127 IMPACT ON HEALTH RELATED QUALITY OF LIFE OF RADICAL PROSTATECTOMY AND PROSTATE BRACHYTHERAPY IN PATIENTS WITH LOW AND INTERMEDIATE-RISK CLINICALLY LOCALIZED PROSTATE CANCER

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Radical retropubic prostatectomy in patients previously submitted to holmium laser enucleation of the prostate for benign prostatic enlargement: a feasibility study

Suardi N., Gallina A., Scattoni V., Capitanio U., Raber M., Roscigno M., Salonia A., Briganti A., Rigatti P., Montorsi F. Scientific Institute San Raffaele, Urology, Milan, Italy Introduction & Objectives: 1.To evaluate the feasibility of radical retropubic prostatectomy (RRP) in patients diagnosed with incidental prostate cancer (IPCa) following holmium laser enucleation of the prostate (HoLEP) for benign prostatic enlargement (BPE). 2.To compare these results with those seen in patients submitted to RRP for IPCa following trans-urethral resection of the prostate (TURP) or open transvesical prostatectomy (OP). Material & Methods: Between January 2004 and September 2006, 16 consecutive patients (pts) with a diagnosis of IPCa following HoLEP for BPE (Group 1), underwent nerve-sparing RRP at our Institution. These pts were matched with an equal number of pts who also underwent RRP for IPCa following TURP (Group 2) or OP (Group 3). Pre-, peri-operative and follow-up oncological plus functional data were evaluated with analysis of variance (ANOVA) and Chi-Square tests. Results are presented as Group 1 vs Group 2 vs Group 3. Results: Mean age was 64,29±6,65, 63,07±5,31 and 71,13±5,23 years (p=0.01). BMI was not statistically different (25.75±2.0vs26.09±3.30vs27.0±2.66 Kg/m2; p=0.5). Pre-operative PSA level was similar in the groups (4.61±4.62 vs3.45±3.28 vs 5.08±3.61 ng/ml;p=0.48), as well as % of Gleason score ≥ 7 (21.4 vs 21.4 vs 42.8;p=0.55); pre-operative erectile function, as measured with the IIEF-EF score, was higher in Group 1 although not statistically significant (23.5±10.4 vs 13.4±10.5 vs 10.9±10.7; p=0.051). Mean operative time was longer in the OP group (126.0±21.5 vs 125.3±34.6 vs 156.0±41.2 min;p=0.02); no difference was found in terms of mean blood loss (1073.0±576 vs 1236.6±507.9 vs 1303.3 ml; p=0.59). Hospital stay and catheter removal was similar in the groups (7.65±5.23 vs 9.05±4.45 vs 10.62±3.68;p=0.81 and 10.65±5.98 vs 11.52±3.65 vs 11.73±4.86;p=0.67). Hystopathologic evaluation: No difference was found in the rate of pT3 stages (6.7% vs 13.3% vs 20%; p=0.53) and of Gleason score ≥7 (23.1 vs 46.2 vs 53.9;p=0.27); positive surgical margins rate was 6.7% vs 33.3% vs 46.7%; p=0.04. No pT0 stages were found. Mean followup was 23.8 months (4-38). There was no statistical difference between the three groups in terms of urinary continence rate, as measured with the ICIQ-SF (2.3±2.9 vs 5.3 vs 5.6 vs 3.8±4.5; p=0.6), and erectile function recovery (IIEF-EF: 14.36±6.78 vs 12.13±7.48 vs 11.0±4.40 in groups 1, 2 and 3 respectively, p=0.41). IIEF-EF in pts on therapy with PDE5-I are: 19.4 ± 7.8 vs 15.9±11.3 vs 14.0 ± 10.1 (p=0.7). Two pts per each group developed anastomotic stricture (6.6%).



