Washington, DC (UroToday.com) In this session, Dr. Sanda spoke on 3 ways to improve outcomes after radical prostatectomy.
First he talked about understanding the differences between open (ORP) and robotic radical prostatectomy (RALP). A Multicenter NIH comparative effectiveness study has fully accrued with 545 ORP and 549 RALP patients. Across groups
there were baseline differences in cancer severity (worse in RALP), prostate size (larger in ORP), nerve-sparing (more in ORP), and the performance of lymphadenectomy (more in ORP). There were no significant differences in age, race, comorbidities, BMI, and PSA across groups. Outcomes reported include reduced length of stay (2.1d ORP v 1.6d RALP, p < 0.001) and reduced blood loss (805ml ORP v 192ml RALP, p <0.001) in patients undergoing RALP. There were no differences in 30d mortality, readmission rate, UTI, PE, and positive margin rates (18%). Over time and with more experience, margin rates improve.
Next, Dr. Sanda implored the audience to focus on baseline urinary and sexual symptoms to individualize expectations. We know, for example, that baseline sexual function influences recovery after surgery (Alemozaffar et al, JAMA 2011). With regard to urinary symptoms, he presented provocative data demonstrating that patients with moderate to severe lower urinary tract symptoms (LUTS) are more likely to report an improvement over baseline LUTS at 2 years after prostatectomy relative to patients with mild LUTS (AUA-SI < 8).
These studies should be incorporated in conversations with our patients to inform expectations in the post-operative recovery period.
Finally, Dr. Sanda encouraged the audience to utilize available patient-reported quality of life outcomes at the point of care. Not only do we have the AUA-SI (Barry et al, J Urol 1992), but the EPIC survey is also available for use in clinical practice. Such tools may more accurately quantify and objectify recovery after radical prostatectomy.
Martin G. Sanda, MD
Benjamin T. Ristau, MD. from the Society of Urologic Oncology Meeting - December 2 - 4, 2015 – Washington, DC.
Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA