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01-02-2020 | Prostate Cancer | Original Article

Recovery of pad-free continence in elderly men does not differ from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer

Authors: Joanne Nyaboe Nyarangi-Dix, Georgi Tosev, Ivan Damgov, Philipp Reimold, Cem Aksoy, Gencay Hatiboglu, Dogu Teber, Josef Mansour, Franklin Emmanuel Kuehhas, Jan Philipp Radtke, Markus Hohenfellner

Published in: World Journal of Urology | Issue 2/2020

Abstract

Purpose

To analyze urinary continence outcome following robot-assisted radical prostatectomy (RARP) for aggressive prostate cancer in men aged ≥ 70 and < 70 years.

Methods

Retrospective analyses of prospectively collected long-term data from a monocentric cohort of 350 men with D’Amico high-risk prostate cancer undergone robot-assisted radical prostatectomy at a single institution between 2005 and 2016. The association between time since operation and zero-pad urinary continence recovery was comparatively analyzed by separate pre-operative and post-operative Cox proportional-hazard regression models.

Results

Median age in the age group ≥ 70 years was 73 years compared with 62 years in the < 70 year age group. Distribution of men receiving adjuvant and salvage radiotherapy/hormonal therapy was similar in both age groups. Urinary continence recovery rate at 12, 24, and 36 months after surgery of men aged ≥ 70 years was 66, 79 and 83%, respectively, and statistically similar to that of men < 70 years: 71, 81, and 85% (log-rank test p = 0.24). Multivariable analyses demonstrated no significant difference in return to continence between the two age groups (p = 0.28 and p = 0.17). In addition, clinical stage and type of nerve sparing (unilateral, bilateral or non-nerve sparing) were found to be independently predictive of pad-free continence recovery.

Conclusions

Regardless of age, return to continence in men with aggressive prostate cancer undergoing RARP continues to improve way beyond the first 12 months after surgery. Considering the dire effects of post-operative radiotherapy on continence in this aggressive cancer cohort, advanced age alone should not discourage recommending multimodal therapy involving RARP.

Stangelberger A, Waldert M, Djavan B (2008) Prostate cancer in elderly men. Rev Urol 10(2):111–119PubMedPubMedCentral

Rogers CG, Sammon JD, Sukumar S et al (2013) Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer. Urol Oncol 31(2):193–197. https://doi.org/10.1016/j.urolonc.2010.11.018 CrossRefPubMed

Kunz I, Musch M, Roggenbuck U et al (2013) Tumour characteristics, oncological and functional outcomes in patients aged ≥ 70 years undergoing radical prostatectomy. BJU Int 111(3 Pt B):E24-9. https://doi.org/10.1111/j.1464-410x.2012.11368.x CrossRefPubMed

Abdollah F, Dalela D, Sood A et al (2017) Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis. Prostate cancer and prostatic diseases 20(4):395–400. https://doi.org/10.1038/pcan.2017.26 CrossRefPubMed

Kumar A, Samavedi S, Bates AS et al (2015) Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors. BJU Int 116(5):764–770. https://doi.org/10.1111/bju.13106 CrossRefPubMed

Grossman DC, Curry SJ, Owens DK et al (2018) Screening for prostate cancer: US preventive services task force recommendation statement. JAMA 319(18):1901–1913. https://doi.org/10.1001/jama.2018.3710 CrossRefPubMed

Young MD, Weizer AZ, Silverstein AD et al (2003) Urinary continence and quality of life in the first year after radical perineal prostatectomy. J Urol 170(6 Pt 1):2374–2378. https://doi.org/10.1097/01.ju.0000097240.99415.a7 CrossRefPubMed

Sacco E, Prayer-Galetti T, Pinto F et al (2006) Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. BJU Int 97(6):1234–1241. https://doi.org/10.1111/j.1464-410x.2006.06185.x CrossRefPubMed

Kumar A, Samavedi S, Bates AS et al (2015) Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy—a propensity score matched study. Eur J Surg Oncol 41(7):837–843. https://doi.org/10.1016/j.ejso.2015.04.006 CrossRefPubMed

10.

Herpel E, Röcken C, Manke H et al (2010) Quality management and accreditation of research tissue banks: experience of the national center for tumor diseases (NCT) Heidelberg. Virchows Arch 457(6):741–747. https://doi.org/10.1007/s00428-010-0998-1 CrossRefPubMed

11.

D’Amico AV, Whittington R, Malkowicz SB et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRef

12.

Barnes B, Kraywinkel K, Nowossadeck E et al (2016) Bericht zum Krebsgeschehen in Deutschland 2016. Robert Koch-Institut. https://doi.org/10.17886/rkipubl-2016-014

13.

Fagin R (2007) Da Vinci prostatectomy: athermal nerve sparing and effect of the technique on erectile recovery and negative margins. J Robot Surg 1(2):139–143. https://doi.org/10.1007/s11701-007-0012-3 CrossRefPubMedPubMedCentral

14.