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Prevalence, Severity, and Chronicity of Pain and General Health-Related Quality of Life in Patients with Localized Prostate Cancer Özgür E.1, Gerbershagen H.2, Raible A.1, Engelmann U.1, Heidenreich A.1

University Hospital Cologne, Urology, Cologne, Germany, 2University Hospital Cologne, Anästhesie, Cologne, Germany 1

Introduction & Objectives: To analyze the prevalence and the severity spectrum of pain and its relationships to health-related quality of life and the bio-psycho-social consequences of pain among patients scheduled for radical prostatectomy. Material & Methods: Urological inpatients completed an epidemiological pain questionnaire extensively exploring preoperative acute and chronic pains in 21 body regions. The severity of pain was determined using von Korff’s Pain Grading (CPGQ). Pain chronicity was estimated employing the Mainz Pain Staging System (MPSS). Anxiety and depressive symptoms were identified with the HADS and the Habitual Well-Being Questionnaire (FW-7). Health-related quality of life was measured using the SF-12. Comorbidities and the comorbidity-related interferences with daily activities were ascertained with the Weighted Illness Checklist. Results: Eighty of 115 patients (69.9%) reported about pain during the last three months preoperatively. 28.7% of the pain patients had pain related to urological disease. Severe dysfunctional pain was identified by pain grades 3 and 4 of the CPGQ in 20% and 13.8%, respectively. Advanced pain chronicity characterized by pain stages II and III of the MPSS was present in 38.8% and 11.3%. Patients with localized prostate cancer without pain complaints had significantly better healthrelated quality of life and habitual well-being, lower anxiety and depression scores and fewer comorbidities. Patients with cancer-related and non-cancer pain did not differ in pain chronicity, pain severity, pain intensities, anxiety, comorbidities and physical health (SF12-PCS).

Conclusions: RRP is feasible in pts with iPCa and who previously underwent HoLEP for BPE. It provides good oncological and functional outcomes in these patients, without any significative difference as compared to patients undergoing RRP after TURP or OP. We found a lower rate of positive surgical margins in patients previously submitted to Holep. Continence rate is acceptable in these patients, while recovery of erectile function is disappointing in these patients.

Conclusions: The high prevalence of severe and chronic pain in cancer patients before scheduled radical prostatectomy –combined with considerable disability effects, markedly reduced quality of life and often insufficient treatment– necessitates a short routine screening-analysis of the severity spectrum of pain and psychopathology. Patient self-rated pain chronicity staging and psychological distress analysis will allow a disorder severity-guided treatment and the prevention of suffering and additional new chronic postsurgical pain.





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Impact on health related quality of life of radical prostatectomy and prostate brachytherapy in patients with low and intermediate-risk clinically localized prostate cancer Suarez J.F.1, Aguilo F.1, Ferrer M.2, Guedea F.3, Fernandez P.4, Mariño A.5, Hervás A.6, Villavicencio H.7, Herruzo I.8, Sancho G.9, Polo A.3, Pastor S.1, Franco E.1 Hospital Universitari de Bellvitge, Urology, L’Hospitalet de Llobregat, Barcelona, Spain, 2Institut Munincipal d’Investigació Mèdica, Health Sciences, Barcelona, Spain, 3Institut Català d’Oncologia, Radiotherapy, L’Hospitalet de Llobregat, Barcelona, Spain, 4Instituto Oncológico de Gipúzkoa, Radiotherapy, San Sebastián, Spain, 5Centro Oncológico de Galicia, Radiotherapy, La Coruña, Spain, 6Hospital Ramón y Cajal, Radiotherapy, Madrid, Spain, 7Fundación Puigvert, Urology, Barcelona, Spain, 8Hospital Regional Carlos Haya, Radiotherapy, Málaga, Spain, 9Hospital de la Santa Creu i Sant Pau, Radiotherapy, Barcelona, Spain 1

