Aim: The aim of this study was to clarify and examine the outcomes of prostate cancer patients classified as intermediate risk (IR) using the D'Amico risk classification system, specifically focusing on the influence of primary and secondary biopsy Gleason score (BGS). Patients and Methods: An institutional review board-approved database of robotic-assisted radical prostatectomies performed after 2006 was stratified by standard D'Amico criteria. IR patients were then sub-stratified by BGS. Pathologic and intermediate-term biochemical disease-free survival (BDFS) outcomes were analyzed. Results: Overall, 1,090 patients were classified as D'Amico low-risk, 896 as IR, and 240 as high-risk. Of the 896 IR patients, 63 had BGS 6, 630 were 3 + 4 = 7, and 203 4 + 3 = 7. Among IR patients, as the BGS increased, there was an increasing likelihood of extracapsular extension (21, 28, and 38%, respectively; p = 0.005), positive surgical margins (14, 26, 31%; p = 0.048), and worse 3-year BDFS (96, 94, 88%; p = 0.01). Multivariable logistic regression and Cox regression analyses confirmed differences among IR groups. Conclusion: D'Amico IR patients demonstrate significant heterogeneity in both pathologic outcomes and BDFS. IR patients with a BGS of 6 appear to have similar intermediate-term BDFS as low-risk patients. An increasing BGS from 3 + 3 to 3 + 4 to 4 + 3 results in a higher likelihood of locally-advanced disease and intermediate-term biochemical failure.

Background: Upgrading following prostate biopsy is very common in clinical practice. This study investigated whether the use of 5-alpha reductase inhibitors (ARI) and alpha blockers affect known clinical predictors of Gleason score upgrading or not. Materials and Methods: A retrospective study on 998 patients treated with robotic assisted laparoscopic prostatectomy for clinically localized biopsy Gleason score 6 prostate cancer were studied. The logarithm of prostate specific antigen concentration, prostate size and tumor volume were compared on the basis of the medication history of 5-ARIs and alpha blockers in the cohort of biopsy Gleason 6 patients with benign prostatic hyperplasia history, and patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without the addition of medications. Results: Alpha blockers, but not 5-ARI were associated with a bigger prostate. Upgrading was associated with older age (OR 1.03, 95% CI 1.01-1.06), higher BMI (OR 1.00 CI 1.01-1.08), higher log prostate specific antigen (OR 7.32, CI 3.546-15.52), smaller prostate size (OR 0.97, CI 0.96-0.98), fewer biopsy cores (OR 0.96 CI 0.92-0.99), more positive cores (OR 1.20, CI 1.08-1.34), and higher percentage of tumor at biopsy (OR 1.02, CI 1.01-1.03). Neither of the two medication classes were a significant predictor of upgrading. Medications made minimal changes in the multivariate predictive models. Conclusion: Although, alpha blockers were associate with bigger prostate size, the modulating effects of alpha blockers and 5-ARIs on common predictors of Gleason score upgrading was not significant.

Purpose: The potential effects of statins on clinical and histopathologic variables, prostate size, or PSA density (PSAD) and resulting influences on active surveillance eligibility have not been adequately explored. This study examines the effect of statins on prostate specimens following prostatectomy.Materials and Methods: Patients that received robotic-assisted laparoscopic prostatectomy (RALP) (n = 2,632) were dichotomized according to preoperative statin use. Logistic regression was used to evaluate associations between statin use and patient clinical and pathological characteristics.Results: Men using statins at the time of prostatectomy were older (61.6 +/- 6.4 versus 58.8 +/- 7.2 years, P < .001), and had poorer health status (P < .001). Biopsy Gleason grade, clinical stage and prostate size were similar among the two groups, although statin users had lower diagnostic PSA levels (5.5 +/- 3.6 versus 6.3 +/- 4.9 ng/mL, P < .001) and PSAD (.12 versus.13, P = .001).Conclusion: Men taking statins at the time of prostatectomy had similar histopathologic characteristics to non-users, despite having significantly lower serum PSA, being older and having similar sized prostates. This supports prior studies suggesting a PSA reduction effect of statins may warrant consideration of statin usage in decision algorithms for active surveillance.

