Transcript Diapositive 1 - Service d'Urologie

Abstract
Introducing a new and simple scoring system to evaluate
Introduction & Objectives
Material & Methods
Three
hundred
and
eleven
consecutive men underwent radical
prostatectomy for localized prostate
cancer from 1999 to 2004 and were
evaluated one year after surgery.
Biochemical
recurrence
was
defined as a single postoperative
PSA level >0.2 ng/ml. Continence,
defined as using no pad, and
potency, defined as the ability to
achieve and maintain an erection
suitable for sexual intercourse,
were evaluated by a prospective,
self-administered
questionnaire.
Each patient received
- 4 points (if PSA <0.2 ng/ml) or 0
points (if PSA >0.2 ng/ml) for
oncological outcome,
- 2 points (if continent) or 0 points
(if not continent) for urinary
continence and
- 1 point (if potent) or 0 points (if not
potent) for erectile function.
The total score represented the
sum of all points, higher scores
indicating a better outcome. The
unique feature of this scoring
system is that each particular score
represents a particular clinical
status regarding oncological and
functional outcome.
Results
One year after surgery, 284
(91.3%) patients had PSA levels
<0.2 ng/ml, 243 (78.1%) were
continent and 113 (36.3%) were
potent. Patients with a total score
>4 had good cancer control and
could be further subdivided into
patients being continent and potent
(score 4+2+1, 22.5%), being
continent but having erectile
dysfunction (ED) (score 4+2+0,
34.1%), being incontinent and
potent (score 4+0+1 points 9.3%),
and being incontinent and having
ED (score 4+0+0, 22.5%). Similarly,
patients with score <4 had no
cancer control and could be further
subdivided into patients being
continent and potent (score 0+2+1,
1.9%), being continent but having
ED (score 0+2+0 6.1%), being
incontinent and potent (score
0+0+1 point, 1.6%), and and being
incontinent and having ED (score
0+0+0, 1.2%).
Conclusions
This score includes the three most
important outcomes after radical
prostatectomy,
cancer
control,
continence and erectile function. It
could allow us to better evaluate
and compare the results of radical
prostatectomy in a multinational,
multicenter setting.
pT2
oncological and functional outcome after radical prostatectomy
Salomon L., De La Taille A., Vordos D., Hoznek A., Yiou R., Abbou C.C.
Department of Urology, Henri Mondor Hospital, Créteil, France
Introduction
Results
Radical prostatectomy is a major, potentially curative procedure for the treatment of
Definition
organ-confined prostate cancer. It can be performed by retropubic or perineal
approaches (1,2) and since 1997 by laparoscopic approach (3). The majority of
urologists use the radical retropubic approach, due to familiarity with surgical anatomy,
as well as the nerve sparing technique first described by Walsh et al. (4). As stated by
Walsh, the goals of radical prostatectomy are cancer control, urinary continence, and
eventually potency with low morbidity (5). However, the presentation of men with
localized prostate cancer during the past 10-20 years has changed: More men are
presenting with localized prostate cancer, low PSA, Gleason score < 6 and normal
digital examination (clinical T1c stage) (6). With the resulting improvement of oncological
outcome, functional results such as postoperative urinary continence and potency are
major concerns for many patients. Although many men are willing to trade their sexual
life and even their continence for a chance to cure cancer, this does not mean that these
functions are unimportant for them (7,8).
Results of radical prostatectomy (cancer control, continence and potency) are usually
presented separately. Postoperative PSA levels allow us to detect progression (9),
continence is evaluated by the number of pads used and potency is evaluated according
to the status of preservation of neurovascular bundles (10-12).
However, the success of radical prostatectomy should be the combination of cancer
control, good urinary continence and maintenance of potency. Although a plethora of
data regarding postoperative outcome exists in the literature, we are often not able to
distinguish if patients with good cancer control also have satisfactory functional results
regarding their urinary continence or erectile function (13). We propose a new method to
evaluate oncological and functional results after radical prostatectomy together, using a
simple scoring system.
Biochemical recurrence: PSA > 0.2 ng/ml
Functional results: prospective self-administered questionnaire:
Continence (ICS): no pad
Potency (IEFF5) erection suitable for sexual intercourse
Score
- 4 points (if PSA <0.2 ng/ml) or 0 point (if PSA > 0.2 ng/ml)
- 2 points (if continent) or 0 point (if incontinent)
-1 point (if potent) or 0 point (if not potent)
Score = sum oncological +continence + potency
From 0 (0+0+0) to 7 (4+2+1)
One Year
Each particular score represents a particular clinical status
regarding oncological and functional outcome
1
,8
Cum. Survival
To create a scoring system, which
takes into account oncological
outcome and functional results
(continence and erectile function) of
patients after radical prostatectomy.
120
34.1%
,6
100
,4
91.3%
,2
80
22.55%
22.5%
Methods
0
60
1999-2004: 311 radical prostatectomies
- Perineal approach: 9
- Retropubic approach: 58
- Laparoscopic approach:
-Transperitoneal: 148
- Extraperitoneal: 85
- Robotic: 11
0
10
20
30
40
50
Foll ow-up (months)
60
70
80
40
Disease progression (PSA failure PSA > 0.2 ng/ml)
9.3%
1.2%
20
Pathological results
Continence (no pad)
(ICS questionnaire)
243 (78.1%)
1.2%
1.9%
1.6%
0
Weight (g)
Preoperative demographic data
Age (years)
PSA (ng/ml)
Clinical stage
T1a-T1b
T1c
T2a
T2b
T2c
Gleason score
of positive biopsie
6
7
8-10
64.2 ± 6.1 (46.77.1)
10.11 ± 8.1 (0.8-80)
9 (2.8%)
223 (71.7%)
68 (21.8%)
4 (1.3%)
7 (2.2%)
6 ± 1.0
230 (73.9%)
64 (20.6%)
17 (5.4%)
Gleason score
6
7
8-10
pT2a
pT2b
pT2c
pT3a
pT3b
pT4
N+
Positive margins
pT2a
pT2b
pT2c
pT3a
pT3b
pT4
57.9 ± 24.7
(20-210)
6.7 ± 10.9
116 (37.3%)
148 (47.5%)
47 (15.1%)
6. 17 (5.4%)
20 (6.4%)
175 (56.3%)
67 (21.5%)
28 (9%)
4 (1.3%)
5 (1.6%)
75 (24.1%)
0 (0%)
2 (10%)
33 (18.8%)
22 (32.8%)
16 (57%)
2 (50%)
Potency
(erection with sexual intercourse)
(IIEF5)
0
1
113 (36.3%)
2
3
4
5
6
7
Salomon L. et al. Eur. Urol. 2003; 44: 656-660
References
Conclusions
We have introduced a score which allows us to evaluate the outcome of radical prostatectomy in terms
of cancer control, continence and potency
These results are depending on preoperative evaluation, patient selection, intraoperative techniques
(eg. neurovascular preservation) and pathological results. Nevertheless, this score can change with time,
as changes the clinical situation of the patient, eg. after improvement of urinary continence or erectile
function.
The most important use of this score is to present all results of radical prostatectomy in a single figure,
This could be useful for the comparison between the different surgical techniques of radical
prostatectomy.
The score could be useful to communicate and compare the results of radical prostatectomy between
many centers in an efficient way, even in a multinational setting. Rassweiler tested this score and
obtained 22.1% of score 7 and 47.9% of score 6 with laparoscopic approach (14)
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