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, KoonHo Rha, Isaac Yi Kim

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)9-14
Number of pages6
JournalAsian Journal of Andrology
Volume20
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

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Urinary Incontinence
Prostatectomy
Prostatic Neoplasms
Incidence
Standard of Care
Operative Time
Androgens
Clinical Trials
Neoplasm Metastasis
Safety
Control Groups

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kim, Dae Keun ; Parihar, Jaspreet Singh ; Kwon, Young Suk ; Kim, Sinae ; Shinder, Brian ; Lee, Nara ; Farber, Nicholas ; Ahlering, Thomas ; Skarecky, Douglas ; Yuh, Bertram ; Ruel, Nora ; Kim, Wun Jae ; Rha, KoonHo ; Kim, Isaac Yi. / Risk of complications and urinary incontinence following cytoreductive prostatectomy : A multi-institutional study. In: Asian Journal of Andrology. 2018 ; Vol. 20, No. 1. pp. 9-14.
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title = "Risk of complications and urinary incontinence following cytoreductive prostatectomy: A multi-institutional study",
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.",
author = "Kim, {Dae Keun} and Parihar, {Jaspreet Singh} and Kwon, {Young Suk} and Sinae Kim and Brian Shinder and Nara Lee and Nicholas Farber and Thomas Ahlering and Douglas Skarecky and Bertram Yuh and Nora Ruel and Kim, {Wun Jae} and KoonHo Rha and Kim, {Isaac Yi}",
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Kim, DK, Parihar, JS, Kwon, YS, Kim, S, Shinder, B, Lee, N, Farber, N, Ahlering, T, Skarecky, D, Yuh, B, Ruel, N, Kim, WJ, Rha, K & Kim, IY 2018, 'Risk of complications and urinary incontinence following cytoreductive prostatectomy: A multi-institutional study', Asian Journal of Andrology, vol. 20, no. 1, pp. 9-14. https://doi.org/10.4103/1008-682X.196852

Risk of complications and urinary incontinence following cytoreductive prostatectomy : A multi-institutional study. / Kim, Dae Keun; Parihar, Jaspreet Singh; Kwon, Young Suk; Kim, Sinae; Shinder, Brian; Lee, Nara; Farber, Nicholas; Ahlering, Thomas; Skarecky, Douglas; Yuh, Bertram; Ruel, Nora; Kim, Wun Jae; Rha, KoonHo; Kim, Isaac Yi.

In: Asian Journal of Andrology, Vol. 20, No. 1, 01.01.2018, p. 9-14.

Research output: Contribution to journalArticle

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T1 - Risk of complications and urinary incontinence following cytoreductive prostatectomy

T2 - A multi-institutional study

AU - Kim, Dae Keun

AU - Parihar, Jaspreet Singh

AU - Kwon, Young Suk

AU - Kim, Sinae

AU - Shinder, Brian

AU - Lee, Nara

AU - Farber, Nicholas

AU - Ahlering, Thomas

AU - Skarecky, Douglas

AU - Yuh, Bertram

AU - Ruel, Nora

AU - Kim, Wun Jae

AU - Rha, KoonHo

AU - Kim, Isaac Yi

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N2 - 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.

AB - 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.

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