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Clinical Research

Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis

Prostate Cancer and Prostatic Diseases volume 20, pages 395–400 (2017)Cite this article

Subjects

Abstract

Background:

To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa).

Methods:

Retrospective analyses of a prospectively maintained database for 769 patients with D’Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score ⩾17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively.

Results:

Mean age of the cohort was 62.3 years, and 62.1% harbored ⩾PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan–Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM ⩾17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation.

Conclusions:

Patients with D’Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.

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Author notes

  1. F Abdollah and D Dalela: These authors contributed equally to this work.

Authors and Affiliations

  1. VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    F Abdollah, D Dalela, A Sood, J Sammon, R Cho, L Nocera, M Diaz, W Jeong, J O Peabody & M Menon

  2. Department of Urology, Vita Salute San Raffaele University, Milan, Italy

    L Nocera, N Fossati, G Gandaglia, A Briganti & F Montorsi

Authors
  1. F Abdollah
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Correspondence to F Abdollah.

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Competing interests

F Abdollah is a consultant/advisor of GenomeDx Biosciences. The authors declare no conflict of interest.

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Abdollah, F., Dalela, D., Sood, A. et al. Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis. Prostate Cancer Prostatic Dis 20, 395–400 (2017). https://doi.org/10.1038/pcan.2017.26

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