Impact and Predictive Value of Prostate Weight on the Outcomes of Nerve Sparing Laparoscopic Radical Prostatectomy in Patients with Low Risk Prostate Cancer
Urology Journal,
Vol. 16 No. 3 (2019),
17 June 2019
,
Page 260-266
https://doi.org/10.22037/uj.v16i3.4327
Abstract
Purpose: To investigate the impact of prostate weight on outcomes of nerve sparing laparoscopic radical prostatectomy (LRP) and assess its predictive value on postoperative continence and potency recovery.
Materials and Methods: We conducted a retrospective study on the clinical data of 165 patients with low risk prostate cancer (PCa) who underwent nerve sparing LRP. All the patients included had normal preoperative urinary and sexual function. The association of prostate weight with perioperative data was assessed using Spearman correlation coefficient. Univariate and multivariate Cox regression analyses were employed to identify prognostic predictors for continence and potency recovery.
Results: Increased prostate weight was significantly associated with older age, higher prostate-specific antigen (PSA), lower biopsy and pathological T stage and Gleason score, longer operative time, and higher estimated blood loss (P < .05). The continence rates at the 3rd, 6th, and 12th month after surgery were 63.6% (105/165), 87.9% (145/165), and 95.8% (158/165); and the potency rates were 44.8% (74/165), 62.4% (103/165) and 77.6% (128/165), respectively. Furthermore, multivariate Cox analysis showed that patient age (HR = 0.52, 95% CI: 0.35- 0.76) and prostate weight (HR = 0.54, 95% CI: 0.34-0.86) were independent predictors for continence recovery, while only patient age (HR = 0.66, 95% CI: 0.45-0.96) could independently predict potency recovery.
Conclusion: Larger prostate size was correlated with older age, higher PSA, lower tumor stage and grade, longer operative time, and more intraoperative blood loss in low risk PCa patients. Increased prostate weight may independently predict poor continence recovery after nerve sparing LRP.
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References
Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. J Urol. 1998;160:2418-24.
Donovan JL, Hamdy FC, Lane JA, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med. 2016;375:1425-37.
Stewart GD, El-Mokadem I, McLornan ME, Stolzenburg JU, McNeill SA. Functional and oncological outcomes of men under 60 years of age having endoscopic surgery for prostate cancer are optimal following intrafascial endoscopic extraperitoneal radical prostatectomy. Surgeon. 2011;9:65-71.
Stolzenburg JU, Kallidonis P, Do M, et al. A comparison of outcomes for interfascial and intrafascial nerve-sparing radical prostatectomy. Urology. 2010;76:743-8.
Stolzenburg JU, Rabenalt R, Do M, et al. Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Eur Urol. 2008;53:931-40.
Feneley MR, Landis P, Simon I, et al. Today men with prostate cancer have larger prostates. Urology. 2000;56:839-42.
Wolff RF, Ryder S, Bossi A, et al. A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. Eur J Cancer. 2015;51:2345-67.
van Tol-Geerdink JJ, Willem Leer J, Weijerman PC, et al. Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid. BJU Int. 2013;111:564-73.
Boylu U, Turan T, Basatac C, Fatih Onol F, Gumus E. The effect of prostate weight on the outcomes of robot-assisted radical prostatectomy. Turk J Urol. 2013;39:209-13.
Min SH, Park YH, Lee SB, Ku JH, Kwak C, Kim HH. Impact of prostate size on pathologic outcomes and prognosis after radical prostatectomy. Korean J Urol. 2012;53:463-6.
Huang AC, Kowalczyk KJ, Hevelone ND, et al. The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes. Eur Urol. 2011;59:595-603.
Chan RC, Barocas DA, Chang SS, et al. Effect of a large prostate gland on open and robotically assisted laparoscopic radical prostatectomy. BJU Int. 2008;101:1140-4.
Pettus JA, Masterson T, Sokol A, et al. Prostate size is associated with surgical difficulty but not functional outcome at 1 year after radical prostatectomy. J Urol. 2009;182:949-55.
Yasui T, Tozawa K, Kurokawa S, et al. Impact of prostate weight on perioperative outcomes of robot-assisted laparoscopic prostatectomy with a posterior approach to the seminal vesicle. BMC Urol. 2014;14:6.
D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer. 2002;95:281-6.
Epstein JI, Allsbrook WC, Jr., Amin MB, Egevad LL. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228-42.
Si-Tu J, Lu MH, Li LY, et al. Prospective evaluation of pentafecta outcomes at 5 years after laparoscopic radical prostatectomy: results of 170 patients at a single center. Neoplasma. 2013;60:309-14.
Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17:307-19.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115-32.
Gao X, Qiu JG, Cai YB, Zhou XF, Hong LQ. Laparoscopic radical prostatectomy. Chin Med J (Engl). 2004;117:148-9.
Van Asseldonk B, Barkin J, Elterman DS. Medical therapy for benign prostatic hyperplasia: a review. Can J Urol. 2015;22 Suppl 1:7-17.
Hou GL, Luo Y, Di JM, et al. Predictors of urinary continence recovery after modified radical prostatectomy for clinically high-risk prostate cancer. Urol J. 2015;12:2021-7.
Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172:2227-31.
Kumar A, Tandon S, Samavedi S, Mouraviev V, Bates AS, Patel VR. Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy. J Robot Surg. 2016;10:187-200.
Ganzer R, Stolzenburg JU, Wieland WF, Brundl J. Anatomic study of periprostatic nerve distribution: immunohistochemical differentiation of parasympathetic and sympathetic nerve fibres. Eur Urol. 2012;62:1150-6.
Alsaid B, Karam I, Bessede T, et al. Tridimensional computer-assisted anatomic dissection of posterolateral prostatic neurovascular bundles. Eur Urol. 2010;58:281-7.
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