Long-term outcomes after local treatments for prostate cancer by functional categories: Late changes, different results

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4507-4507
Author(s):  
R. C. Chen ◽  
J. A. Clark ◽  
S. P. Mitchell ◽  
J. A. Talcott
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
External Beam Radiotherapy ◽  
Normal Function ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Functional Categories ◽  
Prognostic Information ◽  
Functional Changes ◽  
Patient Reported

4507 Background: Although patient-reported treatment outcomes have gained wide acceptance, numerical changes in validated instruments are difficult to interpret by patients and physicians. Using functional categories derived from numerical scales, we report 24- and 36-month outcomes after treatments for localized prostate cancer, presented by patients’ baseline (pre-treatment) functional status, to provide more useful prognostic information and to identify further changes in the third year after treatment. Methods: Using validated symptom indices, we prospectively measured sexual, urinary, and bowel functions of 438 men at baseline, and at fixed intervals post treatment. We translated numerical scores into functional categories: good (normal), intermediate, and poor (severe dysfunction). Results: Abnormal baseline function and surgery in men with normal function uniformly produced poor sexual function ( table ), and more external beam radiotherapy (EBRT) and brachytherapy (BT) patients deteriorated between 24 and 36 months. For those with normal urinary continence, NNSRP (non-nerve sparing radical prostatectomy) produced poor outcomes (26%) more frequently than NSRP (9%) at 24 months and 36 months, despite improvement in some NNSRP patients. Severe incontinence was rare after EBRT (1%) and BT (3%), though slightly more frequent in EBRT patients by 36 months. For patients with normal bowel function, EBRT and BT caused worse outcomes than RP; no change occurred after 24 months. Conclusions: Abnormal baseline sexual function and surgery produced uniformly poor sexual function outcomes and poor function increased significantly between 24 and 36 months after radiation therapy. Significant changes in functional category occurred despite unchanged average numerical scores, indicating that stable numerical indices may conceal significant functional changes. [Table: see text] No significant financial relationships to disclose.

Pre-treatment nomogram to predict potency after treatment for localized prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 32-32 ◽  
Author(s):  
Joseph Zabell ◽  
Martin G. Sanda ◽  
Mark S. Litwin ◽  
Jose Francisco Suarez ◽  
Meredith M. Regan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
External Beam Radiotherapy ◽  
Multivariable Analysis ◽  
The United States ◽  
Post Treatment ◽  
Localized Prostate Cancer ◽  
Patient Reported ◽  
Reported Data ◽  
Prospective Longitudinal

32 Background: Radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy are commonly utilized treatments for localized prostate cancer and may negatively impact sexual function to varying degrees. Patient-, disease-, and treatment-specific factors may all impact post-treatment sexual function. We aimed to evaluate predictors of post-treatment impotency, and develop a prognostic nomogram using prospective, patient-reported data from multiple validated health-related quality-of-life (HRQOL) instruments. Methods: Between 1999 and 2011, patient-reported data regarding treatment-related effects on erectile function were obtained from 2668 patients enrolled in one of four prospective longitudinal HRQOL protocols from the United States and Spain. Patients were treated with RP (n=1,294), EBRT (n=630), or brachytherapy (n=744). Although different HRQOL instruments were used in each protocol, questions pertaining to quality and frequency of erections were identical across the different instruments. Patient responses were obtained at baseline and 2 years after treatment. The endpoint of the model was impotency at 2 years post-treatment. Logistic regression analysis was used to model clinical information and outcome data. Internal validation was performed using bootstrapping. Results: 1,306 patients were potent at baseline and had 24-month follow-up. Differences in baseline patient characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The impotency rate at 2 years was 62%, 53%, and 41% for patients treated by RP, EBRT, and brachytherapy, respectively. In multivariable analysis, age, PSA, modality of treatment, frequency of preoperative erections, diabetes, and hypertension were associated with post-treatment impotency (all p<0.05). A nomogram based on the predictive parameters had a concordance index of 0.726 and predictions were well-calibrated with observed outcome. Conclusions: A validated nomogram that predicts 2-year risk of impotency after treatment of localized prostate cancer has been developed and is anticipated to be useful for patient counseling regarding treatment options.

