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Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis.
- Source :
-
Prostate cancer and prostatic diseases [Prostate Cancer Prostatic Dis] 2017 Dec; Vol. 20 (4), pp. 395-400. Date of Electronic Publication: 2017 May 02. - Publication Year :
- 2017
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Abstract
- Background: To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa).<br />Methods: Retrospective analyses of a prospectively maintained database for 769 patients with D'Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score ⩾17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively.<br />Results: Mean age of the cohort was 62.3 years, and 62.1% harbored ⩾PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan-Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM ⩾17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation.<br />Conclusions: Patients with D'Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.
- Subjects :
- Aged
Erectile Dysfunction rehabilitation
Erectile Dysfunction surgery
Humans
Male
Middle Aged
Prostatic Neoplasms physiopathology
Prostatic Neoplasms rehabilitation
Robotics
Treatment Outcome
Urinary Reservoirs, Continent
Erectile Dysfunction physiopathology
Prostatectomy rehabilitation
Prostatic Neoplasms surgery
Robotic Surgical Procedures rehabilitation
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5608
- Volume :
- 20
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Prostate cancer and prostatic diseases
- Publication Type :
- Academic Journal
- Accession number :
- 28462944
- Full Text :
- https://doi.org/10.1038/pcan.2017.26