Age-stratified outcomes after radical prostatectomy in a randomized setting (LAP-01): do younger patients have more to lose?

Impact of Posterior Tibial Nerve Stimulation on Early Continence Following Extraperitoneal Laparoscopic Radical Prostatectomy With Three Trocars

AIM

Posterior tibial nerve stimulation (PTNS) might stimulate the sacral nerves and lead to work pelvic floor muscles. We evaluated to effects of PTNS on continence results after extraperitoneal laparoscopic radical prostatectomy (eLRP) with three trocars during early post operative period.

METHODS

Prospectively recorded data of eLRP with three trocars was retrospectively reviewed for continence results between January 2017 and April 2024. Demographic, clinical, and follow-up data including age, prostate-specific antigen, prostate volume, nerve sparing surgery, and Gleason score were considered for match-paired analysis criteria. Patients were divided into two groups according to whether received PTNS therapy after surgery or not. Group 1 consisted of patients without PTNS (n = 66), and Group 2 consisted of patients who were applied PTNS (n = 66) after eLRP. Continence status, urine loss ratio (ULR), ICIQ-SF, and SF-12 Quality of Life Scale were recorded during outpatient control after 2nd, 3rd, 6th and 12th months of surgery. Statistically significant p was p ≤ 0.05.

RESULTS

Mean follow-up was 25 ± 8.7 months. There were 66 patients in each group and match-paired analyses were performed. Group 2 had significant lower incontinence rate and ICIQ-SF score at second and third months follow-up (p = 0.026 and p = 0.045; p = 0.044 and p = 0.031 respectively). Group 2 had significantly higher Physical Component Summary (PCS) and Mental Component Summary (MCS) (p = 0.005 and p = 0.011 for PCS; p = 0.008 and p = 0.025 for MCS, respectively) at second and third months follow-up. Additionally, ULR was significant better in Group 2 at second and third month of surgery (p = 0.042, p = 0.037, respectively). All these parameters were comparable between groups after sixth and 12th months.

CONCLUSIONS

PTNS can be safely applied to provide early continence in patients underwent eLRP. Due to improved functional outcomes, higher quality of life might be gained in early follow-up period.

Tumor characteristics, treatments, and oncological outcomes of prostate cancer in men aged ≤60 years: real-world data from a single urological center over a 10-year period

BACKGROUND

Prostate cancer (PCa) has emerged as one of the most common malignancies among men globally. However, its pathogenesis, clinical features, and treatment responses in younger patients (aged 60 years or below) remain underexplored. This study aims to evaluate the distinctive clinical features, treatment strategies, and oncological outcomes of PCa in men aged 60 years or younger over a 10-year period at a single urological center.

METHODS

We retrospectively analyzed data from The Second Hospital of Tianjin Medical University, spanning January 2010 to June 2020. The study included patients aged ≤60 years who underwent prostate biopsies. We examined clinical characteristics, pathological findings, treatment approaches, and survival outcomes using t-tests and chi-square tests. Adjusted linear regression models evaluated the relationships between treatment modalities and outcomes, while Kaplan-Meier survival analysis and Cox regression assessed progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

RESULTS

Of the 5,686 patients who underwent prostate biopsy, 643 (11.3%) were ≤60 years old. Among these, 42.8% (275/643) were diagnosed with PCa, with 59.6% presenting at advanced stages. Compared to those with negative pathology, patients with PCa were older and more likely to have hypertension, alcohol consumption, and metabolic syndrome. Most patients (69.8%) received definitive local therapy, while 22.2% opted for palliative care and 8.0% were loss to follow-up. The median follow-up period for the entire cohort was 28.0 months and the median PFS was 77.0 months. For patients receiving definitive local therapy, the median CSS and OS were not reached, while those undergoing palliative therapy had median CSS and OS of 52.0 and 59.0 months, respectively. Multivariable analysis identified prostate-specific antigen >20 ng/mL, International Society of Urological Pathology >3, bone metastasis, and localized treatment as independent factors affecting PFS. Propensity score matching showed that definitive therapy led to superior PFS compared to palliative therapy for patients with localized PCa and a life expectancy of over 5 years.

CONCLUSIONS

Our findings highlight the influence of incidence, diagnostic characteristics, and treatment methods in younger men with PCa, emphasizing the need to identify specific risk factors and treatment response patterns. Further large-scale, multi-center research is necessary to improve diagnosis and outcomes for PCa patients in this age group.

Urinary continence outcomes, surgical margin status, and complications after radical prostatectomy in 2,141 German patients treated in one high-volume inpatient rehabilitation clinic in 2022

PURPOSE

To identify independent predictors of urinary continence and report early complications after radical prostatectomy (RP) in a large, contemporary German cohort.

