C Surcel1,2, C Mirvald3,4, G Gandaglia5, A Kretschmer6, I Tsaur7, H Borgmann7, Isabel Heidegger8, A P Labanaris9, I Sinescu1,2, Derya Tilki10, G Ploussard11, A Briganti5, F Montorsi5, R Mathieu12, M Valerio13, V Jinga14, D Badescu14, D Radavoi14, R C N van den Bergh15. 1. "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. 2. Department of Urology, Fundeni Clinical Institute, Bucharest, Romania. 3. "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. cmirvald@gmail.com. 4. Department of Urology, Fundeni Clinical Institute, Bucharest, Romania. cmirvald@gmail.com. 5. Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. 6. Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany. 7. Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany. 8. Department of Urology, Medical University Innsbruck, Innsbruck, Austria. 9. Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece. 10. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 11. Department of Urology, La Croix du Sud Hospital, Toulouse, France. 12. Department of Urology, CHU Rennes, Rennes, France. 13. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 14. Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. 15. Unit of Urology/Division of Oncology, St Antonius Hospital, Utrecht, Netherlands.
Abstract
OBJECTIVE: To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). PATIENTS AND METHODS: Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien-Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. RESULTS: Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3-41) for the entire cohort with a median survival of 15 months (95% CI 10.1-19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62-17.23, p = 0.164). CONCLUSION: Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome.
OBJECTIVE: To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). PATIENTS AND METHODS: Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien-Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. RESULTS: Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3-41) for the entire cohort with a median survival of 15 months (95% CI 10.1-19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62-17.23, p = 0.164). CONCLUSION: Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome.
Authors: Axel Heidenreich; Mark Bludau; Christiane Bruns; Tim Nestler; Daniel Porres; David Johannes Karl Paul Pfister Journal: BJU Int Date: 2020-05-16 Impact factor: 5.588