392 COMPARISON OF PATHOLOGIC AND ONCOLOGIC OUTCOMES OF RADICAL RETRO PUBIC PROSTATECTOMY AMONG MEN WITH UNILATERAL VS. BILATERAL PROSTATE CANCER: IMPLICATIONS FOR FOCAL THERAPY Tareen B., Sankin A., Godoy G., Temkin S., Lepor H., Taneja S.S. New York University School of Medicine, Dept. of Urologic Oncology, New York, United States of America Introduction & Objectives: Recent attention on focal therapy for prostate cancer has lead to greater interest in identifying patients at low risk of adverse surgical pathology. As ideal candidates for focal therapy are those with unilateral disease, we sought to determine if men with unilateral disease have lower risk of adverse pathologic and oncologic outcomes. Material & Methods: The charts of 1458 consecutive patients undergoing open radical prostatectomy by a single surgeon from January 2000 to June of 2007 were reviewed. 3DWLHQWVZHUHVHJUHJDWHGRQWKHSUHVHQFHRIHLWKHUXQLODWHUDOGLVHDVHQ RUELODWHUDO GLVHDVHQ RQᚏQDOSDWKRORJLFVSHFLPHQ*URXSVZHUHFRPSDUHGZLWKUHVSHFWWRWKH presence of extra capsular extension, surgical margin status, pathologic Gleason score and biochemical recurrence. Results: 3DWLHQWV ZLWK XQLODWHUDO GLVHDVH KDG VLJQLᚏFDQWO\ ORZHU UDWHV RI H[WUD FDSVXODU extension, (p=.0046) seminal vesical invasion, (p=.0017) and Gleason score <7 compared to SDWLHQWVZLWKELODWHUDOGLVHDVHVHHWDEOH $WPHGLDQIROORZXSRIPRQWKVUDQJHPRQWKV to 78 months) the rate of biochemical recurrence was 7.6% and 15%. (p=.0004) Unilateral disease did not predict a lower likelihood of having a positive surgical margin. Table 1: 8QLODWHUDOQ %LODWHUDOQ Extra capsular extension Seminal vesicle invasion Gleason >/= 7 Positive surgical margins %LRFKHPLFDOUHFXUUHQFHDWPRQWKV
71/1078 (7%) 552/1080 (51%) 121/1081 (11%)
p=.0046 p=.0017 p=.0047 S p=.0008
Conclusions: Patients with unilateral disease on prostatectomy specimen have lower rates of extra capsular extension, seminval vesical invasion, Gleason score <7 and biochemical UHODSVH FRPSDUHG WR WKHLU ELODWHUDO FRXQWHUSDUWV )XUWKHU VWXG\ LV QHHGHG WR EHWWHU GHᚏQH this select cohort and ultimately determine if these patients may be suitable candidates for focal therapy.
394 ONCOLOGICAL OUTCOME AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY: 10 YEARS EXPERIENCE
MSKCC, Dept. of Surgery, New York, United States of America, MSKCC, Dept. of Epidemiology and Biostatistics, New York, United States of America Introduction & Objectives: We analyzed the oncological outcome after laparoscopic radical prostatectomy (LRP) in a consecutive series of patients with prostate cancer.
