External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Petroski, R A; Warlick, William B.; Herring, Judi; Donahue, Timothy F.; Sun, Leon; Smith, C.; Connelly, RR; McLeod, David G.; Moul, Judd W.

doi:10.1038/sj.pcan.4500718

Cited by 17 publications

(10 citation statements)

References 23 publications

(20 reference statements)

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“…175 Fontaine et al 176 also reported no change in continence status in 16 of 17 men after salvage radiation. However, Petroski et al 177 reported that post-operative radiotherapy worsened continence in 26% of 129 patients followed for a median of 5 years. On the other hand salvage RP following EBRT has been has been generally reported to have a high incidence of urinary incontinence 178 -180 possibly because of radiationinduced fibrosis of the external sphincter.…”

Section: Incontinence After External Beam Radiotherapy Alone and In Cmentioning

confidence: 99%

Surgical treatment of stress incontinence in men

Herschorn

Bruschini

Comiter

et al. 2009

Neurourology and Urodynamics

177

137

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Aims:The committee was charged with the responsibility of reviewing and evaluating all published data relating to surgical treatment of male urinary incontinence since the previous consultation in 2004. Methods: Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The articles were evaluated using Levels of Evidences adapted by the ICUD from the Oxford Centre for Evidence Based Medicine. The Recommendations for Care were based on the level of evidence and discussed among the committee members to reach consensus. The incontinence problems were classified according to their etiology, that is, either primarily sphincter or bladder related. Results: Specialist evaluation of the patient is primarily a clinical approach with history, frequency-volume chart, physical examination, and postvoid residual urine. Other investigations such as radiographic imaging of the lower urinary tract, cystoscopy, and urodynamic studies can provide important information for the clinician. For stress incontinence of various etiologies the artificial urinary sphincter (AUS) has the longest record of satisfactory results. Consideration must be given to the need for revisions for mechanical breakdown, erosion/infection, and recurrent incontinence, as well as cost. Sling procedures are increasingly being reported to have good outcomes for mild to moderate incontinence. Injectable agents have not shown durable results but newer technologies such as volume-adjustable balloons have shown favorable early results. Incontinence following cystectomy with neobladder and pelvic trauma has been treated most commonly with the AUS. Conclusions: Although the literature is replete with well-done cohort studies, there is a need for prospective randomized clinical trials. Recommendations for trials include standardized workup and outcome measures and complete reporting of adverse events and long-term results. Further research is also needed to elucidate the mechanism of post-prostatectomy incontinence.

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Section: Incontinence After External Beam Radiotherapy Alone and In Cmentioning

confidence: 99%

Surgical treatment of stress incontinence in men

Herschorn

Bruschini

Comiter

et al. 2009

Neurourology and Urodynamics

177

137

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“…Urinary continence can improve for up to 24 months after RP and early RT may interfere with or prolong this return to continence. 19 In this study, UI was more common in the early RT group at the time of RT and UI rates improved in both groups at years 1, 2, and 3 post-RT. Although the severity of UI was not recorded, only 12 patients in the cohort had an AUS placed.…”

Section: Complications Of Radiotherapy After Prostatectomymentioning

confidence: 68%

“…As such, adjuvant RT is frequently delayed after RP to allow for wound healing and return of urinary continence. 19 In this study, the mean time to RT in the early group was 3.6 months with a range of 1-5 months indicating that some patients received RT earlier than recommended. Patients who received early RT in our series either opted for adjuvant RT or exhibited early biochemical relapse, whereas those who received late RT generally exhibited late relapse or a relapse with a slow doubling time.…”

Section: Complications Of Radiotherapy After Prostatectomymentioning

confidence: 95%

Long-term complications in men who have early or late radiotherapy after radical prostatectomy.

