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

Authors
 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 
Citation
 Asian Journal of Andrology, Vol.20(1) : 43357, 2018 
Journal Title
 Asian Journal of Andrology 
ISSN
 1008-682X 
Issue Date
2018
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.
Files in This Item:
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DOI
10.4103/1008-682x.196852
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실)
Yonsei Authors
나군호(Rha, Koon Ho)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162387
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