Premium
Long‐term evaluation of survival, continence and potency ( SCP ) outcomes after robot‐assisted radical prostatectomy ( RARP )
Author(s) -
Ficarra Vincenzo,
Borghesi Marco,
Suardi Nazareno,
De Naeyer Geert,
Novara Giacomo,
Schatteman Peter,
De Groote Ruben,
Carpentier Paul,
Mottrie Alexander
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12001
Subject(s) - shim (computing) , medicine , prostatectomy , erectile dysfunction , prostate cancer , urology , potency , biochemical recurrence , surgery , cancer , biochemistry , chemistry , in vitro
Objective To report combined oncological and functional outcome in a series of patients who underwent robot‐assisted radical prostatectomy ( RARP ) for clinically localised prostate cancer in a single E uropean centre after 5‐year minimum follow‐up according to survival, continence and potency ( SCP ) outcomes.Patients and Methods We extracted from our prostate cancer database all consecutive patients with a minimum follow‐up of 5 years after RARP . Biochemical failure was defined as a confirmed PSA concentration of >0.2 ng/ mL . All patients alive at the last follow‐up were evaluated for functional outcomes using the E xpanded P rostate C ancer I ndex C omposite ( EPIC ) and S exual H ealth I nventory for M en ( SHIM ) questionnaires. Oncological and functional outcomes were reported according to the SCP system. Specifically, patients were classified as using no pad ( C 0), using one pad for security ( C 1), and using ≥1 pad ( C 2) (not including the prior definition). Patients potent ( SHIM score of >17) without any aids were classified as P 0 category; patients potent ( SHIM score of >17) with use of phosphodiesterase type 5 inhibitorsas P 1; and patients with erectile dysfunction ( SHIM score of <17) as P 2 category. Patients who did not undergo a nerve‐sparing technique, who were not potent preoperatively, who were not interested in erections, or who did not have sexual partners were classified as P x category.Results The 3‐, 5‐ and 7‐year biochemical recurrence‐free survival rates were 96.3%; 89.6% and 88.3%, respectively. At follow‐up, 146 (79.8%) were fully continent ( C 0), 20 (10.9%) still used a safety pad ( C 1) and 17 (9.3%) were incontinent using ≥1 pad ( C 2). Excluding P x patients, 52 patients (47.3%) were classified as P 0; 41 patients (37.3%) were classified as P 1 and 17 patients (15.5%) were P 2. In patients preoperatively continent and potent, who received a nerve‐sparing technique and did not require any adjuvant therapy, oncological and functional success was attained by 77 (80.2%) patients. In the subgroup of 67 patients not evaluable for potency recovery ( P x), oncological and continence outcomes were attained in 46 patients (68.7%).Conclusions Oncological and functional success was attained in a high percentage of patients who underwent RARP at ≥5 years follow‐up. Interestingly, this study confirmed that excellent oncological and functional outcomes can be obtained in the ‘best’ category of patients, i.e. those preoperatively continent and potent and with tumour characteristics suitable for a nerve‐sparing technique.