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Prostate Cancer: Localized: Surgical Therapy VI (MP64): Moderated Poster 64: Monday, September 13, 2021

MP64-09 MARKED CLINICAL IMPROVEMENT OF LOWER URINARY TRACT SYMPTOM BURDEN DUE TO ROBOT-ASSISTED RADICAL PROSTATECTOMY: RESULTS OF A LARGE HIGH-VOLUME CENTER COHORT

Liakos, Nikolaos; Leyh-Bannurah, Sami-Ramzi; Mendrek, Mikolaj; Karagiotis, Theodoros; Wagner, Christian; Schuette, Andreas; Urbanova, Katarina; Oelke, Matthias; Witt, Jorn H.

doi: 10.1097/JU.0000000000002104.09
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INTRODUCTION AND OBJECTIVE:

To assess clinically meaningful improvement of preoperative lower urinary tract symptoms (LUTS) and associated quality of life (QoL) after robot-assisted radical prostatectomy (RARP) of prostate cancer patients.

METHODS:

We identified 6,866 RARP patients from 2007-2019 who were preoperatively continent with corresponding follow-up, had complete clinicopathological data and International Prostate Symptom Score (IPSS) and -QoL questionnaires before and 6 months after RARP. Based on these timepoints, marked clinical improvement was defined by using the most stringent IPSS-difference of 8 points. Analyses were restricted to patients with preoperatively moderate (IPSS 8-19) vs. severe (IPSS 20-35) LUTS burden (n=2956). T-Test was used to compare mean change of LUTS score according to aforementioned LUTS burden and mean change of QoL according to ∆IPSS ≤-8 vs. >-8. Multivariable logistic regression analyses (LRM) for prediction of ∆IPSS≤-8 were adjusted for age, PSA, preoperative LUTS burden (moderate [REF.] vs. severe), gland weight (g), CAPRA-S score, nerve-sparing (none vs. uni- vs. bilateral) and bladder neck reconstruction width (1-5 cm).

RESULTS:

Preoperative LUTS was categorized as moderate and severe in 37% (n=2556) and 5.8% (n=400) of patients, respectively. Here, a postoperative marked improvement, i.e. ∆IPSS≤-8, was reported in 36% vs. 89%, with corresponding mean change of -2.0 vs. -15.1 (p<0.001). A ∆IPSS ≤-8 vs. >-8 translated to QoL mean changes of +0.28 vs. -1.5 (p<0.001). In LRM, only preoperative LUTS burden (severe vs. moderate [REF.] OR 14 95%CI 10-19; p<0.001) and gland weight (per 10g, OR 1.12 95%CI 1.08-1.16; p<0.001) were independent predictors of a marked LUTS improvement after RARP, ∆IPSS ≤-8.

CONCLUSIONS:

In one of the largest RARP cohorts with preoperative moderate or severe LUTS burden, we observed substantial proportions of patients with marked improvements of LUTS at already 6 months after RARP, which translates to improvement of QoL. LRM revealed greatest benefit in those with preoperatively greatest LUTS burden and prostate enlargement. In presence of such findings, such postoperative functional and QoL prospects are integral for patient counseling of prostate cancer treatment.

Source of Funding:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

© 2021 by American Urological Association Education and Research, Inc.