Publication date: December 2019
Source: Urologic Oncology: Seminars and Original Investigations, Volume 37, Issue 12
Author(s): Kassem S. Faraj, Haidar M. Abdul-Muhsin, Kyle M. Rose, Anojan K. Navaratnam, Michael W. Patton, Sarah Eversman, Rohan Singh, William G. Eversman, Scott M. Cheney, Mark D. Tyson, Erik P. Castle
Abstract
Objectives
There is scant information about intermediate / long-term comparative outcomes between robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC). The purpose of this study is to present survival and oncological outcomes between bladder cancer patients who undergo RARC vs. ORC with an overall median follow-up of over 5 years.
Materials and Methods
A query of all patients who underwent radical cystectomy between January, 2007 and January, 2018 at Mayo Clinic Arizona yielded 595 patients. After excluding cystectomy performed for nonmalignant indication, cancer secondary to nonbladder primary, and cancers with grossly metastatic disease at the time of surgery, 481 patients remained. Data was collected on patient demographics, preoperative information, operative details, complications, and follow-up. Statistical analyses were generated using SPSS 22.0.
Results
In 481 total patients, 203 (42.2%) underwent RARC and 278 (57.8%) underwent ORC. The median follow-up for the entire cohort was 66 months. The 5-year recurrence-free survival (RFS) was 70.8% vs. 64.7% and the 10-year RFS was 69.6% vs. 62.7% for the RARC vs. ORC, respectively (P = 0.135). The 5-year overall survival (OS) was 58.9% vs. 57.7% and the 10-year OS was 39.9% vs. 45.6% for RARC vs. ORC patients, respectively (P = 0.466). There were no differences in any recurrence patterns, including the incidence of atypical recurrences (1.5% vs. 1.8% [P = 0.786], respectively). A Cox-proportional hazards model was fitted that included independent predictors of RFS and OS. The results revealed no difference in RFS (HR 1.235, 95% CI: 0.832–1.833, P = 0.295) or OS (HR 0.790, 95% CI: 0.550–1.135, P = 0.202) between the respectively.
Conclusions
Recurrence free survival, OS, and recurrence patterns are similar in bladder cancer patients who undergo either RARC or ORC.
Publication date: December 2019
Source: Urologic Oncology: Seminars and Original Investigations, Volume 37, Issue 12
Author(s): Cosimo De Nunzio, Antonio Luigi Pastore, Riccardo Lombardo, Fabiana Cancrini, Antonio Carbone, Andrea Fuschi, Lorenzo Dutto, Andrea Tubaro, Joern Heinrich Witt
ABSTRACT
Objectives
The aim of our study is to evaluate the role of preoperative quality of life (QL) as a possible risk factor for post robotic assisted radical prostatectomy (RARP) urinary incontinence. The secondary aim is to evaluate the possible effect of preoperative QL on post RARP lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).
Methods and materials
Between 2012 and 2017, all patients undergoing RARP for prostate cancer were enrolled. Patient's demographic, clinical, and histological characteristics were recorded. ED, LUTS, urinary incontinence, and QL were evaluated at baseline and postoperatively at 3, 6, and 12 months. Incontinence was evaluated with the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form questionnaire and QL with the EORTC QLQ-C30 global health score (QLQ-GHS). Multivariate logistic regression analysis was used to evaluate the risk of postoperative incontinence, moderate/severe incontinence, LUTS, and moderate/severe ED.
Results
Overall 4,603 patients were enrolled. Incontinence rates at 3, 6, and 12 months were respectively 17%, 10%, and 8%. On multivariate analysis, QL was an independent predictor of early incontinence (QLQ-GHS:0.71, CI:0.59–0.86; P= 0.001), severe incontinence (QLQ-GHS:0.65, CI:0.49–0.97; P= 0.006), and LUTS (QLQ-GHS:0.48, CI:0.41–0.57; P= 0.001). Single center design may be considered a limitation.
Conclusions
In our study a comprehensive evaluation of preoperative patient's QL, assessed by the EORTC QLQ-C30 questionnaire, can predict the early and long-term moderate/severe incontinence risk in RARP treated patients. Further studies should confirm our results.
Publication date: December 2019
Source: Urologic Oncology: Seminars and Original Investigations, Volume 37, Issue 12
Author(s): Neal A. Patel, Art Sedrakyan, Fernando Bianco, Ruth Etzioni, Michael A. Gorin, Wei-Chun Hsu, Jialin Mao, Paul L. Nguyen, Edward Schaeffer, Jonathan Shoag, Andrew Vickers, Jim C. Hu
Abstract
Introduction
We examined the most recent Surveillance, Epidemiology, and End Results release to corroborate temporal trends in nonmetastatic and distant prostate cancer metastases in the United States.
Methods
Surveillance, Epidemiology, and End Results was analyzed for the incidence of nonmetastatic and distant metastasis for men with prostate cancer aged 50–74 and ≥75 years during 2004–2015. Incidence ratios (IR) were calculated relative to the year prior.
Results
The incidence of distant metastasis significantly increased from 451.0 to 504.0 per million (IR:1.12, 95% CI:1.01–1.24) from 2011 to 2012 and 532.3 to 586.1 per million (IR:1.10, 95% CI:1.00–1.21) from 2014 to 2015 in men aged ≥75 years. The incidence of distant metastasis did not significantly increase in men aged 55–74 over the study period.
Conclusion
We demonstrate a sustained and definitive increase in prostate cancer distant metastases in men aged ≥75 years. Although our observational study design cannot pinpoint the exact cause of this increase, which is likely multifactorial, this shift reverses declines in metastases at diagnoses that followed the advent of prostate-specific antigen screening.