Hatiboglu G, Teber D, Tichy D et al (2016) Predictive factors for immediate continence after radical prostatectomy. World J Urol 34(1):113–120. https://doi.org/10.1007/s00345-015-1594-4 CrossRefPubMed

15.

van Velthoven RF, Ahlering TE, Peltier A et al (2003) Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Urology 61(4):699–702CrossRef

16.

Nyarangi-Dix JN, Pahernik S, Bermejo JL et al (2012) Significance of the intraoperative methylene blue test for post-operative evaluation of the vesicourethral anastomosis. Adv Urol 2012:702412. https://doi.org/10.1155/2012/702412 CrossRefPubMedPubMedCentral

17.

Chang SS, Cookson MS (2006) Impact of positive surgical margins after radical prostatectomy. Urology 68(2):249–252. https://doi.org/10.1016/j.urology.2006.03.053 CrossRefPubMed

18.

Stamey TA (1980) Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. Ann Surg 192(4):465–471CrossRef

19.

Lin DY, Wei LJ, Ying Z (1993) Checking the Cox model with cumulative sums of martingale-based residuals. Biometrika 80(3):557–572CrossRef

20.

Albertsen PC, Nease RF, Potosky AL (1998) Assessment of patient preferences among men with prostate cancer. J Urol 159(1):158–163CrossRef

21.

Patel VR, Coelho RF, Palmer KJ et al (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56(3):472–478. https://doi.org/10.1016/j.eururo.2009.06.007 CrossRefPubMed

22.

Catalona WJ, Carvalhal GF, Mager DE et al (1999) Potency, continence and complication rates in 1870 consecutive radical retropubic prostatectomies. J Urol 162(2):433–438CrossRef

23.

Kundu SD, Roehl KA, Eggener SE et al (2004) Potency, continence and complications in 3477 consecutive radical retropubic prostatectomies. J Urol 172(6 Pt 1):2227–2231CrossRef

24.

Disterhoft JF, Oh MM (2006) Learning, aging and intrinsic neuronal plasticity. Trends Neurosci 29(10):587–599. https://doi.org/10.1016/j.tins.2006.08.005 CrossRefPubMed

25.

Zorn KC, Mendiola FP, Rapp DE et al (2007) Age-stratified outcomes after robotic-assisted laparoscopic radical prostatectomy. J Robot Surg 1(2):125–132. https://doi.org/10.1007/s11701-007-0009-y CrossRefPubMedPubMedCentral

26.

Ficarra V, Novara G, Rosen RC et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417. https://doi.org/10.1016/j.eururo.2012.05.045 CrossRef

27.

Greco KA, Meeks JJ, Wu S et al (2009) Robot-assisted radical prostatectomy in men aged ≥ 70 years. BJU Int 104(10):1492–1495. https://doi.org/10.1111/j.1464-410x.2009.08718.x CrossRefPubMed

28.

Basto MY, Vidyasagar C, te Marvelde L et al (2014) Early urinary continence recovery after robot-assisted radical prostatectomy in older Australian men. BJU Int 114(Suppl 1):29–33. https://doi.org/10.1111/bju.12800 CrossRef

29.

Lavery HJ, Nabizada-Pace F, Carlucci JR et al (2012) Nerve-sparing robotic prostatectomy in preoperatively high-risk patients is safe and efficacious. Urol Oncol 30(1):26–32. https://doi.org/10.1016/j.urolonc.2009.11.023 CrossRefPubMed

30.

Nyarangi-Dix J, Wiesenfarth M, Bonekamp D et al (2018) Combined clinical parameters and multiparametric magnetic resonance imaging for the prediction of extraprostatic disease-a risk model for patient-tailored risk stratification when planning radical prostatectomy. Eur Urol Focus. https://doi.org/10.1016/j.euf.2018.11.004 CrossRefPubMed

31.

Srougi V, Tourinho-Barbosa RR, Nunes-Silva I et al (2017) The role of robot-assisted radical prostatectomy in high-risk prostate cancer. J Endourol 31(3):229–237. https://doi.org/10.1089/end.2016.0659 CrossRefPubMed

Title: Recovery of pad-free continence in elderly men does not differ from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer
Authors: Joanne Nyaboe Nyarangi-Dix
Georgi Tosev
Ivan Damgov
Philipp Reimold
Cem Aksoy
Gencay Hatiboglu
Dogu Teber
Josef Mansour
Franklin Emmanuel Kuehhas
Jan Philipp Radtke
Markus Hohenfellner
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Urinary Incontinence
Prostatectomy
Urinary Incontinence
Prostatectomy
Published in: World Journal of Urology / Issue 2/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02797-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Recovery of pad-free continence in elderly men does not differ from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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