Login to Access Video or Poster Abstract: MP93-07
Sources of Funding: None

Introduction

Surgical management of high-risk and non-metastatic prostate cancer has received renewed attention since the publication of the Protect study which suggests at best marginal benefits for low and intermediate risk categories._x000D_ Tailor-made wide excision surgery is generally offered as part of combined modality treatment with adjuvant radiotherapy. Functional outcome in this group of patients is rarely publicised and is expected to reflect the extensive nature of the disease._x000D_ We prospectively assess the rate of incontinence at follow up of at least one year and compute independent pre- and perioperative predictive parameters of adverse outcome.

Methods

A total of 178 patients with high risk CaP (44.6% were cT3a/b) underwent laparoscopic radical prostatectomy with pelvic lymphadenectomy from July 2007 to 2016 at Imperial College NHS Trust, London. Pad-use was assessed independently by a specialist nurse from the surgical team at a minimum follow up of 1 year via a telephone clinic and questionnaires. _x000D_ Pre-op factors assessed were: age, psa, Gleason grade, previous TURP, clinical stage, radiological stage, prostate size, family history of prostate cancer, BMI. _x000D_ Peri-op factors assessed were: operating time, blood loss, any nerve sparing, bladder neck sparing, presence of middle lobe, hospital stay, early complication, late complication, Clavien scale complication. _x000D_ Complications were prospectively assessed and graded meticulously with Clavien classification._x000D_ Univariate and multivariate analysis utilising logistic regression was computed to predict a binary outcome of no versus any pad use._x000D_

Results

Pad use at one year after surgery for high risk prostate cancer was 17% and artificial urethral sphincter or advance tape was inserted in 5% of men, a urethral stricture was observed in 1.2%. Only hospital stay was independently predictive of persistent urinary incontinence on multivariate analysis p=0.018 OR 1.78 (95% CI 1.106-2.876). _x000D_

Conclusions

Men who stay longer in hospital are more likely to experience incontinence. Hospital stay is a likely surrogate for early complications, more extensive surgery or bleeding. A better classification of postoperative complications after radical prostatectomy for high risk prostate cancer may allow prediction of postoperative continence.

Funding

None