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

Garcia, Cristina Cano; Wenzel, Mike; Koll, Florestan; Zatik, Agnes; Kollermann, Jens; Graefen, Markus; Tilki, Derya; Karakiewicz, Pierre I.; Kluth, Luis A.; Chun, Felix K.H.; Mandel, Philipp; Hoeh, Benedikt

doi:10.1016/j.clinsp.2023.100284

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100284 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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

HIGHLIGHTS

No difference in long-term continence in extraprostatic vs. organ-confined prostate cancer.

Even after multivariable adjustment, no difference between these two groups was identified.

Characteristic	Overall n = 201 (100 %)	Extraprostatic^a a Median (IQR, Interquartile Range); n (%) n = 75 (37 %)	Organ-confined^a a Median (IQR, Interquartile Range); n (%) n = 126 (63 %)	p-value^b b Kruskal-Wallis rank sum test; Pearson’s Chi-Square test; Fisher’s exact test.
Age at diagnosis (years)	66 (61, 70)	67 (63, 70)	66 (60, 70)	0.6
PSA in mg/mL	7.0 (5.2, 10.0)	9.0 (6.3, 12.0)	6.7 (5.0, 9.4)	<0.001
BMI in kg/m²	26.4 (24.5, 28.7)	27.1 (24.7, 29.9)	26.0 (24.2, 28.4)	0.11
Prostate volume in cm³	39 (30, 52)	35 (30, 46)	40 (30, 59)	0.036
Gleason grade group Biopsy-specimen				<0.001
I	51 (25 %)	10 (13 %)	41 (33 %)
II	92 (46 %)	35 (47 %)	57 (45 %)
III	32 (16 %)	15 (20 %)	17 (13 %)
IV	17 (8.5 %)	7 (9 %)	10 (8 %)
V	9 (4.5 %)	8 (11 %)	1 (1 %)
D’Amico risk groups				<0.001
Low	35 (18 %)	6 (8 %)	36 (24 %)
Intermediate	125 (63 %)	43 (57 %)	97 (66 %)
High	39 (20 %)	26 (35 %)	15 (10 %)
Nerve sparing				0.003
Complete bilateral	119 (61 %)	32 (45 %)	87 (71 %)
Bilateral with one side partial	24 (12 %)	10 (14 %)	14 (11 %)
Unilateral	24 (12 %)	14 (20 %)	10 (8 %)
No	27 (14 %)	15 (21 %)	12 (10 %)
FFLU+NeuroSAFE	131 (65 %)	83 (66 %)	47 (64 %)	0.8
Gleason grade group RP-specimen				<0.001
I	40 (20 %)	5 (7 %)	35 (28 %)
II	103 (51 %)	36 (48 %)	67 (53 %)
III	31 (15 %)	15 (20 %)	16 (13 %)
IV	9 (4 %)	4 (5 %)	5 (4 %)
V	18 (10 %)	15 (20 %)	3 (3 %)
pN-stage				<0.001
pN0	179 (89 %)	62 (83 %)	117 (93 %)
pN1	9 (4 %)	9 (12 %)	0 (0 %)
pNx	13 (7 %)	4 (5 %)	9 (7 %)
Surgical margins				<0.001
R0	145 (72 %)	33 (44 %)	112 (89 %)
R1	53 (26 %)	40 (53 %)	13 (10 %)
RX	3 (2 %)	2 (3 %)	1 (1 %)

Characteristic	Overall (n = 201)	Extraprostatic^a a n (%). , n = 75 (37 %)	Organ-confined^a a n (%). , n = 126 (63 %)	p-value^b b Kruskal-Wallis rank sum test; Pearson’s Chi-Square test; Fisher’s exact test.
Long-term continence				0.3
Yes	163 (81%)	58 (77%)	105 (83%)
No	38 (19%)	17 (23%)	21 (17%)

	Multivariable
	Odds ratio	95 % confidence interval	p-value
Extraprostatic disease ^b b Urinary continence was defined by usage of no or one safety pad within 24h.
No	Reference	–	–
Yes	0.91	0.34–2.50	0.85

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[1] * Corresponding author. E-mail address: cristina.canogarcia@kgu.de (C. Cano Garcia).