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C154 IMPROVED PROGRESSION-FREE SURVIVAL WITH ADJUVANT RADIOTHERAPY AFTER RADICAL PROSTATECTOMY: SINGLE INSTITUTION EXPERIENCE
C151
Disorders in micturion at patients after radical prostatectomy
Starownik R., Kiś J., Muc K., Michalak J., Bar K. Medical University, Dept. of Urology, Lublin, Poland Introduction & Objectives: Radical prostatectomy is a procedure by choice of patients with clinically localized prostate cancer ≤cT2 N0 M0. The most frequent complication of past operation is urinary incontinence, which usually is a result of insufficiency of urethral external sphincter, as well as anastomotic stricture. These complications lead to disorders in micturion, which significantly lower the quality of patients’ life. The aim of the research was the evaluation of disorders in micturion by patients after radical prostatectomy due to clinically localized prostate cancer. Material & Methods: 46 patients out of 290 exposed to radical prostatectomy had urodynamic evaluation carried out. Time after past operational treatment was from 8 to 24 months. All patients were questioned about disorders in micturion: continence was evaluated in detail, features of bladder’s detrusor instability, subjective opinion of urinary flow. Results: 27 patients (58,7 %) didn’t raise any ailment from urinary tract (the right continence and urinary flow). In the performed URD evaluation, correct values of urinary flow as well as voiding cystometry were stated. 19 patients (41,3%) were stated with urinary flow weakening, six of them (13%) weren’t succeeded with entering catheter to bladder. The narrowing of urethra was stated with one patient and five had anastomotic stricture. Those patients were sent to endoscopical treatment. 17 patients (36,9%) were stated with various degrees of urinary incontinence, 7 patients had overactive bladder. 4 patients with incontinence got Deflux in the area of urethral external sphincter, which resulted in significant improvement of continence. Patients with stated overactive bladder received Vesicare (5mg once a day). Conclusions: 1. The right continence and the lack of ailments from urinary tract were stated with 58,7 % of patients. 2. The weakening of urinary flow was stated with 41,3% patients and it was most frequently caused by anastomotic stricture. 3.Various symptoms of urinary incontinence appeared at 36,9 % of patients.
C152
High-intensity focused ultrasound ablation for prostate cancer: Initial experience
Manea C.N.1, Crisan N.1, Giurgiu C.R.1, Oblezniuc A.1, Urs O.2, Coman I.1 1 Endoplus Clinic, Dept. of HIFU, Cluj Napoca, Romania, 2Saarbrücker, HIFU Center Saar, Kleinblittersdorf, Germany Introduction & Objectives: High intensity focused ultrasound (HIFU) is a method that delivers acoustic energy to a focal point, which causes a precise and irreversible coagulation necrosis. This technique can be applied after radiotherapy and also in local post therapeutic recurrence. We want to present our experience with HIFU and the initial results of focal therapy in prostate carcinoma. Material & Methods: 47 patients with prostate carcinoma were included in our study: 43 of them had local prostatic cancer (T1c-T2) and 4 had local recurrence after radical prostatectomy or external radiotherapy. Focal therapy was applied to all 47 patients. Results: The median operating time was 135 minutes. There were no intraoperatory incidents and the hospitalization of HIFU patients lasted less than 24 hours. 37 of the patients (78,7%) had a three months PSA nadir <0,3ng/ml. 6 patients (12,7%) developed urethral stricture and the 3 patients (6,4%) that have tumoral residual tissue which was confirmed by biopsy will benefit from reHIFU. 5, respectively 4 patients (8,5%) undergone transurethral resection of the prostate before and after the HIFU treatment. None of the patients developed urinary incontinence. The erectile function was preserved in 87.2% of the patients. Conclusions: HIFU is a modern therapy for prostate cancer, often used in selected patients with localized disease. HIFU is a high precision and minimally invazive medical procedure with competitive socio-proffesional reintegration. Our results demonstrate the efficacy and the safety of HIFU. HIFU does not exclude other treatment options and can be repeated when needed. The oncological results are extremely promising even when HIFU is applied for post surgical or post external radiotherapy tumoral recurrence.