METHODS

Urinary incontinence data of patients undergoing 3-week inpatient rehabilitation (IR) after RP were prospectively assessed by 24-hr pad test and uroflowmetry at the beginning and the end of IR, respectively. Lymphoceles were assessed prospectively by ultrasound. Tumor and patient characteristics, and information on urinary leakage on initial cystography were retrospectively extracted from discharge letters and surgical reports. Regression analyses were performed to identify predictors of urinary continence at the beginning of IR.

RESULTS

Overall, 2,141 patients were included in the final analyses. Anastomotic leakage on the initial cystography and lymphoceles were found in 11.4% and 30.8% of patients, respectively. Intervention for a symptomatic lymphocele was required in 4.2% of patients. At the end of IR, 54.2% of patients were continent, while the median urine loss decreased to 73 g (interquartile range 15-321). Multivariable logistic regression analysis identified age and diabetes mellitus as independent negative predictors, but nerve-sparing surgery as an independent positive predictor of urinary continence (each p < 0.001). Multivariable linear regression analysis showed that 24-hr urine loss increased by 7 g with each year of life (p < 0.001), was 79 g higher in patients with diabetes mellitus (p = 0.007), and 175 g lower in patients with NS (p < 0.001).

CONCLUSION

Age, diabetes mellitus, and NS are significantly associated with continence outcomes in the early period after RP. Our analyses may help clinicians to pre-operatively counsel patients on potential surgical outcomes.

The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study

OBJECTIVE

We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects.

MATERIAL AND METHODS

This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014-2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment.

RESULTS

Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min-max 44-84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] -0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance.

CONCLUSIONS

In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Quality of Life after Radical Prostatectomy: A Longitudinal Study

BACKGROUND

Men with prostate cancer who undergo radical prostatectomy experience a decrease in quality of life, often related to sexual disfunction and urinary incontinence. Knowing and measuring the impact of radical prostatectomy on the individual's social, emotional, and family quality of life could help to plan and develop an appropriate, patient-centred therapeutic approach.

AIM

In this study, we aimed to evaluate changes in quality of life of patients with prostate cancer before and after radical prostatectomy.

METHODS

A longitudinal, observational study of 114 participants was conducted using the method of test-retest. Quality of life before and after radical prostatectomy was measured through the following self-administered questionnaires: (1) The EORTC QLQ-C30 in its Spanish version was used to assess the generic quality of life the participants; (2) the EORTC QLQ-PR25 in its Spanish version was used to assess the specific, health-related quality of life of prostate cancer patients.

RESULTS

A total of 114 men took part in this study. The results from the QLQ-C30 questionnaire indicated an improvement in the dimensions of emotional role and cognitive function, as well as in the symptoms of fatigue, pain, nausea and vomiting, insomnia, and loss of appetite, after surgery. Patients scored lower in the dimensions of role functioning, social function, and economic impact after radical prostatectomy. According to the results from the QLQ-PR25 questionnaire, 61.40% of the participants experienced sexual impotence and 26.31% suffered urinary incontinence after surgery. There were significant differences in some postsurgical outcomes between patients who had neurovascular bundles preserved and those who had not.

CONCLUSIONS

In-depth knowledge of, and measurement of changes in, quality of life after radical prostatectomy should allow for comprehensive, multidisciplinary, patient-centred care planning. Psychosocial assessment, both before and after surgery, is crucial in patients with prostate cancer. This study was prospectively registered with the CEIC-A on 2012-06-27, with registration number C.P.-C.I. PI12/0088.

Impact of Age on Long-Term Urinary Continence after Robotic-Assisted Radical Prostatectomy

Aim and Objectives: We aimed to test the impact of age on long-term urinary continence (≥12 months) in patients undergoing robotic-assisted radical prostatectomy. Methods and Materials: We relied on an institutional tertiary-care database to identify the patients who underwent robotic-assisted radical prostatectomy between January 2014 and January 2021. Patients were divided into three age groups: age group one (≤60 years), age group two (61-69 years) and age group three (≥70 years). Multivariable logistic regression models tested the differences between the age groups in the analyses addressing long-term urinary continence after robotic-assisted radical prostatectomy. Results: Of the 201 prostate cancer patients treated with robotic-assisted radical prostatectomy, 49 (24%) were assigned to age group one (≤60 years), 93 (46%) to age group two (61-69 years) and 59 (29%) to age group three (≥70 years). The three age groups differed according to long-term urinary continence: 90% vs. 84% vs. 69% for, respectively, age group one vs. two vs. three (p = 0.018). In the multivariable logistic regression, age group one (Odds Ratio (OR) 4.73, 95% CI 1.44-18.65, p = 0.015) and 2 (OR 2.94; 95% CI 1.23-7.29; p = 0.017) were independent predictors for urinary continence, compared to age group three. Conclusion: Younger age, especially ≤60 years, was associated with better urinary continence after robotic-assisted radical prostatectomy. This observation is important at the point of patient education and should be discussed in informed consent.