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Observational Study
. 2023 Sep 30:78:100284.
doi: 10.1016/j.clinsp.2023.100284. eCollection 2023.

Differences in long-term continence rates between prostate cancer patients with extraprostatic vs. organ-confined disease undergoing robotic-assisted radical prostatectomy: An observational studys

Cristina Cano Garcia  1 , Mike Wenzel  2 , Florestan Koll  2 , Agnes Zatik  2 , Jens Köllermann  3 , Markus Graefen  4 , Derya Tilki  5 , Pierre I Karakiewicz  6 , Luis A Kluth  2 , Felix K H Chun  2 , Philipp Mandel  2 , Benedikt Hoeh  2
Affiliations
Observational Study

Differences in long-term continence rates between prostate cancer patients with extraprostatic vs. organ-confined disease undergoing robotic-assisted radical prostatectomy: An observational studys

Cristina Cano Garcia et al. Clinics (Sao Paulo). .

Abstract

Objectives: Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP).

Method: In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used.

Results: Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85).

Conclusion: In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates.

Keywords: Extraprostatic; FFLU; Long-term continence; NeuroSAFE; Organ-confined; Robotic-assisted radical prostatectomy.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of long-term (≥ 12 months) continence rate of patients undergoing Roboter-Assisted Radical Prostatectomy stratified according to extraprostatic vs. organ-confined disease between eras: before 11/2017 (= Standard) and since 11/2017 (= Implementation of Full Functional-Length Urethra preservation [FFLU] and Neurovascular Structure-Adjacent Frozen-Section Examination [NeuroSAFE]).
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