Impact of Adjuvant Radiation Therapy on Urinary Continence Recovery After Radical Prostatectomy

Background

Little is known about the impact of adjuvant radiation therapy (aRT) after radical prostatectomy (RP) on urinary continence (UC).

Objective

To evaluate the impact of aRT on UC recovery in patients with unfavourable pathologic characteristics.

Design, setting, and participants

The study included 361 patients with either pT2 with positive surgical margin(s) or pT3a/pT3b node-negative disease treated with RP at a tertiary care referral centre.

Intervention

Patients were stratified according to the administration of aRT into two groups: group 1 (no aRT; n = 208; 57.8%) and group 2 (aRT; n = 153; 42.2%).

Outcome measurements and statistical analysis

Continence was defined as no use of protective pads. Log-rank test was used to compare the rate of UC recovery according to aRT status. The association between aRT and UC was also tested in Cox regression models after accounting for age, Cancer of the Prostate Risk Assessment (CAPRA) score, nerve-sparing (NS) status, Charlson Comorbidity Index, body mass index, and year of surgery.

Results and limitations

At a mean follow-up of 30 mo, 254 patients (70.4%) recovered complete UC. The 1- and 3-yr UC recovery was 51% and 59% for patients submitted to aRT versus 81% and 87% for patients not receiving aRT, respectively (p < 0.001). At univariable analysis, older age (p < 0.001), presence of non–organ-confined disease (p < 0.001), non-NS procedure (p < 0.001), and delivery of aRT (p < 0.001) were significantly associated with lower UC. At multivariable analysis, the delivery of aRT remained an independent predictor of worse UC recovery (hazard ratio: 0.57; p = 0.001). Patients treated with aRT had a 1.6-fold higher risk of incontinence. Younger age (p = 0.02), lower CAPRA score (p = 0.03), and NS approach (p < 0.001) also represented independent predictors of UC recovery. The main limitations of the study are related to the lack of validated questionnaires in the evaluation of UC and in the lack of information regarding UC status at aRT.

Conclusions

The delivery of aRT has a detrimental effect on UC. The oncologic benefits must be balanced with an impaired UC recovery. Patients should be informed of such impairment before adjuvant treatments are planned.     

低温下筋膜内前列腺癌根治术对早期控尿及勃起功能的影响

目的：探讨低温下筋膜内前列腺癌根治术对早期控尿及勃起功能的影响。方法：选择穿刺活检证实的早期前列腺癌患者21例,其中有性生活者17例,在25℃生理盐水局部低温处理下行筋膜内前列腺癌根治术。结果：21例手术均顺利完成,出血量2001100（300±95）ml,平均留置尿管8（6～14）天。术后随访6个月,完全控尿18例（85％）;17例术前有性生活的患者中,术后6个月可完成性生活者13例（76％）。结论：局部低温的应用减轻了前列腺癌根治术的创伤性炎症后遗反应;低温下筋膜内前列腺癌根治术对早期控尿与勃起功能的恢复有益。     

Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia.

PURPOSE: We studied the relationship of nocturia with the International Prostate Symptom Score in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Baseline symptom score and the change in the score by treatment were analyzed in 219 consecutive Japanese men with BPH using basic statistics, and correlation, cluster and principal component analyses. RESULTS: The average nocturia score was the middle of that of the 7 symptoms at baseline and by far the highest after treatment. Hence, the score change was the smallest. Analysis of baseline scores demonstrated that all symptoms were the initial component in principal component analysis with individual symptom scores correlating with the total symptom score and quality of life index. However, the correlation was least for nocturia. Observations were similar when analyzing the score change by treatment. These results indicate that the nocturia score is least specific to symptoms associated with BPH or least sensitive to the therapeutic effect on symptoms. This finding may be related to the high nocturia score in the age matched control population. CONCLUSIONS: The nocturia score of the International Prostate Symptom Score behaves differently in the symptom complex of BPH in Japanese men, partially because it is most confounded by the aging factor.