Background: To define the pathologic and functional outcomes of men 50 years of age and younger with prostate cancer in a contemporary robotic cohort, this study was designed.Methods: Patients undergoing robotic-assisted laparoscopic prostatectomy from April 2002 to April 2012 (n = 2,495) formed the base population for the current analyses. The patients were dichotomized according to their age <= 50 (n = 271) and > 50-year-old (n = 2,224). Clinicopathological and health-related quality-of-life outcomes were recorded and analyzed for differences. Propensity score matching was used when assessing urinary and sexual function outcome.Results: Baseline prostate-specific antigen and clinical stage were similar between men older than 50 years and those younger. Younger patients had less severe disease (D'Amico risk and Gleason scores) and smaller prostates. Young men had higher rates of erectile function at all time points, including baseline (94% vs. 83% at 12 mo, P < 0.01). Continence was similar at all time points except for 6 months, where younger patients experienced a faster return than older patients and then remained constant, while older patients continued to improve (96% vs. 89%, P < 0.01). After matching process, the difference in erectile function at 6-month follow-up was lost.Conclusion: Most men aged 50 years and younger who received robotic-assisted laparoscopic prostatectomy had clinically significant prostate cancer. Although histopathologic and short-term oncologic outcomes were nearly identical when compared to older patients, younger men had a more rapid and superior return of erectile function. (C) 2017 Elsevier Inc. All rights reserved.

OBJECTIVE To assess patients' perceived causes of prostate cancer (PCa) and relation to treatment satisfaction, an Internet-based survey study was designed. PCa is a profoundly personal disease, considering the location and common sequelae of treatment. Deeply held patient self-perceptions regarding the etiology of a patient's PCa may generate lasting beliefs that impact satisfaction with treatment selection.MATERIALS AND METHODS Third-party web-based surveys were sent to patients receiving radical prostatectomy for clinically localized PCa. Patients were queried regarding demographic characteristics, family history, socioeconomic status, sexual function, urinary control, and factors believed to cause their PCa.RESULTS Among respondents (293 of 524, 55.9%), 237 (81.5%) provided primary causes for PCa. Evidence-based answers were provided by 128 (53.5%) patients, whereas a wide range of non-evidencebased responses were provided by 49 (20.5%) patients. Forty patients (16.7%) were undecided, and 20 (8.3%) offered belief-based responses. Evidence-based responses were more common in patients with a family history of PCa (P <. 01); however, no significant differences were seen among race, educational level, or income. Patients providing an evidence-based cause of PCa were more likely to be potent (P <. 01). Providing a non-evidence-based cause for PCa was associated with considering surgery as a wrong decision in treatment selection.CONCLUSION Among men with localized PCa, there is a wide spectrum of patient beliefs regarding the etiology of their disease that may reflect background and information sources. Further research is warranted to determine whether patient counseling should incorporate these considerations. (C) 2016 Elsevier Inc.

The natural history and optimal management strategy for men with human immunodeficiency virus (HIV) and prostate cancer remain to be definitively characterized. This study was conducted to evaluate the clinical characteristics and outcomes of HIV-seropositive men treated with robotic-assisted radical laparoscopic prostatectomy for localized prostate cancer. After Institutional Review Board approval, a prospective database of 2175 operative cases of clinically localized prostate adenocarcinoma was reviewed. Thirteen patients were identified as HIV-positive. Tumor characteristics, operative outcomes, postoperative outcomes, histology (Gleason score), local invasion, biochemical recurrence, and surgical complications were compared with HIV-negative patients. There were no preoperative demographic differences between the HIV-positive and HIV-negative patients. HIV-positive patients had higher prostate specific antigen (PSA) levels at time of diagnosis which was not statistically significant. However, HIV-positive patients had higher D’Amico risk assessment (p < 0.05). There was no postoperative complication. HIV-positive patients treated with robotic prostatectomy had similarly favorable perioperative and short-term biochemical recurrence-free survival outcomes. Our findings show that minimally invasive prostatectomy can be safely considered as a therapeutic option in otherwise eligible HIV-positive patients with clinically significant prostate cancer. Further research is necessary to outline a diagnostic and treatment guideline for HIV-positive men in detection and treatment of prostate cancer.

