For both treatment groups, the rate of complications peaked within two years of treatment, but continued at a steady rate for the next 10 years.CONCLUSIONS: Complications are common following prostate cancer treatment and occur many years after treatment. The type of primary treatment (radiotherapy versus prostatectomy) is an important predictor of complication rates for all categories.INTRODUCTION AND OBJECTIVES: It is often assumed that there is little improvement in incontinence and erectile dysfunction (ED) beyond 12 to 24 mos after radical prostatectomy. There is sparse data addressing this issue. We sought to determine the probability of achieving good urinary function (UF) and erectile function (EF) up to 48 mos post-operatively based on patient reported functional status at 12 mos. METHODS: We identified 2537 patients who underwent radical prostatectomy (RP) between 2007e2012 at a tertiary institution with self-reported UF and EF scores at 12 mos and beyond. Our main outcome was good EF as defined by IIEF 22 (range 1e30) or good UF as defined by a validated urinary questionnaire score of 17 (range 0e21). Kaplan-Meier analyses and multivariable Cox proportional hazards models were used to determine the probability of achieving continence and functional erections in patients that had not achieved good UF and EF by 12 mos. Patients with preoperative incontinence or ED were excluded. RESULTS: At 12 mos post-operatively, 629 (30%) and 897 (66%) patients had not achieved good UF and EF, respectively. Of those who were incontinent at 12 mos, there was increasing probability of achieving good UF at 24, 36, and 48 mos (33%, 49%, and 61%, respectively). To account for the possibility of adapting to urinary symptoms, we used pad free status as the outcome and found lower probabilities of UF recovery but a similar rising trend at the same time points (29%, 40%, and 47%, respectively). In patients who had ED at 12 mos, there was also an increasing probability of recovering EF at 24, 36, and 48 mos (21%, 32%, and 42%, respectively).CONCLUSIONS: In this large cohort with self-reported outcomes, men continue to achieve improvement in UF and EF with increasing time from surgery, despite having incontinence or ED at 12 mos. The probabilities of achieving good function were considerably higher than initially anticipated. These findings may represent natural history, but the effect of informative censoring, patients' response biases, and rehabilitative interventions are being investigated.
follow-up among survivors was 3.86 years. P-MIBC patients had significantly worse OS (p ¼ 0.026), RFS (p ¼ 0.002), and CSS (p ¼ 0.022) on univariable analysis as compared to DN-MIBC patients (Fig. 1). After adjusting for pathologic T stage on multivariable analysis, P-MIBC associations with OS and CSS were no longer significant; however, P-MIBC remained associated with a significantly increased risk of recurrence compared to DN-MIBC (HR: 2.40, 95% CI¼ 1.38-4.19, p ¼ 0.002).CONCLUSIONS: Patients with P-MIBC appear less likely to respond to NAC than DN-MIBC, though these findings should be confirmed in prospective studies. The mechanisms for platinum resistance in P-MIBC are under investigation, but the benefits of earlier surgical intervention before progression to MIBC cannot be overstated.
Purpose-We compared clinical outcomes, and identified predictors of cancer specific and overall survival after radical cystectomy in patients with urothelial carcinoma with squamous differentiation and those with pure squamous cell carcinoma.Materials and Methods-We reviewed data on 2,031 patients treated with radical cystectomy and pelvic lymph node dissection at a single high volume referral center. Of these patients 78 had squamous cell carcinoma and 67 had squamous differentiation. Survival estimates by histological subtype were described using Kaplan-Meier methods. Within histological subtypes pathological stage, nodal invasion, soft tissue margins, age and gender were evaluated as predictors of cancer specific survival and overall survival using univariate Cox regression.Results-Median followup was 44 months. Of 104 patient deaths 60 died of their disease. We did not find a statistically significant difference between survival curves of patients with squamous cell carcinoma and squamous differentiation (log rank overall survival p = 0.6, cancer specific survival p = 0.17). Positive soft tissue margins were associated with worse cancer specific survival (HR 6.92, p ≤ 0.0005) and overall survival (HR 3.68, p ≤ 0.0005) in patients with pure squamous cell carcinoma. Among patients with squamous differentiation, pelvic lymphadenopathy was associated with decreased overall survival (HR 2.52, 95% CI 1.33-4.77, p = 0.004) and cancer specific survival (HR 3.23, 95% CI 1.57-6.67, p = 0.002).Conclusions-There appears to be no evidence of a difference in cancer specific survival or overall survival between patients with squamous cell carcinoma and those with squamous differentiation treated with radical cystectomy and pelvic lymph node dissection. Patients with squamous differentiation and tumor metastases to pelvic lymph nodes should be followed more closely, and adjuvant treatment should be considered to improve survival. Wide surgical resection is critical to achieve local tumor control and improve survival in patients with squamous cell carcinoma. Urothelial carcinoma with SqD occurs along a similar molecular pathway, and is histologically characterized by intercellular bridges and keratinization. [3][4][5] Compared to conventional urothelial carcinoma, SqD is an adverse pathological feature associated with worse recurrence-free and cancer specific survival. 6,7 Similarly, compared to conventional urothelial carcinoma, SCC has been associated with adverse oncologic outcomes after adjusting for the effects of stage and common prognostic factors. 8To our knowledge no study has compared the clinical outcomes of patients with SCC to the outcomes of those with SqD. We compared the cancer specific survival and overall survival of patients with SCC and SqD, and identified prognostic factors in those treated with radical cystectomy for each histological variant. MATERIALS AND METHODS Patient PopulationBetween February 1990 and July 2009, 2,031 patients were treated with RCPLND at our institution. Of these cases...
In patients with GS 3+3, PI-RADS 5 is associated with biopsy upgrade and progression, and PI-RADS 1-2 with non-progression. mpMRI may be a viable adjunct in treatment decision making for men on AS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.