C153
Effect of conservative treatment methods on quality of life after radical prostatectomy
Benyo M., Kriston A., Besenyei R., Herman A., Molnar Cs.A., Molnar Zs., Flasko T. University of Debrecen, Medical and Health Science Center, Dept. of Urology, Debrecen, Hungary
According to recently published articles early pelvic floor muscle training seems to have positive effect on continence especially when combined with other conservative therapeutic options. The authors’ aim was to compare the effectiveness of personal pelvic floor muscle training and extracorporeal magnetic innervation (EXMI) on incontinence and erectile dysfunction after radical prostatectomy. Material & Methods: 74 patients were selected, who were incontinence 1 month after radical prostatectomy. The patients formed 3 groups: A (n=22), B (n=32) and C (n=20). The first group performed tutored pelvic floor muscle training (KRISTON Intimate Training®), the second group went under multiple treatments of EXMI and the third got the combination of these two therapies. The education of training was performed 3-6 months after radical prostatectomy when the patients were supplied with a personal training program for home. The EXMI treatments were started 6 weeks after the surgical procedure. One month and 1 year after the operation patients filled the authors’ independent form in addition with international questionnaires (IIEF-5, ICIQ-SF) to evaluate the alterations in continence and erectile function. Results: 60.81% of all patients had considerable recovery of continence after one year. Group A and C presented the best improvement, the average decrease of ICIQ-SF score was 4.39 and 4.37 in opposite of B group’s result: 2.35. Patients of group B got 9, group C got 7 times EXMI treatment in average (1 treatment lasted 5x30 minutes). The IIEF-5 score increased by 0.78 in group A, 0.56 in group B and 3.00 in group C. The division of mild erectile dysfunction before radical prostatectomy was similar in all groups: 36-30-31%. Conclusions: According to our results application of validated international questionnaires is essential in contrast with self-composed forms. Latter can be useful only in combination by the evaluation of parameters like continence or erectile function. The combination of different conservative treatment options seems to have the most promising results on improving quality of life after radical prostatectomy. Personally planned pelvic floor muscle training may have additional benefits to other methods. To evaluate the long-term effects of conservative treatment to prevent incontinence, randomized and well powered studies are necessary.
C154
Improved progression-free survival with adjuvant radiotherapy after radical prostatectomy: Single institution experience
Milecki P.1, Antczak A.2, Kwias Z.2 1 Greater Poland Cancer Center, Dept. of Radiotherapy, Poznan, Poland, 2Medical University, Dept. of Urology, Poznan, Poland Introduction & Objectives: to evaluate the efficacy of adjuvant radiotherapy (RT) after radical prostatectomy (RP) for patients with prostate cancer who represented high-risk group of disease relapse (pT3 and/or positive margin). Material & Methods: Between May 1999 and December 2004, 234 prostate cancer patients after RP with the following factors: pT3 and/or positive postoperative margin were assigned to group A (104 patients) treated with RP and “wait – and – see” policy, and group B (134 patients) treated with RP plus RT. Median time from RP to RT was 85 days (range: 49 – 153 days). Patients were irradiated with threedimensional conformal radiotherapy with median total dose of 60.4 Gy (range: 56 Gy to 66 Gy). Patients represented the following clinical characteristics: median pre-surgery level of PSA (group A – 14.2 ng/ml, group B – 14.4 ng/ml), Gleason score < 8 (group A - 81% vs. Group B - 82%), pT2 (group A – 17% vs. group B – 19%), pT3 (group A – 83% vs. group B - 81%), presence of positive margin (A – 54%, B – 51%). Follow-up duration was 37 months (range: 16 to 78 months) and 36 months (range: 15 to 72 months) for group A and B, respectively. Biochemical failure was defined if PSA level increases above 0.2 ng/ml in two consecutive determinations with minimal time between them of two weeks. Actuarial survival rates were calculated using Kaplan-Meier method and the log-rank test was performed to verify the differences between rates. The RTOG/EORTC morbidity classification was used for evaluation of side effects of RT. Results: No statistical significant difference in overall survival (OS) (log rank, p= 0.66), cause specific survival (CSS), ( log rank, p=0.26) were showed. Significant improvement fro combined modality (RP + RT) were noted for distant metastasesfree survival (DMFS) ( log rank, p=0.04) and biochemical progression free-survival (b-PFS) (log rank p= 0.001). The 5-year bPFS rates were 73% and 82% for group A and group B, respectively. Tolerance of adjuvant RT was very good with 5-year actuarial 5% late grade 2 side effects for genitourinary and 5% for gastrointestinal tract. Conclusions: The results of our study have indicated that adjuvant RT after RP improved biochemical outcome (bPFS) and in distant metastases-free survival, but had no impact on cause specific survival, and overall survival. RT was well tolerated with modest acute and late gastrointestinal and genitourinary toxicities.
Introduction & Objectives: Urinary incontinence in men after radical prostatectomy is one of the most common complications affecting quality of life, 8-36% of the patients remain incontinent a year after the operation. Data on conservative therapy for postoperative incontinence is contradictory. Nonetheless, conservative treatment strategies must generally be attempted before any operative technique.