Sowerby

Gani²,

Yim³

et al. 2014

CUAJ

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Introduction: Choosing adjuvant radiotherapy (RT) or salvage RT after radical prostatectomy (RP) for locally advanced prostate cancer is controversial. Performing RT early after RP may increase the risk of urinary complications compared to RT performed later. We evaluated the urinary complication rates of men treated with surgery followed by early or late RT. Methods: Using a retrospective chart review, we compared rates of urinary incontinence (UI), bladder neck contracture (BNC), or urethral stricture in men with prostate cancer treated with early RT (<6 months after RP) or late RT (≥6 months after RP), 3 years after RT. Results: In total, 652 patients (between 2000 and 2007) underwent early RT (162,24.8%) or late RT (490, 75.2%) after RP. The mean time to early RT was 3.6 months (range: 1-5 months) and to late RT was 30.1 months (range: 6-171 months). At 3 years post-RT, UI rates were similar in the early RT and the late RT groups (24.5% vs. 23.3%, respectively, p = 0.79). Prior to RT, 27/652 (4%) patients had a BNC and 11/652 (1.7%) had a urethral stricture, of which only 1 BNC persisted at 3 years post-RT. After RT, 17/652 (2.6%) BNC and 4/652 (0.6%) urethral stricture developed; of these, 6 BNC and 2 urethral strictures persisted at 3 years. Conclusion: Rates of UI, BNC, and urethral stricture were similar with early and late RT at 3 years post-RT. These findings suggest that the timing of RT after RP does not alter the incidences of these urinary complications and can aid in the decision-making process regarding adjuvant RT versus salvage RT.

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“…EAU guidelines currently recommend radical prostatectomy only in patients with PSA <20 ng/mL 6 . Adjuvant radiotherapy for these patients can worsen the continence rates 7 . Recently, opinion in favor of radical prostatectomy as a part of a multimodality approach in patients with locally advanced disease has been progressively increasing 9 …”

Section: Discussionmentioning

confidence: 99%

“…Although adjuvant radiotherapy could be considered for patients with positive margins and high risk of biochemical recurrence, concern prevails about the worsening of urinary continence. 7 On this background , we present our experience of MIRP in this subgroup of patients including the operative, pathological and short-term oncological outcomes.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate‐specific antigen: Feasibility and 1‐year outcomes

Ragavan

Dietel

et al. 2012

Int J of Urology

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Abbreviations & AcronymsObjectives: Urologists are cautious to offer minimally invasive radical prostatectomy in prostate cancer patients with high prostate-specific antigen (and therefore anticipated to have locally advanced or metastatic disease) because of concerns regarding lack of complete cure after minimally invasive radical prostatectomy and of worsening of continence if adjuvant radiotherapy is used. Methods: A retrospective review of our institutional database was carried out to identify patients with PSA Ն20 ng/mL who underwent minimally invasive radical prostatectomy between January 2002 and October 2010. Intraoperative, pathological, functional and short-term oncological outcomes were assessed. Results: Overall, 233 patients met study criteria and were included in the analysis. The median prostate-specific antigen and prostate size were 28.5 ng/mL and 47 mL, respectively. Intraoperative complications were the following: rectal injury (0.86%) and blood transfusion (1.7%). Early postoperative complications included prolonged (>6 days) catheterization (9.4%), hematoma (4.7%), deep venous thrombosis (0.86%) and lymphocele (5.1%). Late postoperative complications included cerebrovascular accident (0.4%) and anastomotic stricture (0.8%). Pathology revealed poorly differentiated cancer in 48.9%, pT3/pT4 disease in 55.8%, positive margins in 28.3% and lymph node disease in 20.2% of the cases. Adverse pathological findings were more frequent in patients with prostatespecific antigen >40 ng/mL and (or) in those with locally advanced disease (pT3/pT4). In 62.2% of the cases, adjuvant radiotherapy was used. At 1-year follow up, 80% of patients did not show evidence of biochemical recurrence and 98.8% of them had good recovery of continence. Conclusion: Minimally invasive radical prostatectomy might represent a reasonable option in prostate cancer patients with high prostate-specific antigen as a part of a multimodality treatment approach.

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External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Cited by 17 publications

References 23 publications

Surgical treatment of stress incontinence in men

Surgical treatment of stress incontinence in men

Long-term complications in men who have early or late radiotherapy after radical prostatectomy.

Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate‐specific antigen: Feasibility and 1‐year outcomes

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