In localised prostate cancer, radical prostatectomy was associated with more sexual dysfunction and urinary incontinence than radiation or active surveillance

Purpose Earlier studies evaluating the effect on quality of life (QoL) of localized prostate cancer interventions included patients receiving adjuvant hormone therapy, which could have affected their outcomes. Our objective was to compare the QoL impact of the three most common primary treatments on patients who were not receiving adjuvant hormonal treatment. Patients and Methods This was a prospective study of 435 patients treated with radical prostatectomy, external-beam radiotherapy, or brachytherapy. QoL was assessed before and after treatment with the Short Form-36 and the Expanded Prostate Cancer Index Composite. Differences between groups were tested by analysis of variance. Distribution of outcome at 3 years was examined by stratifying according to baseline status. Generalized estimating equation models were constructed to assess the effect of treatment over time. Results Compared with the brachytherapy group, the prostatectomy group showed greater deterioration on urinary incontinence and sexual scores but better urinary irritative-obstructive results (−18.22, −13.19, and +6.38, respectively, at 3 years; P < .001). In patients with urinary irritative-obstructive symptoms at baseline, improvement was observed in 64% of those treated with nerve-sparing radical prostatectomy. Higher bowel worsening (−2.87, P = .04) was observed in the external radiotherapy group, with 20% of patients reporting bowel symptoms. Conclusion Radical prostatectomy caused urinary incontinence and sexual dysfunction but improved pre-existing urinary irritative-obstructive symptoms. External radiotherapy and brachytherapy caused urinary irritative-obstructive adverse effects and some sexual dysfunction. External radiotherapy also caused bowel adverse effects. Relevant differences between treatment groups persisted for up to 3 years of follow-up, although the difference in sexual adverse effects between brachytherapy and prostatectomy tended to decline over long-term follow-up. These results provide valuable information for clinical decision making.

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Faculty Opinions recommendation of Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717992427.793473599 ◽

2013 ◽

Author(s):

Jean Pierre Droz ◽

Helen Boyle

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Biochemical Recurrence ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Lifetime Health and Economic Outcomes of Active Surveillance, Radical Prostatectomy, and Radiotherapy for Favorable-Risk Localized Prostate Cancer

Value in Health ◽

10.1016/j.jval.2021.06.004 ◽

2021 ◽

Author(s):

Koen Degeling ◽

Niall M. Corcoran ◽

Amanda Pereira-Salgado ◽

Anis A. Hamid ◽

Shankar Siva ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Economic Outcomes ◽

Localized Prostate Cancer

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Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽

10.3390/diagnostics11020355 ◽

2021 ◽

Vol 11 (2) ◽

pp. 355

Author(s):

Matteo Ferro ◽

Gennaro Musi ◽

Deliu Victor Matei ◽

Alessandro Francesco Mistretta ◽

Stefano Luzzago ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Inflammatory Markers ◽

Low Risk ◽

Inclusion Criteria ◽

Robotic Radical Prostatectomy ◽

Lymphocyte Ratio ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

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Re: Radical Prostatectomy Findings in Patients in Whom Active Surveillance of Prostate Cancer Fails

The Journal of Urology ◽

10.1016/j.juro.2010.01.038 ◽

2010 ◽

Vol 183 (5) ◽

pp. 2099-2099

Author(s):

Nathan Lawrentschuk ◽

Neil E. Fleshner

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance

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968 Oncological outcomes of patients undergoing robot-assisted laparoscopic radical prostatectomy after previous failure of active surveillance for prostate cancer

European Urology Supplements ◽

10.1016/s1569-9056(12)60965-8 ◽

2012 ◽

Vol 11 (1) ◽

pp. e968-e968a

Author(s):

A.P. Labanaris ◽

C. Wagner ◽

P. Lange ◽

J.H. Witt ◽

V. Zugor

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Laparoscopic Radical Prostatectomy ◽

Robot Assisted ◽

Oncological Outcomes

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MP43-18 FOR MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER, OLDER AGE AT DIAGNOSIS AND AT RADICAL PROSTATECTOMY PORTENDS POOR OUTCOMES

The Journal of Urology ◽

10.1016/j.juro.2017.02.1328 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Sasha Druskin ◽

Mufaddal Mamawala ◽

Jeffrey Tosoian ◽

H. Ballentine Carter ◽

Bruce Trock

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Older Age ◽

Age At Diagnosis ◽

Poor Outcomes

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A comprehensive analysis of cost of an active surveillance cohort compared to radical prostatectomy as primary treatment for prostate cancer

World Journal of Urology ◽

10.1007/s00345-018-2500-7 ◽

2018 ◽

Vol 37 (7) ◽

pp. 1297-1303 ◽

Cited By ~ 1

Author(s):

Carmen Pozo ◽

Virginia Hernández ◽

Carlos Capitán ◽

Enrique de la Peña ◽

Guillermo Fernández-Conejo ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Primary Treatment ◽

Comprehensive Analysis

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Adverse pathology as a predictor of distant metastasis and prostate cancer mortality with 20-year follow up.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.219 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 219-219

Author(s):

Michael Austin Brooks ◽

Lewis Thomas ◽

Cristina Magi-Galluzi ◽

Jianbo Li ◽

Michael Crager ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Distant Metastasis ◽

Cancer Mortality ◽

High Grade ◽

Intermediate Risk ◽

Sampling Weights ◽

Prostate Cancer Mortality

219 Background: Adverse pathology (AP) at radical prostatectomy (RP) is often used as a proxy for long-term prostate cancer outcomes. The goal of this study was to assess the association of AP at RP, defined as high-grade (> Grade Group 3) and/or non-organ confined disease (pT3), with distant metastasis and prostate cancer death. Methods: A stratified cohort sample of 428 patients was used to evaluate the association of adverse pathology with the risk of distant metastases and prostate cancer-specific mortality over 20 years after prostatectomy in 2641 patients treated between 1987-2004. Cox regression of cause-specific hazards was used to estimate the absolute risk of both endpoints, with death from other causes treated as a competing risk. Subgroup analysis in patients with low/intermediate risk disease potentially eligible for active surveillance was performed. Results: Among the 428 patients, 343 had AUA Low or Intermediate risk disease and 85 had High risk disease. Median follow-up time was 15.5 years (IQR 14.6–16.6 years). Using the cohort sampling weights for estimation, at RP 29.8% of patients had high-grade disease, 42.3 % had non-organ confined disease, 19.3% had both, and thus 52.8% had AP. Adverse pathology was highly associated with metastasis and prostate cancer mortality in the overall cohort (HR 12.30, 95% CI 5.30-28.55, and 10.03, 95% CI 3.42-29.47, respectively, both p<0.001), and in the low/intermediate risk subgroup potentially eligible for active surveillance (HR 10.48, 95% CI 4.18-26.28, and 8.60, 95% CI 2.40-30.84, respectively, both p≤0.001). Conclusions: Adverse pathology at radical prostatectomy is highly associated with future development of metastasis and prostate cancer mortality and may be used as a short-term predictor of outcomes. [Table: see text]

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