Eur Urol Suppl 2010;9(6):657
Disorders in micturion at patients after radical prostatectomy
Starownik R., Kiś J., Muc K., Michalak J., Bar K. Medical University, Dept. of Urology, Lublin, Poland Introduction & Objectives: Radical prostatectomy is a procedure by choice of patients with clinically localized prostate cancer ≤cT2 N0 M0. The most frequent complication of past operation is urinary incontinence, which usually is a result of insufficiency of urethral external sphincter, as well as anastomotic stricture. These complications lead to disorders in micturion, which significantly lower the quality of patients’ life. The aim of the research was the evaluation of disorders in micturion by patients after radical prostatectomy due to clinically localized prostate cancer. Material & Methods: 46 patients out of 290 exposed to radical prostatectomy had urodynamic evaluation carried out. Time after past operational treatment was from 8 to 24 months. All patients were questioned about disorders in micturion: continence was evaluated in detail, features of bladder’s detrusor instability, subjective opinion of urinary flow. Results: 27 patients (58,7 %) didn’t raise any ailment from urinary tract (the right continence and urinary flow). In the performed URD evaluation, correct values of urinary flow as well as voiding cystometry were stated. 19 patients (41,3%) were stated with urinary flow weakening, six of them (13%) weren’t succeeded with entering catheter to bladder. The narrowing of urethra was stated with one patient and five had anastomotic stricture. Those patients were sent to endoscopical treatment. 17 patients (36,9%) were stated with various degrees of urinary incontinence, 7 patients had overactive bladder. 4 patients with incontinence got Deflux in the area of urethral external sphincter, which resulted in significant improvement of continence. Patients with stated overactive bladder received Vesicare (5mg once a day). Conclusions: 1. The right continence and the lack of ailments from urinary tract were stated with 58,7 % of patients. 2. The weakening of urinary flow was stated with 41,3% patients and it was most frequently caused by anastomotic stricture. 3.Various symptoms of urinary incontinence appeared at 36,9 % of patients.
C152
High-intensity focused ultrasound ablation for prostate cancer: Initial experience
Manea C.N.1, Crisan N.1, Giurgiu C.R.1, Oblezniuc A.1, Urs O.2, Coman I.1 1 Endoplus Clinic, Dept. of HIFU, Cluj Napoca, Romania, 2Saarbrücker, HIFU Center Saar, Kleinblittersdorf, Germany Introduction & Objectives: High intensity focused ultrasound (HIFU) is a method that delivers acoustic energy to a focal point, which causes a precise and irreversible coagulation necrosis. This technique can be applied after radiotherapy and also in local post therapeutic recurrence. We want to present our experience with HIFU and the initial results of focal therapy in prostate carcinoma. Material & Methods: 47 patients with prostate carcinoma were included in our study: 43 of them had local prostatic cancer (T1c-T2) and 4 had local recurrence after radical prostatectomy or external radiotherapy. Focal therapy was applied to all 47 patients. Results: The median operating time was 135 minutes. There were no intraoperatory incidents and the hospitalization of HIFU patients lasted less than 24 hours. 37 of the patients (78,7%) had a three months PSA nadir <0,3ng/ml. 6 patients (12,7%) developed urethral stricture and the 3 patients (6,4%) that have tumoral residual tissue which was confirmed by biopsy will benefit from reHIFU. 5, respectively 4 patients (8,5%) undergone transurethral resection of the prostate before and after the HIFU treatment. None of the patients developed urinary incontinence. The erectile function was preserved in 87.2% of the patients. Conclusions: HIFU is a modern therapy for prostate cancer, often used in selected patients with localized disease. HIFU is a high precision and minimally invazive medical procedure with competitive socio-proffesional reintegration. Our results demonstrate the efficacy and the safety of HIFU. HIFU does not exclude other treatment options and can be repeated when needed. The oncological results are extremely promising even when HIFU is applied for post surgical or post external radiotherapy tumoral recurrence.