Material & Methods: Laparoscopic radical prostatectomy provided 5-year cancer control in 79% RISDWLHQWVZLWKFOLQLFDOO\ORFDOL]HGSURVWDWHFDQFHUDQGRIWKRVHZLWKKLJKULVNFDQFHUV$ pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases. from 1998 to 2007, 1564 consecutive patients (median age 61 years, IQ UDQJH ZLWKFOLQLFDOO\ORFDOL]HGSURVWDWHFDQFHUF7FF7D ZHUHWUHDWHGZLWK/53DW,00 3DULV )UDQFH RU 06.&& 1HZ 90%, 89% to 71% and < 70% respectively. Results: the overall 5-year probability of freedom from progression was 79% (95% CI 74%82%). For low, intermediate and high risk cancer, the 5-year progression free probability was &, &, DQG&, UHVSHFWLYHO\ Surgical margins were positive in 12.5% of cases. The 5-year progression free probability was &, ZKHQWKHVXUJLFDOPDUJLQVZHUHSRVLWLYHYV&, LQQHJDWLYHVXUJLFDOPDUJLQVFDVHV1RGDOPHWDVWDVHVZHUHGHWHFWHGLQRIWKHSDWLHQWVDIWHU limited pelvic lymph node dissection and in 10% after a standard pelvic lymph node dissection S 7KH\HDUSUREDELOLW\RIIUHHGRPIURPSURJUHVVLRQIRUQRGHSRVLWLYHSDWLHQWVZDV 46%. There were 22 overall deaths and 2 deaths from prostate cancer. Conclusions: Laparoscopic radical prostatectomy provided 5-year cancer control in 79% of patients with clinically localized prostate FDQFHUDQGRIWKRVHZLWKKLJK risk cancers. A pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases.
Tu J.J.1, Jhaveri J.K.2, Yadav R.2, Leung R.A.2, Te A.E.2, Shemtov M.M.2, Horninger W., Bartsch G., Vaughan E.D.2, Tewari A.K.2 1
Weill Cornell Medical College, Dept. of Pathology, New York, United States of America, Weill Cornell Medical College, Dept. of Urology, New York, United States of America, Innsbruck Medical University, Dept. of Urology, Innsbruck, Austria 2
Introduction & Objectives: Prostate cancer is the most commonly diagnosed solid organ neoplasm in men in the US and Western Europe. Controversy exists over the optimum management of the disease. Stage migration and lag-time bias make ideal WUHDWPHQW VHOHFWLRQ HYHQ PRUH GLᚑFXOW 1R UDQGRPL]HG FRQWURO WULDO H[LVWV FRPSDULQJ robotic radical prostatectomy with open radical prostatectomy. We aim to compare the oncological outcome of two leading centres amongst a cohort of contemporary prostate cancer patients. Material & Methods: Data were collected prospectively using an IRB approved protocols from each respective institution. The open cohort consisted of men operated on between the years 2000 and 2004 (n = 560) and the robotic series was comprised of men operated EHWZHHQQ :HOLPLWHGRXUDQDO\VLVWRRUJDQFRQᚏQHGGLVHDVHRQᚏQDO SDWKRORJ\DQGFRPSXWHGRGGVUDWLRV3RVLWLYHVXUJLFDOPDUJLQVDUHGHᚏQHGDVWXPRXUDW the inked margin. All cases were reviewed by a referee pathologist. Results: 7KHURERWLFFRKRUWKDGDPHDQDJHRI>ದ@PHDQ36$RI>ದ@ DQGPHDQ3ULPDU\*OHDVRQ6FRUHRI7KHRSHQFRKRUWKDGDPHDQDJHRI>ದ@ PHDQ36$RI>ದ@DQGPHDQ3ULPDU\*OHDVRQ6FRUHRI7KHRGGVUDWLRIRU FRPSDULVRQRI553DQG253IRUDOORUJDQFRQᚏQHGFDQFHUVZDV Positive Surgical Margin
Negative Surgical Margin
Conclusions: 7KH SUHVHQW VWXG\ VXJJHVWV WKDW ZLWKLQ RUJDQ FRQᚏQHG GLVHDVH URERWLF SURVWDWHFWRP\ RᚎHUV FRPSDUDEOH FDQFHU FRQWURO RXWFRPHV WR RSHQ UDGLFDO prostatectomy.
