Reduction of lower urinary tract symptoms in prostate cancer patients treated with robot assisted laparoscopic prostatectomy
DOI:
https://doi.org/10.2340/sju.v59.40070Keywords:
Prostate cancer, radical prostatectomy, LUTS, EPIC-26, SF-12Abstract
Problem: The aim of this study was to evaluate the change in LUTS in patients treated with RALP and to assess factors that may predict an improvement of LUTS.
Materials and method: In our institutional prospective research registry, 1935 patients operated in the period between 2009 and 2021 with complete baseline- and 12-month EPIC-26 questionnaire were eligible for the study. Also SF-12 data estimating general quality of life (QoL) were analyzed. A LUTS summary score was constructed from the two questions concerning voiding stream/residual and frequency, and transformed linearly to a 0-100 scale with higher scores representing less symptoms A change of 6 points or more were considered Meaningful Clinical Differences (MCD). Two summary scores were calculated from the SF-12 – a mental component score (MCS-12) and a physical component score (PCS-12). Multivariate regression was used to estimate covariates associated with postoperative MCD, MCS-12 and PCS-12.
Results: Mean change of LUTS-score showed an increase of 10 points 12-months post-RALP. 52% of patients achieved MCD. In multivariate logistic regression, preoperative LUTS was statistically significant associated with MCD. Reduction of LUTS was associated improved mean score of MCS-12 and PCS-12.
Discussion and conclusion: Along with information about risk for urinary incontinence after RALP, patients with LUTS at baseline must be informed that these symptoms may be reduced after RALP. In our study, this LUTS reduction was associated with better general QoL.
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Kim JH, Ha YS, Jeong SJ, et al. Impact of robot-assisted radical prostatectomy on lower urinary tract symptoms and predictive factors for symptom changes: a longitudinal study. Urology. 2013 Apr;81(4):787–93. https://doi.org/10.1016/j.urology.2012.12.038 DOI: https://doi.org/10.1016/j.urology.2012.12.038
Chandra Engel J, Palsdottir T, Aly M, et al. Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50–69 years with PSA ≥3 ng/ml. Scand J Urol. 2020 Feb;54(1):1–6. https://doi.org/10.1080/21681805.2019.1703806 DOI: https://doi.org/10.1080/21681805.2019.1703806
Chapple CR, Wein AJ, Abrams P, et al. Lower urinary tract symptoms revisited: a broader clinical perspective. Eur Urol. 2008 Sep;54(3):563–9. https://doi.org/10.1016/j.eururo.2008.03.109 DOI: https://doi.org/10.1016/j.eururo.2008.03.109
Latz I, Weber M, Korda R, et al. Lower urinary tract symptoms in relation to region of birth in 95,393 men living in Australia: the 45 and up study. World J Urol. 2013 Jun;31(3):673–82. https://doi.org/10.1007/s00345-012-0937-7 DOI: https://doi.org/10.1007/s00345-012-0937-7
Walz J, Suardi N, Hutterer GC, et al. Lower urinary tract symptoms affect one-third of men in a prostate cancer screening population. J Endourol. 2008 Feb;22(2):369–76. https://doi.org/10.1089/end.2007.0135 DOI: https://doi.org/10.1089/end.2007.0135
Kupelian V, Wei JT, O’Leary MP, et al. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol. 2012 Jan;61(1):78–84. https://doi.org/10.1016/j.eururo.2011.05.065 DOI: https://doi.org/10.1016/j.eururo.2011.05.065
Geraerts I, Van Poppel H, Devoogdt N, et al. Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot-assisted radical prostatectomy. BJU Int. 2013 Nov;112(7):936–43. https://doi.org/10.1111/bju.12258 DOI: https://doi.org/10.1111/bju.12258
Åkerla J, Pesonen JS, Pöyhönen A, et al. Impact of lower urinary tract symptoms on mortality: a 21-year follow-up among middle-aged and elderly Finnish men. Prostate Cancer Prostatic Dis. 2019 May;22(2):317–23. https://doi.org/10.1038/s41391-018-0108-z DOI: https://doi.org/10.1038/s41391-018-0108-z
Locke J, Ellis W, Wallner K, et al. Risk factors for acute urinary retention requiring temporary intermittent catheterization after prostate brachytherapy: a prospective study. Int J Radiat Oncol Biol Phys. 2002 Mar 1;52(3):712–19. https://doi.org/10.1016/S0360-3016(01)02657-8 DOI: https://doi.org/10.1016/S0360-3016(01)02657-8
