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

Asian Journal of Andrology 2018年第1期20卷 9-14页

作者： 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-lae Kim Koon Ho Rha Isaac Yi Kim Department of Urology CHA Seoul Station Medical Center CHA University CHA Medical School Seou104637 Korea Department of Urology School of Medicine Graduate School Hanyang University Seou104763 Korea 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 Department of Biostatistics Rutgers School of Public Health The State University of New Jersey New Brunswick NJ Piscataway 08854 USA Department of Internal Medicine Rutgers Robert Wood Johnson Medical School Rutgers The State University of New Jersey New Brunswick 08901 USA Department of Urology University of California Irvine School of Medicine Orange 92687 USA Division of Urology and UroLogic Oncology City of Hope National Medical Center Duarte 91010 USA Department of Urology Chungbuk National University College of Medicine Cheongju 28644 Korea Department of Urology and Urological Science Institute College of Medicine Yonsei University Seou103722. Korea

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% Ch 1.02-1.37; P= 0.025） and surgery type-adjusted model （OR： 1.17; 95% Ch 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.

关键词： cytoreductive surgical procedures metastatic prostate cancer outcome radical prostatectomy

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