Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study.

Dae Keun Kim; Jaspreet Singh Parihar; Young Suk Kwon; Sinae Kim; Brian Shinder; Nara Lee; Nicholas Farber; Thomas Ahlering; Douglas Skarecky; Bertram Yuh; Nora Ruel; Wun-jae Kim; Koon Ho Rha; Isaac Yi Kim

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Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study.

Author: Dae Keun KIM ¹ ; Jaspreet Singh PARIHAR ² ; Young Suk KWON ² ; Sinae KIM ² ; Brian SHINDER ² ; Nara LEE ³ ; Nicholas FARBER ² ; Thomas AHLERING ⁴ ; Douglas SKARECKY ⁴ ; Bertram YUH ⁵ ; Nora RUEL ⁵ ; Wun-Jae KIM ⁶ ; Koon Ho RHA ⁷ ; Isaac Yi KIM ²
Author Information

1. Department of Urology, CHA Seoul Station Medical Center, CHA University, CHA Medical School, Seoul 04637, Korea.
2. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA.
3. Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA.
4. Department of Urology, University of California, Irvine School of Medicine, Orange 92687, USA.
5. Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte 91010, USA.
6. Department of Urology, Chungbuk National University College of Medicine, Cheongju 28644, Korea.
7. Department of Urology and Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Korea.
Publication Type:Multicenter Study
MeSH: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Cytoreduction Surgical Procedures/adverse effects*; Humans; Male; Middle Aged; Neoplasm Grading; Postoperative Complications/epidemiology*; Predictive Value of Tests; Prostatectomy/adverse effects*; Prostatic Neoplasms/surgery*; Retrospective Studies; Urinary Incontinence/etiology*
From: Asian Journal of Andrology 2018;20(1):9-14
CountryChina
Language:English
Abstract: Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02-1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01-1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.