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

MP64-20 PREOPERATIVE MEMBRANOUS URETHRAL LENGTH IS ASSOCIATED WITH POST-PROSTATECTOMY URINARY FUNCTION IN ASIAN MEN

Basourakos, Spyridon; Ramaswamy, Ashwin; Yu, Miko; Margolis, Daniel; Hu, Jim

doi: 10.1097/JU.0000000000002104.20
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INTRODUCTION AND OBJECTIVE:

Studies demonstrate that Asian and African-American race (vs. white) and preoperative membranous urethral length (MUL) measured on MRI have been associated with post-radical prostatectomy (RP) urinary incontinence. However, the relationship of race and MUL has not been studied: this is noteworthy given improved patient selection as an approach to minimize the risk of post-RP incontinence.

METHODS:

We retrospectively identified men who self-identified as “Asian” and underwent robot-assisted RP for localized prostate cancer between 2015 and 2020. After appropriate training of two readers by an expert genitourinary radiologist, MULs were blindly measured by the two readers independently. Urinary function was assessed using the Expanded Prostate Cancer Index for Clinical Practice (EPIC-CP). Baseline clinicopathologic characteristic and imaging measurements were compared with Wilcoxon-Mann-Whitney and χ2 test. We used a generalized estimating equation (GEE) model to evaluate if Asian race is associated with urinary function recovery.

RESULTS:

There were no racial differences by age (66.8 95%CI 64.7-69.0 vs. 65.6, 95%CI 62.6-68.6; p=0.6), BMI (25.9, 95%CI 24.7-27.2 vs. 26.7, 95%CI 25.7-27.8; p=0.3), PSA (10.3, 95%CI 7.6-12.9 vs. 8.6, 95%CI 6.3-11.0; p=0.4), prostate volume (50.4, 95%CI 37.8-63.0 vs. 41.5, 95%CI 25.9-46.7; p=0.2) or complete nerve sparing status (86% vs. 86%; p=1.0). Asian men had shorter MUL (7.9mm, 95%CI 7.5–8.3 vs. 10.9mm, 95%CI 10.2–11.7; p<0.01) and worse EPIC-CP urinary function scores (3.82; 95%CI 2.47-5.17 vs. 1.95; 95%CI 1.11–2.79; p=0.022) at 12 months post-RP compared to non-Asians. Our GEE model demonstrated that Asian race is associated of a higher (worse) EPIC-CP urinary score when compared to non-Asians (parameter estimate 0.56; 95%CI 0.04-1.08; p=0.034). Furthermore, we found that lower MUL (p=0.03) and Asian race (p=0.036) were associated with increased 12-month EPIC-CP urinary function scores in a multivariate logistic model that included age and BMI.

CONCLUSIONS:

Asian race was associated with shorter MUL, and both Asian race and shorter MUL are independently associated with worse urinary function. Further confirmatory studies and comparative racial studies of MUL are necessary to better characterize disparities in outcomes.

Source of Funding:

Jim C. Hu receives research support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. Jim C. Hu also receives salary support from NIH R01 CA241758 and PCORI CER-2019C1-15682. The remaining authors report no further disclosures related to this work

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