Long-term functional outcomes after radical prostatectomy are excellent, regardless of surgical technique, when the procedure is performed by experienced surgeons at a high-volume center, according to a recent study.
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The retrospective analysis, which was presented at the 2015 AUA annual meeting in New Orleans and is in press in European Urology Focus,
looked at men with clinically localized prostate cancer operated on from 2009 to 2012 at Mayo Clinic in Rochester, MN or Massachusetts General Hospital, Boston. Based on the hypothesis that there is a relationship between surgeon volume and functional outcomes, only men operated on by a high-volume surgeon (≥25 cases annually) were included. The final cohort was comprised of 1,089 men who underwent robot-assisted surgery, 441 men who had an open procedure, and 156 men who had laparoscopic radical prostatectomy.
Analyses of responses on the Expanded Prostate Cancer Index Composite (EPIC) showed there were no statistically significant differences between surgical groups in the proportions of men who reported a moderate/big problem with overall urinary function (5.1% to 6.8%) or overall sexual function (36.1% to 37.5%) or in responses to other EPIC questions relevant to urinary or sexual quality of life. In addition, surgical technique was not associated with overall urinary or sexual bother in either univariable or multivariable logistic regression models adjusting for differences in case mix between surgical groups.
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“Recent population-based data suggested alarmingly high rates of urinary incontinence and erectile dysfunction in men who underwent open or robotic radical prostatectomy. We were interested in investigating patient-reported functional outcomes in a contemporary cohort of men operated on by high-volume surgeons,” said first author Boris Gershman, MD, urologic oncology fellow at Mayo Clinic.
Next: Volume more important than technique
Volume more important than technique
“The take-home message from our study is that when it comes to determining functional outcomes after radical prostatectomy, it is more important that the procedure be done by an experienced surgeon at a high-volume center than what technique is used,” added Dr. Gershman, who worked on the study with R. Jeffrey Karnes, MD, and co-authors.
The men who were included ranged in age from 40 to 74 years at the time of surgery (median 62 years) and completed the EPIC survey at a median of 30.5 months after surgery. About one-third of men had a diagnosis of erectile dysfunction preoperatively, and almost 20% were on treatment for erectile dysfunction.
Gleason score at radical prostatectomy was 6 in about 40% of men, 7 in 54%, and 8-10 in 6%. Eighty-three percent of men had ≤pT2 disease, and only 2% had positive nodes.
In the multivariable logistic regression analysis, only age at surgery independently predicted overall urinary function. Age at surgery as well as Gleason score at radical prostatectomy, prostate volume, and being on treatment for erectile dysfunction preoperatively were independent predictors of having a moderate or big problem with sexual function after surgery. Men who received treatment for erectile dysfunction preoperatively reported bother with overall sexual function more frequently than men who did not (55% vs. 34%).
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