C153
Effect of conservative treatment methods on quality of life after radical prostatectomy
Benyo M., Kriston A., Besenyei R., Herman A., Molnar Cs.A., Molnar Zs., Flasko T. University of Debrecen, Medical and Health Science Center, Dept. of Urology, Debrecen, Hungary
According to recently published articles early pelvic floor muscle training seems to have positive effect on continence especially when combined with other conservative therapeutic options. The authors’ aim was to compare the effectiveness of personal pelvic floor muscle training and extracorporeal magnetic innervation (EXMI) on incontinence and erectile dysfunction after radical prostatectomy. Material & Methods: 74 patients were selected, who were incontinence 1 month after radical prostatectomy. The patients formed 3 groups: A (n=22), B (n=32) and C (n=20). The first group performed tutored pelvic floor muscle training (KRISTON Intimate Training®), the second group went under multiple treatments of EXMI and the third got the combination of these two therapies. The education of training was performed 3-6 months after radical prostatectomy when the patients were supplied with a personal training program for home. The EXMI treatments were started 6 weeks after the surgical procedure. One month and 1 year after the operation patients filled the authors’ independent form in addition with international questionnaires (IIEF-5, ICIQ-SF) to evaluate the alterations in continence and erectile function. Results: 60.81% of all patients had considerable recovery of continence after one year. Group A and C presented the best improvement, the average decrease of ICIQ-SF score was 4.39 and 4.37 in opposite of B group’s result: 2.35. Patients of group B got 9, group C got 7 times EXMI treatment in average (1 treatment lasted 5x30 minutes). The IIEF-5 score increased by 0.78 in group A, 0.56 in group B and 3.00 in group C. The division of mild erectile dysfunction before radical prostatectomy was similar in all groups: 36-30-31%. Conclusions: According to our results application of validated international questionnaires is essential in contrast with self-composed forms. Latter can be useful only in combination by the evaluation of parameters like continence or erectile function. The combination of different conservative treatment options seems to have the most promising results on improving quality of life after radical prostatectomy. Personally planned pelvic floor muscle training may have additional benefits to other methods. To evaluate the long-term effects of conservative treatment to prevent incontinence, randomized and well powered studies are necessary.
C154
Improved progression-free survival with adjuvant radiotherapy after radical prostatectomy: Single institution experience
Milecki P.1, Antczak A.2, Kwias Z.2 1 Greater Poland Cancer Center, Dept. of Radiotherapy, Poznan, Poland, 2Medical University, Dept. of Urology, Poznan, Poland Introduction & Objectives: to evaluate the efficacy of adjuvant radiotherapy (RT) after radical prostatectomy (RP) for patients with prostate cancer who represented high-risk group of disease relapse (pT3 and/or positive margin). Material & Methods: Between May 1999 and December 2004, 234 prostate cancer patients after RP with the following factors: pT3 and/or positive postoperative margin were assigned to group A (104 patients) treated with RP and “wait – and – see” policy, and group B (134 patients) treated with RP plus RT. Median time from RP to RT was 85 days (range: 49 – 153 days). Patients were irradiated with threedimensional conformal radiotherapy with median total dose of 60.4 Gy (range: 56 Gy to 66 Gy). Patients represented the following clinical characteristics: median pre-surgery level of PSA (group A – 14.2 ng/ml, group B – 14.4 ng/ml), Gleason score < 8 (group A - 81% vs. Group B - 82%), pT2 (group A – 17% vs. group B – 19%), pT3 (group A – 83% vs. group B - 81%), presence of positive margin (A – 54%, B – 51%). Follow-up duration was 37 months (range: 16 to 78 months) and 36 months (range: 15 to 72 months) for group A and B, respectively. Biochemical failure was defined if PSA level increases above 0.2 ng/ml in two consecutive determinations with minimal time between them of two weeks. Actuarial survival rates were calculated using Kaplan-Meier method and the log-rank test was performed to verify the differences between rates. The RTOG/EORTC morbidity classification was used for evaluation of side effects of RT. Results: No statistical significant difference in overall survival (OS) (log rank, p= 0.66), cause specific survival (CSS), ( log rank, p=0.26) were showed. Significant improvement fro combined modality (RP + RT) were noted for distant metastasesfree survival (DMFS) ( log rank, p=0.04) and biochemical progression free-survival (b-PFS) (log rank p= 0.001). The 5-year bPFS rates were 73% and 82% for group A and group B, respectively. Tolerance of adjuvant RT was very good with 5-year actuarial 5% late grade 2 side effects for genitourinary and 5% for gastrointestinal tract. Conclusions: The results of our study have indicated that adjuvant RT after RP improved biochemical outcome (bPFS) and in distant metastases-free survival, but had no impact on cause specific survival, and overall survival. RT was well tolerated with modest acute and late gastrointestinal and genitourinary toxicities.
Introduction & Objectives: Urinary incontinence in men after radical prostatectomy is one of the most common complications affecting quality of life, 8-36% of the patients remain incontinent a year after the operation. Data on conservative therapy for postoperative incontinence is contradictory. Nonetheless, conservative treatment strategies must generally be attempted before any operative technique.
Eur Urol Suppl 2010;9(6):657