Introduction & Objectives: Prostate cancer is the 3rd cause of death by cancer among men in Spain. PSA allows detecting clinically localized asymptomatic prostate cancers, nowadays more than 58% of prostate cancers are diagnosed as clinically localized. Radical Retropubic Prostatectomy is the main therapeutic option but with considerable side effects. In the 90s patients in the US started to be treated with Brachytherapy, with less important side effects in the short term. First studies with 7 year survival results for Brachytherapy similar to those of Prostatectomy in low risk tumors1,2. The objective of this study is to compare the effectiveness of Radical Retropubic Prostatectomy (PR) and Prostate Brachytherapy (BP), in terms of Quality of Life, in patients with clinically localized prostate cancer. 1. D’Amico AV et al. JAMA 1998;280:969-74. 2. Stokes SH. Int J Radiat Oncol Biol Phys 2000;47:129-36. Material & Methods: Longitudinal observational prospective study. The patients were recruited consecutively at the 8 Spanish clinical centers participating in the study. Decision on treatment was made jointly by patients and physicians. Inclusion criteria: 1. Low and intermediate-risk clinically localized prostate cancer, and 2. No previous transurethral resection of the prostate. Pre-treatment and post-treatment evaluations: months 1, 3, 6, and 12 Clinical variables: TNM, PSA and Gleason Quality of Life evaluation gathered centrally using computed-assisted telephone administration: SF-36 generic questionnaire. Expanded Prostate Cancer Index Composite (EPIC). Functional Assessment of Cancer Therapy (FACT-G & FACT-P). International Prostate Symptom Score (IPSS). International Index of Erectile Function (IIEF). Results: A total of 514 patients were included in the study. 56 patients rejected keep on the study, and 64 were lost due to technical problems. Thus, 394 patients were eligible to analysis, 139 in the prostatectomy group and 255 in the brachytherapy group. Significant differences between the two groups were found regarding age, PSA level at diagnosis, and Gleason score. Differences according to treatment group were found in SF-36 in Physical Functioning, Role Physical, Role Emotional, and Urinary, and Sexual in EPIC questionnaire, but at 12 months, only Sexual and Urinary topics in EPIC questionnaire showed significant differences between the two groups. Conclusions: Compared to surgery, which is the most established treatment, the Prostate Brachytherapy proves clearly in this study a smaller negative impact on the HRQoL, regarding on sexual and urinary symptoms, on patients with low and intermediate-risk clinically localized prostate cancer until a year after the treatment. The fact of short follow-up and being a no-randomized study limits the conclusions to extract of our data.

Eur Urol Suppl 2007;6(2):54

Positive surgical margins increase the risk of biochemical recurrence independently from pathological stage or grade

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Gallina A.1, Walz J.1, Eichelberg C.2, Zanni G.3, Reuther A.4, Klein E.4, Eastham J.A.5, Scardino P.T.5, Perrotte P.6, Montorsi F.3, Graefen M.7, Huland H.2, Karakiewicz P.I.1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2University Medical Centre Eppendorf, Urology, Hamburg, Germany, 3Vita-Salute University, Urology, Milan, Italy, 4Cleveland Clinic Foundation, Urology, Cleveland, United States of America, 5Memorial Sloan Kettering Cancer Center, Urology, New York, United States of America, 6 University of Montreal Health Center, Urology, Montreal, Canada, 7Martini-Clinic, Prostate Cancer Centre, Hamburg, Germany 1

Introduction & Objectives: Positive surgical margins (+SM) status at radical prostatectomy are a well known prognostic factor for biochemical recurrence after radical prostatectomy (RP). However, some has questioned the value of +SM in either clearly favorable or clearly unfavorable prostate cancer (PCa) patients. We tested the effect of +SM on the rate of BCR-free survival in patients with either clearly favorable or clearly unfavorable pathological characteristics. Material & Methods: Clinical and pathological data were available for 8620 patients from 1 European and 2 North American referral centers, subjected to retropubic RP between 1987 and 2006. Patients were stratified between favorable (PSA ≤10 ng/mL, RP Gleason sum ≤6, no extracapsular extension [ECE], no seminal vesicle invasion [SVI] and no lymph node invasion [LNI]), unfavorable (PSA >20 ng/mL or RP Gleason sum 8-10 and SVI or LNI) and intermediate (all remaining patients) pathological characteristics. Kaplan-Meier and Cox regression analyses addressed the rate of BCR after RP in each stratum. Results: At RP, 2474 (28.7%), 5267 (61.1%) and 879 (10.2%) patients were classified as favorable, intermediate and unfavorable PCa patients, respectively. In favorable patients, +SM conferred a 4.3 fold increase in the risk of BCR (p<0.001) vs. a 2.3-fold increase (p<0.001) in intermediate patients vs. a 1.5-fold increase in unfavorable patients. Conclusions: Patients with positive surgical margins have a statistically significant lower BCR-free survival, across all pathological stage.