MP58-06: Urinary Continence Recovery after Retzius-Sparing Robot-Assisted Radical Prostatectomy and Adjuvant Radiation Therapy
Sunday, May 5, 2024 1:00 PM to 3:00 PM · 2 hr. (US/Central)
221C
Abstract
Information
Full Abstract and Figures
Author Block
Alberto Olivero*, Stefano Tappero, Ofir Maltzman, Francesco Chierigo, Alberto Caviglia, Antonio Piccione, Enrico Vecchio, Marco Martiriggiano, Valerio Cellini, Erika Palagonia, Carlo Buratto, Giancarlo Napoli, Michele Barbieri, Elena Strada, Dario Di Trapani, Giovanni Petralia, Silvia Secco, Aldo Massimo Bocciardi, Antonio Galfano, Paolo Dell'Oglio, Milan, Italy
Introduction
Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) allows the preservation of structures advocated to be crucial in the continence mechanism. This study evaluates the association between adjuvant radiation therapy (aRT) and urinary continence (UC) recovery after RS-RARP.
Methods
The patients submitted to RS-RARP at a single high-volume European institution between January 2010 and December 2021 were identified. The inclusion criteria for the study were pT2 stage with PSM or pT3/pN1 stage with or without PSM. We divided the patients into two groups: patients who received aRT and patients who underwent observation. Administration of aRT was based on the indication given by each treating physician and discussion with patients. Adjuvant RT was delivered within 1–6 months after surgery. Between 2010 and 2014, all patients underwent three-dimensional conformal radiation therapy (3D- CRT). Since 2015, intensity-modulated RT (IMRT) with image-guided RT or volumetric arc (VMAT) with image-guided RT has been used. Data on radiation dose (Gy) and the interval between RS- RARP and aRT were collected.
Results
After 1:1 propensity score matching, 124 aRT patients were compared with 124 no-aRT counterparts. The median follow-up was 49 months. According to D'Amico risk stratification, 88 vs. 81% of, respectively, aRT vs. no-aRT patients were classified as high-risk. Compared with no-aRT patients, those who received aRT harbored worse pathology (pT and pN stages, pathologic ISUP grade). Partial and full NS was performed in 9 vs. 9% and 34 vs. 35% of aRT vs. no-aRT patients (p = 0.9). No difference was recorded in PSM (60 vs. 63%, p = 0.6). At 12 months from RS-RARP, UC recovery rates were 81 vs. 84% in aRT vs. no- aRT patients (log-rank p = 0.9). In univariable Cox regression analyses, aRT was associated with worse UC recovery at 12 months (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.73–0.97; p = 0.040). Such association was not confirmed in multivariable Cox regression model. In the sensitivity analysis focused on aRT patients, only the NS technique was independently associated with UC recovery at 12 months (partial NS, HR: 1.79; 95% CI: 1.01–3.14; p = 0.045; full NS, HR: 2.24; 95% CI: 1.17–5.21; p = 0.032). Conversely, the type of aRT did not reach the independent predictor status (HR 1.28; 95% CI: 0.72–2.27; p = 0.4).
Conclusions
In our study, we did not find significant differences in 12-month UC recovery between RS-RARP patients treated and nontreated with aRT, and aRT did not reach the independent predictor status for UC recovery.
Source Of Funding
Nothing to declare
Author Block
Alberto Olivero*, Stefano Tappero, Ofir Maltzman, Francesco Chierigo, Alberto Caviglia, Antonio Piccione, Enrico Vecchio, Marco Martiriggiano, Valerio Cellini, Erika Palagonia, Carlo Buratto, Giancarlo Napoli, Michele Barbieri, Elena Strada, Dario Di Trapani, Giovanni Petralia, Silvia Secco, Aldo Massimo Bocciardi, Antonio Galfano, Paolo Dell'Oglio, Milan, Italy
Introduction
Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) allows the preservation of structures advocated to be crucial in the continence mechanism. This study evaluates the association between adjuvant radiation therapy (aRT) and urinary continence (UC) recovery after RS-RARP.
Methods
The patients submitted to RS-RARP at a single high-volume European institution between January 2010 and December 2021 were identified. The inclusion criteria for the study were pT2 stage with PSM or pT3/pN1 stage with or without PSM. We divided the patients into two groups: patients who received aRT and patients who underwent observation. Administration of aRT was based on the indication given by each treating physician and discussion with patients. Adjuvant RT was delivered within 1–6 months after surgery. Between 2010 and 2014, all patients underwent three-dimensional conformal radiation therapy (3D- CRT). Since 2015, intensity-modulated RT (IMRT) with image-guided RT or volumetric arc (VMAT) with image-guided RT has been used. Data on radiation dose (Gy) and the interval between RS- RARP and aRT were collected.
Results
After 1:1 propensity score matching, 124 aRT patients were compared with 124 no-aRT counterparts. The median follow-up was 49 months. According to D'Amico risk stratification, 88 vs. 81% of, respectively, aRT vs. no-aRT patients were classified as high-risk. Compared with no-aRT patients, those who received aRT harbored worse pathology (pT and pN stages, pathologic ISUP grade). Partial and full NS was performed in 9 vs. 9% and 34 vs. 35% of aRT vs. no-aRT patients (p = 0.9). No difference was recorded in PSM (60 vs. 63%, p = 0.6). At 12 months from RS-RARP, UC recovery rates were 81 vs. 84% in aRT vs. no- aRT patients (log-rank p = 0.9). In univariable Cox regression analyses, aRT was associated with worse UC recovery at 12 months (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.73–0.97; p = 0.040). Such association was not confirmed in multivariable Cox regression model. In the sensitivity analysis focused on aRT patients, only the NS technique was independently associated with UC recovery at 12 months (partial NS, HR: 1.79; 95% CI: 1.01–3.14; p = 0.045; full NS, HR: 2.24; 95% CI: 1.17–5.21; p = 0.032). Conversely, the type of aRT did not reach the independent predictor status (HR 1.28; 95% CI: 0.72–2.27; p = 0.4).
Conclusions
In our study, we did not find significant differences in 12-month UC recovery between RS-RARP patients treated and nontreated with aRT, and aRT did not reach the independent predictor status for UC recovery.
Source Of Funding
Nothing to declare