[Radical prostatectomy in a certified prostate cancer center: medical treatment and outcome]

[Does structural and process quality of certified prostate cancer centers result in better medical care?]

BACKGROUND

An improved structural and process quality could be demonstrated 13 years after certification of the first German prostate cancer center. The question of optimization of the functional quality by establishing organ cancer centers arises.

OBJECTIVE

A critical benefit-risk analysis of organ cancer centers was carried out to evaluate an improved quality of results.

MATERIAL AND METHODS

Based on published results from individual centers and the individual annual reports of the German Cancer Society (DKG), the data for evaluating the quality of results were checked. For the issuing of certificates, the focus is on quality indicators for oncological surgery. The functional quality of results is assessed exclusively by a questionnaire-based survey.

RESULTS

An improvement in the quality of functional results after radical prostatectomy has not yet been demonstrated. The functional quality features of urinary continence and erectile function that are essential for the quality of life and patient satisfaction are only insufficiently assessed due to the lack of objective measuring instruments and are not relevant for certification. There is no reliable evidence for improved overall survival, reduction in tumor-specific mortality, and optimization of functional results in certified centers.

CONCLUSION

The relationship between certification and excellence cannot be proven without individual consideration of a surgeon-specific pentafecta analysis. For this reason, certification-relevant surgeon-related quality assurance is recommended.

Is there a clinical benefit from prostate cancer center certification? An evaluation of functional and oncologic outcomes from 22,649 radical prostatectomy patients

PURPOSE

To explore whether patients undergoing radical prostatectomy at a German Cancer Society (DKG: Deutsche Krebsgesellschaft) certified center (CC) have superior functional and surgical outcomes compared to patients undergoing radical prostatectomy at a non-certified hospital (nCC).

METHODS

A retrospective cohort of 22,649 patients treated between 2008 and 2017 and subsequently recovered at two rehabilitation clinics within 35 days of surgery were analyzed. Urine loss (24 h-pad-test), margin status, and nerve-sparing status at rehab admission were compared between CC and nCC patients, adjusting for age, histopathology (pT, pN, Gleason score), metastases (cM), Karnofsky performance status, time from surgery to rehabilitation, and insurance provider (statutory vs. private).

RESULTS

Thirty-four percent of patients underwent surgery at a CC. Complete continence is more pronounced in patients treated in CC (16.6% vs. 24.4%, p < 0.001). In the adjusted models, incontinent patients from CC had less urine loss compared to patients from nCC (- 27.41% difference; 95% CI - 31.71% to - 22.84%, p < 0.001). CC patients were less likely to have positive resection margins (adjusted OR 0.71; 95% CI 0.66 to 0.76, p < 0.001) and more likely to have had a nerve-sparing procedure (adjusted OR 1.29; 95% CI 1.21 to 1.38, p < 0.001).

CONCLUSION

Patients treated at certified centers presented to rehab with better urinary continence, higher nerve-sparing rates, and lower positive-margin rates. These results imply superior care at DKG certified centers.

[Urethral stricture rate after prostate cancer radiotherapy : Five-year data of a certified prostate cancer center]

BACKGROUND

A urethral stricture is a scar of the urethral epithelium which can cause obstructive voiding dysfunction with consequential damage of the upper urinary tract. Almost 45% of all strictures are iatrogenic; they develop in 2-9% of patients after radical prostatectomy, but can also occur after prostate cancer radiotherapy. This study provides 5‑year data of a certified prostate cancer center (PKZ) in terms of urethral strictures.

MATERIALS AND METHODS

Between 01/2008 and 12/2012 a total of 519 men were irradiated for prostate cancer (LDR and HDR brachytherapy as well as external beam radiation). The entire cohort was followed-up prospectively according to a standardized protocol (by type of irradiation). Short segment urethral strictures were treated by urethrotomy, recurrent and long segment stenosis with buccal mucosa urethroplasty.

RESULTS

A total of 18 of 519 (3.4%) patients developed a urethral stricture post-therapeutically, which recurred in 66% of cases after the first operative treatment. The largest risk for developing a urethral stricture is attributed to the HDR brachytherapy (8.9%).

CONCLUSION

Urethral strictures after prostate cancer radiotherapy should be diagnosed and treated in time for long-term preservation of renal function. The rate of radiogenic urethral strictures (3.4%) is equivalent to those after radical prostatectomy. Due to a high rate of recurrences, urethrotomy has a limited importance after irradiation.