing groups after excludingthose with baseline sexual dysfunction (p = 0.003). Similarly,health-related utility scores were different across groups (p < 0.001).Conclusion: Our results do not suggest a difference in 1-year patientreportedcontinence based on the type of nerve-sparing RP.However, baseline continence and urinary frequency were significantpredictors of continence at 1 year.Introduction : L’incontinence urinaire réduit grandement la qualitéde vie après une prostatectomie radicale (PR). Or, les donnéespubliées ne permettent pas d’établir l’impact sur la continenced’une intervention avec préservation des filets nerveux.Méthodologie : Des hommes atteints de cancer de la prostate etayant subi une PR ont été trouvés dans la base de données duUniversity Health Network Prostate Centre. Avant l’interventionet lors de chaque visite après celle-ci, les patients devaient utili -ser le questionnaire PORPUS d’auto-évaluation, un instrumentvalidé de psychométrie sur les troubles de la prostate et l’état desanté. Un seul point du questionnaire a trait à l’incontinence. Lespatients ayant reçu une radiothérapie ou dont le suivi était inférieurà 10 mois étaient exclus. Les groupes ont été comparés à l’aidede tests du chi carré et d’analyses ANOVA. Une analyse de régressionlogistique multivariée a permis de vérifier les effets de lapréservation des filets nerveux et d’autres covariables.Résultats : Sur les 253 patients admissibles traités entre 2003 et2007, 159 avaient subi une intervention bilatérale avec préservationdes filets nerveux, 32, une intervention unilatérale avec préservationdes filets nerveux et 62, une intervention sans préservationdes filets nerveux. De ces nombres, 27 %, 17 % et 34 %respectivement étaient considérés incontinents après un an. Laproportion de patients incontinents n’était pas significativementdifférente entre les groupes (p = 0,23). L’analyse de régressionlogistique multivariée a fait ressortir que la continence urinaire etla fréquence mictionnelle au départ étaient des facteurs de prédictionimportants de la continence évaluée par les patients unan après l’intervention, les rapports des risques étant respectivementde 1,7 (intervalle de confiance [IC] à 95 % : 1,1 à 2,9) et1,5 (IC à 95 % : 1,0 à 2,3).Une différence significative a été notée dans le taux de scoresPORPUS de dysfonction sexuelle entre les groupes ayant subi uneintervention avec préservation des filets nerveux, après exclusiondes patients présentant une dysfonction sexuelle au départ (p =0,003). De même, les scores concernant l’état de santé étaientdifférents d’un groupe à l’autre (p < 0,001).Conclusion : Nos résultats ne portent pas à croire à l’existence d’unedifférence sur le plan de la continence un an après l’interventionen fonction du type de PR avec préservation des filets nerveux.Cependant, la continence et la fréquence mictionnelle au départconstituent d’importants facteurs de prédiction de la continenceun an après l’intervention.

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