Whiting PF, Moore TH, Jameson CM, et al. Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review. BJU Int. 2016 Aug;118(2):193–204. https://doi.org/10.1111/bju.13499 DOI: https://doi.org/10.1111/bju.13499
Dommer L, Birzele JA, Ahmadi K, et al. Lower urinary tract symptoms (LUTS) before and after robotic-assisted laparoscopic prostatectomy: does improvement of LUTS mitigate worsened incontinence after robotic prostatectomy? Transl Androl Urol. 2019 Aug;8(4):320–8. https://doi.org/10.21037/tau.2019.06.24 DOI: https://doi.org/10.21037/tau.2019.06.24
Chen RC, Chang P, Vetter RJ, et al. Recommended patient-reported core set of symptoms to measure in prostate cancer treatment trials. J Natl Cancer Inst. 2014 Jul;106(7):dju132. https://doi.org/10.1093/jnci/dju132 DOI: https://doi.org/10.1093/jnci/dju132
Martin NE, Massey L, Stowell C, et al. Defining a standard set of patient-centered outcomes for men with localized prostate cancer. Eur Urol. 2015 Mar;67(3):460–7. https://doi.org/10.1016/j.eururo.2015.08.016 DOI: https://doi.org/10.1016/j.eururo.2015.08.016
Fossa SD, Storas AH, Steinsvik EA, et al. Psychometric testing of the Norwegian version of the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26). Scand J Urol. 2016 Aug;50(4):280–5. https://doi.org/10.3109/21681805.2016.1163617 DOI: https://doi.org/10.3109/21681805.2016.1163617
Skolarus TA, Dunn RL, Sanda MG, et al. Minimally important difference for the expanded prostate cancer index composite short form. Urology. 2015 Jan;85(1):101–5. https://doi.org/10.1016/j.urology.2014.08.044 DOI: https://doi.org/10.1016/j.urology.2014.08.044
Cornford P, Tilki D, van den Bergh RCN, Briers E, et al. EAU - EANM - ESTRO - ESUR - ISUP - SIOG Guidelines on Prostate Cancer. Edn presented at the EAU Annual Congress Paris 2024, ISBN 978-94-92671-23-3, EAU Guidelines Office, Arnhem, The Netherlands, 2024.
Jenkinson C, Layte R. Development and testing of the UK SF-12 (short form health survey). J Health Serv Res Policy. 1997 Jan;2(1):14–18. https://doi.org/10.1177/135581969700200105 DOI: https://doi.org/10.1177/135581969700200105
Gandek B, Ware J, Aaronson N, et al. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. J Clin Epidemiol. 1998;51:1171–8. https://doi.org/10.1016/S0895-4356(98)00109-7 DOI: https://doi.org/10.1016/S0895-4356(98)00109-7
Nagelkerke N. A note on a general definition of the coefficient of determination. Biometrika. 1991;78(3):691–2. https://doi.org/10.1093/biomet/78.3.691 DOI: https://doi.org/10.1093/biomet/78.3.691
Leyh-Bannurah SR, Wagner C, Schuette A, et al. Improvement of quality of life and symptom burden after robot-assisted radical prostatectomy in patients with moderate to severe LUTS. Sci Rep. 2021 Aug 18;11(1):16757. https://doi.org/10.1038/s41598-021-95525-2 DOI: https://doi.org/10.1038/s41598-021-95525-2
Masters JG, Rice ML. Improvement in urinary symptoms after radical prostatectomy: a prospective evaluation of flow rates and symptom scores. BJU Int. 2003 Jun;91(9):795–7. https://doi.org/10.1046/j.1464-410X.2003.04231.x DOI: https://doi.org/10.1046/j.1464-410X.2003.04231.x
Taylor BC, Wilt TJ, Fink HA, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006 Oct;68(4):804–9. https://doi.org/10.1016/j.urology.2006.04.019 DOI: https://doi.org/10.1016/j.urology.2006.04.019
Berge V, Berg RE, Hoff JR, et al. A prospective study of transition from laparoscopic to robot-assisted radical prostatectomy: quality of life outcomes after 36-month follow-up. Urology. 2013 Apr;81(4):781–6. https://doi.org/10.1016/j.urology.2013.01.017 DOI: https://doi.org/10.1016/j.urology.2013.01.017
Vertosick EA, Vickers AJ, Cowan JE, et al. Interpreting patient reported urinary and sexual function outcomes across multiple validated instruments. J Urol. 2017 Sep;198(3):671–7. https://doi.org/10.1016/j.juro.2017.03.121 DOI: https://doi.org/10.1016/j.juro.2017.03.121
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