Nomogram predicting treatment-related urinary incontinence for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), or brachytherapy (PI).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 49-49
Author(s):  
Joseph C. Klink ◽  
Martin G. Sanda ◽  
Mark S. Litwin ◽  
Montserrat Ferrer ◽  
Meredith M. Regan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Urinary Incontinence ◽  
External Beam Radiotherapy ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Patient Counseling ◽  
Patient Reported ◽  
Prospective Longitudinal

49 Background: RP, EBRT, and PI for the treatment of clinically localized prostate cancer may negatively impact urinary continence. Predictions of treatment-related urinary problems from patient-reported, prospective data may be useful in treatment decision-making. Methods: Patient-reported data on treatment-related urinary incontinence was obtained from four prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n = 1,294), EBRT (n = 630), and PI (n = 744). A single HRQOL instrument was not uniformly used for each study, although questions pertaining to the quantity (pad use) and frequency of urinary incontinence (“never” to “more than once per day”) were identical among the studies. Patient responses were obtained at baseline and at two years after treatment. The endpoint of the model was urinary continence defined as no pad use and leakage of urine less than once per day. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Overall, 1,937 (92%) of patients with complete data available were considered to be continent at baseline. Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The overall continence rate at two years was 66%, 88%, and 87% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, age (p = 0.001), baseline frequency of incontinence (p < 0.001), EBRT (p < 0.001), PI (p < 0.001), and ethnicity (p < 0.001) were associated with urinary continence. A nomogram based on the predictive parameters had a concordance index of 0.74 and predictions were well-calibrated with observed outcome. Conclusions: An externally-validated nomogram that predicts two-year urinary continence after treatment for localized prostate cancer has been developed and will be useful for patient counseling regarding treatment options.

Impact of focal versus whole-gland therapy for prostate cancer in sexual function and urinary continence

2019 ◽  
Vol 18 (1) ◽  
pp. e2193
Author(s):  
R.C. Borges ◽  
R.R. Tourinho-Barbosa ◽  
S. Collura-Merlier ◽  
F. Muttin ◽  
D.S. Constantin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
Urinary Continence

scholarly journals NeuroSAFE robot-assisted laparoscopic prostatectomy versus standard robot-assisted laparoscopic prostatectomy for men with localised prostate cancer (NeuroSAFE PROOF): protocol for a randomised controlled feasibility study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028132 ◽  
Author(s):  
Eoin Dinneen ◽  
Aiman Haider ◽  
Clare Allen ◽  
Alex Freeman ◽  
Tim Briggs ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Feasibility Study ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Laparoscopic Prostatectomy ◽  
Patient Reported ◽  
Randomised Controlled

IntroductionRobot-assisted laparoscopic prostatectomy (RALP) offers potential cure for localised prostate cancer but is associated with considerable toxicity. Potency and urinary continence are improved when the neurovascular bundles (NVBs) are spared during a nerve spare (NS) RALP. There is reluctance, however, to perform NS RALP when there are concerns that the cancer extends beyond the capsule of the prostate into the NVB, as NS RALP in this instance increases the risk of a positive surgical margin (PSM). The NeuroSAFE technique involves intraoperative fresh-frozen section analysis of the posterolateral aspect of the prostate margin to assess whether cancer extends beyond the capsule. There is evidence from large observational studies that functional outcomes can be improved and PSM rates reduced when the NeuroSAFE technique is used during RALP. To date, however, there has been no randomised controlled trial (RCT) to substantiate this finding. The NeuroSAFE PROOF feasibility study is designed to assess whether it is feasible to randomise men to NeuroSAFE RALP versus a control arm of ‘standard of practice’ RALP.MethodsNeuroSAFE PROOF feasibility study will be a multicentre, single-blinded RCT with patients randomised 1:1 to either NeuroSAFE RALP (intervention) or standard RALP (control). Treatment allocation will occur after trial entry and consent. The primary outcome will be assessed as the successful accrual of 50 men at three sites over 15 months. Secondary outcomes will be used to aid subsequent power calculations for the definitive full-scale RCT and will include rates of NS; PSM; biochemical recurrence; adjuvant treatments; and patient-reported functional outcomes on potency, continence and quality of life.Ethics and disseminationNeuroSAFE PROOF has ethical approval (Regional Ethics Committee reference 17/LO/1978). NeuroSAFE PROOF is supported by National Institute for Healthcare Research Research for Patient Benefit funding (NIHR reference PB-PG-1216-20013). Findings will be made available through peer-reviewed publications.Trial registration numberNCT03317990.

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