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Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy.
Eur Urol. 2014 Mar; 65(3):546-51.EU

Abstract

BACKGROUND

Little is known about the impact of adjuvant radiation therapy (aRT) after radical prostatectomy (RP) on urinary continence (UC).

OBJECTIVE

To evaluate the impact of aRT on UC recovery in patients with unfavourable pathologic characteristics.

DESIGN, SETTING, AND PARTICIPANTS

The study included 361 patients with either pT2 with positive surgical margin(s) or pT3a/pT3b node-negative disease treated with RP at a tertiary care referral centre.

INTERVENTION

Patients were stratified according to the administration of aRT into two groups: group 1 (no aRT; n=208; 57.8%) and group 2 (aRT; n=153; 42.2%).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Continence was defined as no use of protective pads. Log-rank test was used to compare the rate of UC recovery according to aRT status. The association between aRT and UC was also tested in Cox regression models after accounting for age, Cancer of the Prostate Risk Assessment (CAPRA) score, nerve-sparing (NS) status, Charlson Comorbidity Index, body mass index, and year of surgery.

RESULTS AND LIMITATIONS

At a mean follow-up of 30 mo, 254 patients (70.4%) recovered complete UC. The 1- and 3-yr UC recovery was 51% and 59% for patients submitted to aRT versus 81% and 87% for patients not receiving aRT, respectively (p<0.001). At univariable analysis, older age (p<0.001), presence of non-organ-confined disease (p<0.001), non-NS procedure (p<0.001), and delivery of aRT (p<0.001) were significantly associated with lower UC. At multivariable analysis, the delivery of aRT remained an independent predictor of worse UC recovery (hazard ratio: 0.57; p=0.001). Patients treated with aRT had a 1.6-fold higher risk of incontinence. Younger age (p=0.02), lower CAPRA score (p=0.03), and NS approach (p<0.001) also represented independent predictors of UC recovery. The main limitations of the study are related to the lack of validated questionnaires in the evaluation of UC and in the lack of information regarding UC status at aRT.

CONCLUSIONS

The delivery of aRT has a detrimental effect on UC. The oncologic benefits must be balanced with an impaired UC recovery. Patients should be informed of such impairment before adjuvant treatments are planned.

Authors+Show Affiliations

Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy. Electronic address: suardi.nazareno@hsr.it.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23415377

Citation

Suardi, Nazareno, et al. "Impact of Adjuvant Radiation Therapy On Urinary Continence Recovery After Radical Prostatectomy." European Urology, vol. 65, no. 3, 2014, pp. 546-51.
Suardi N, Gallina A, Lista G, et al. Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. Eur Urol. 2014;65(3):546-51.
Suardi, N., Gallina, A., Lista, G., Gandaglia, G., Abdollah, F., Capitanio, U., Dell'Oglio, P., Nini, A., Salonia, A., Montorsi, F., & Briganti, A. (2014). Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. European Urology, 65(3), 546-51. https://doi.org/10.1016/j.eururo.2013.01.027
Suardi N, et al. Impact of Adjuvant Radiation Therapy On Urinary Continence Recovery After Radical Prostatectomy. Eur Urol. 2014;65(3):546-51. PubMed PMID: 23415377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. AU - Suardi,Nazareno, AU - Gallina,Andrea, AU - Lista,Giuliana, AU - Gandaglia,Giorgio, AU - Abdollah,Firas, AU - Capitanio,Umberto, AU - Dell'Oglio,Paolo, AU - Nini,Alessandro, AU - Salonia,Andrea, AU - Montorsi,Francesco, AU - Briganti,Alberto, Y1 - 2013/02/04/ PY - 2012/08/29/received PY - 2013/01/24/accepted PY - 2013/2/19/entrez PY - 2013/2/19/pubmed PY - 2014/8/21/medline KW - Adjuvant radiation therapy KW - Prostate cancer KW - Radical prostatectomy KW - Urinary continence SP - 546 EP - 51 JF - European urology JO - Eur Urol VL - 65 IS - 3 N2 - BACKGROUND: Little is known about the impact of adjuvant radiation therapy (aRT) after radical prostatectomy (RP) on urinary continence (UC). OBJECTIVE: To evaluate the impact of aRT on UC recovery in patients with unfavourable pathologic characteristics. DESIGN, SETTING, AND PARTICIPANTS: The study included 361 patients with either pT2 with positive surgical margin(s) or pT3a/pT3b node-negative disease treated with RP at a tertiary care referral centre. INTERVENTION: Patients were stratified according to the administration of aRT into two groups: group 1 (no aRT; n=208; 57.8%) and group 2 (aRT; n=153; 42.2%). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Continence was defined as no use of protective pads. Log-rank test was used to compare the rate of UC recovery according to aRT status. The association between aRT and UC was also tested in Cox regression models after accounting for age, Cancer of the Prostate Risk Assessment (CAPRA) score, nerve-sparing (NS) status, Charlson Comorbidity Index, body mass index, and year of surgery. RESULTS AND LIMITATIONS: At a mean follow-up of 30 mo, 254 patients (70.4%) recovered complete UC. The 1- and 3-yr UC recovery was 51% and 59% for patients submitted to aRT versus 81% and 87% for patients not receiving aRT, respectively (p<0.001). At univariable analysis, older age (p<0.001), presence of non-organ-confined disease (p<0.001), non-NS procedure (p<0.001), and delivery of aRT (p<0.001) were significantly associated with lower UC. At multivariable analysis, the delivery of aRT remained an independent predictor of worse UC recovery (hazard ratio: 0.57; p=0.001). Patients treated with aRT had a 1.6-fold higher risk of incontinence. Younger age (p=0.02), lower CAPRA score (p=0.03), and NS approach (p<0.001) also represented independent predictors of UC recovery. The main limitations of the study are related to the lack of validated questionnaires in the evaluation of UC and in the lack of information regarding UC status at aRT. CONCLUSIONS: The delivery of aRT has a detrimental effect on UC. The oncologic benefits must be balanced with an impaired UC recovery. Patients should be informed of such impairment before adjuvant treatments are planned. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/23415377/Impact_of_adjuvant_radiation_therapy_on_urinary_continence_recovery_after_radical_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(13)00096-1 DB - PRIME DP - Unbound Medicine ER -