P24 BPH: MEDICAL THERAPY II Thursday, 27 March, 12.15-13.45, Red Hall 1
SEXUAL FUNCTION AND OPINION OF PATIENTS TREATED FOR THE FIRST TIME FOR LUTS/BPH Fourcade R.O.1, Theret N.2, Taieb C.2
Touijer K.1, Cronin A.2, Vickers A.2, Guillonneau B.1 1
393 CANCER CONTROL OUTCOMES FOLLOWING RADICAL PROSTATECTOMY: A COMPARISON BETWEEN ROBOTIC AND OPEN
Hospital of Auxerre, Dept. of Urology, Auxerre, France, 2Pierre Fabre S.A., Dept. of Public Health, Quality of Life & Health Economics, Boulogne-Billancourt, France 1
Introduction & Objectives: To describe sexual function and health-related opinion of patients medically treated for LUTS/BPH in primary care. Material & Methods: This observational, cross-sectional study was carried out by GPs in France, Spain and 3RUWXJDODQGRᚑFHEDVHGXURORJLVWVLQ*HUPDQ\$OOZHUHNHSWEOLQGWRWKHVSRQVRU3DWLHQWVDJHGุ\HDUV were recruited if decision for medical treatment of LUTS/BPH was taken on that day. Results: 3K\VLFLDQVLQFOXGHGSDWLHQWVQ LQ)U6S3RU*H DJHGs\HDUV,366 ZDVs4XDOLW\RIOLIH4R/ ,366VFRUHZDVs*HRJUDSKLFDOGLᚎHUHQFHVZHUHQRWHGIRUDJH (p=0.009, the youngest in Ge), IPSS (p=0.017, the highest in Sp), QoL (p<0.001, the less altered in Ger), and sexual activity (p=0.010, the highest proportion in Por), but not for comorbidities and concomitant medication. ,366ZDVFRUUHODWHGZLWKDJHU DQG4R/U 0RVW SDWLHQWVUHSRUWHGKDYLQJKDGุVH[XDO trouble in the 6 previous months: decreased libido (69%), erectile dysfunction (ED, 62%) and premature HMDFXODWLRQ ('RFFXUUHGಯRIWHQರLQRISDWLHQWVLQ6S*H)U3RU7ZRWKLUG 67%) of patients, from 66% in Ge to 89% in Por (p=0.010), considered they were sexually active. Frequency RIVH[XDOLQWHUFRXUVHZDV!WLPHVPRQWKIRURIWKHPPRVWRIWHQLQ3RU DQGWLPHVPRQWKIRU RI WKHP FRQVLGHUHG WKDW PDLQWDLQLQJ VH[XDOLW\ ZDV LPSRUWDQW HVSHFLDOO\ LQ 3RU ZHUH VDWLVᚏHG with their sexual life. Severe urinary symptoms (IPSS>19) were not linked with sexual activity (age-adjusted S (YHQLQUHWXUQIRUFRPSOHWHVXSSUHVVLRQRI/8767DEOH PRVWSDWLHQWVHVSHFLDOO\VH[XDOO\DFWLYH patients, declared they would not agree to continue the treatment if they had to experience adverse events VXFK DV WKRVH XVXDOO\ H[SHFWHG ZLWK %3+ PHGLFDO WKHUDSLHV 7KHUH ZHUH QR PDUNHG GLᚎHUHQFHV EHWZHHQ countries. Conclusions: One major concern of patients with LUTS/BPH requiring treatment was preservation of sexual activity, at the cost of BPH treatment discontinuation. Treatment decisions should take into account patient perceptions and expectations. In return for complete suppression of urinary problems, would you agree to continue the treatment if the following HᚎHFWVKDGWRRFFXU" Whole cohort (n=480): 6LJQLᚏFDQWWHVWLVSDLQ - Decrease in libido - Erectile disorders - Ejaculation disorders 6H[XDOO\DFWLYHQ - Decreased libido - Erectile disorders - Ejaculation disorders
Would completely agree (%)
Would agree (%)
Would not agree (%)
Would not agree at all (%)
11 15 15 14
8 20 18 20
40 22 27 22
11 10 11
18 14 17
Eur Urol Suppl 2008;7(3):169