The treatment of choice for prostate cancer is radical prostatectomy. It is usually followed by incontinence. Attainment of early continence could serve as a reliable prognostic marker.
A retrospective analysis of 3713 patients investigated whether this early continence is due to postoperative swelling or can also be applied to long-term prognosis. Indeed, even after three months and one year, respectively, almost all patients with early continence remained continent (97.0% and 99.0%, respectively). And early continence also seems to be a reliable marker for potency. The chance of regaining potency was significantly higher in patients with early contingency (OR 1.8 p<0.001). Age, no or only unilateral nerve sparing, and prostate volume were verified as risk factors for permanent incontinence.
Obesity can also have advantages
A group of researchers from Bad Wildungen dealt with the early functional relationship between obesity and continence. In the course of early rehabilitation, data from patients after radical prostatectomy up to 35 days postoperatively were evaluated for this purpose. They were divided into cohorts according to BMI. Urine loss in the 24-h pad test, micturition frequency, pad count, and uroflowmetry were compared. The results were surprising: The patients with overweight (obesity I° or II°) had a partially significantly better early functional outcome compared with underweight, normal weight, or obesity III° patients.
PSA persistence and poor outcome.
Prostate cancer patients with persistent PSA after radical prostatectomy have an increased risk of mortality. Therefore, if indicated, salvage irradiation should be started as early as possible. However, the first PSA measurement is recommended 12 weeks after surgery. Ideally, however, the PSA value should no longer be measurable after six weeks. And there is also the question of whether early salvage management does not lead to better results.
Therefore, the aim of a study was to generate long-term oncological data from patients with PSA persistence. Of a total of 11,604 patients, 8.8% showed PSA persistence. At 15 years after RP, metastasis-free survival, overall survival, and cancer-specific survival were 53.0% vs. 93.2% (p<0.001), 64.7% vs. 81.2% (p<0.001), and 75.5% vs. 96.2% (p<0.001) for patients with and without PSA persistence, respectively. Salvage radiotherapy can improve overall survival and cancer-specific survival of patients with PSA persistence (HR: 0.37, p=0.02 and HR: 0.12, p<0.01, respectively).
Source: 71st Congress of the German Society of Urology (DGU)
InFo ONCOLOGY & HEMATOLOGY 2019; 7(5): 32 (published 10/17/19, ahead of print).