AimsThis study was designed to assess lower urinary tract symptoms (LUTS) following robotic‐assisted laparoscopic prostatectomy.MethodsIn a single surgeon series, 938 patients underwent robotic prostatectomy and completed International Prostate Symptom Score surveys at baseline and 6‐month follow‐up. Patients preoperative LUTS were categorized as mild, moderate, or severe according to the original International Prostate Symptom Score validation. Patient demographics, in addition to clinical and pathologic outcomes were obtained from an Institutional Review Board‐approved database.ResultsPreoperatively, 55.8% of patients presented with mild, 36.4% with moderate, and 7.8% with severe LUTS. Increased prostate size trended with increased LUTS severity (P < 0.001). Patients who had severe preoperative LUTS witnessed a 57% reduction in International Prostate Symptom Score (from 24.1 to 10.7, P < 0.001). Men with moderate preoperative LUTS also witnessed a significant decrease in postoperative LUTS (from 12.1 to 8.3, P < 0.001).ConclusionsThe majority of patients with moderate or severe LUTS improved significantly following robotic prostatectomy, with the largest improvements seen in the severe group. Prostate cancer patients with severe LUTS should be counseled on the beneficial role of robotic prostatectomy in an effort to improve their voiding dysfunction and as a viable cancer treatment.

OBJECTIVE: To investigate whether tumours at threshold values for detection on magnetic resonance imaging (MRI) represent clinically significant tumours or not, and therefore the utility of MRI in active surveillance (AS) protocols.PATIENTS AND METHODS: A retrospective analysis of a single institution database was performed after Institutional Review Board approval. Between 2010 and 2013, 1633 patients underwent robot-assisted laparoscopic prostatectomy (RALP) at a single institution by a single surgeon. Of these, 1361 had complete clinical data and were included in analysis. Multivariate logistic regression was used to assess histopathological grade compared to tumour size whilst controlling for biopsy Gleason score, prostate-specific antigen level, body mass index, race, and age.RESULTS: Of 120 tumours < 5 mm in size, four were Gleason score 4 + 3. Of 276 tumours of 5-10 mm, 22 (8.1%) were Gleason score 4 + 3 and one (0.2%) was Gleason score 8. On multivariate regression analyses, tumours of < 5 mm were much less likely to be high grade (Gleason score > 3 + 4) at RALP compared to larger tumours (3.3% vs 25.1%, P < 0.001), or Gleason score >= 8 (0.0% vs 7.6%, P < 0.001). Size was further shown to significantly correlate with grade on multivariate regression (P < 0.001).CONCLUSIONS: Prostate tumours below the detection threshold for MRI (5 mm) most probably represent clinically insignificant tumours, which alone would not necessitate leaving AS in favour of more aggressive therapy. These findings point to a possible role of MRI in modern AS protocols.(C) 2016 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.

Objectives: Longitudinal studies report racial disparities in prostate cancer (PCa) including greater incidence, more aggressive tumor biology, and increased cancer-specific mortality in African American (AA) men. Regret concerning primary treatment selection is underevaluated in patients with PCa. We investigated the relationships between clinicopathologic variables across racial and socioeconomic lines following robotic-assisted laparoscopic prostatectomy.Materials and methods: We assessed treatment decisional regret using a validated questionnaire in a total of 484 white and 72 AA patients with PCa who were followed up for a median of 16.6 months post robotic-assisted laparoscopic prostatectomy. Socioeconomic status (SES) information was aggregated from 2010 US census zip code data. Perioperative clinicopathologic characteristics and functional outcomes were compared between groups. Univariate and multivariate regression analyses were used to evaluate the influence of race, aggregate SES, and other clinical and demographic characteristics on decisional regret.Results: The majority (87.7%) of the population was not regretful of their decision to undergo treatment. However, a greater proportion of AA vs. white patients were regretful (20.6% vs. 11.2%, respectively; P = 0.03). AA and white men were similar on all functional, clinical, and pathologic features with the exception of younger age among AA men (56 vs. 60 y, respectively; P < 0.001). Although there were significant differences in SES by race (P < 0.001), regret did not differ by SES (beta = -1.53; P = 0.15). Race, postoperative sexual dysfunction, pad usage, and length of hospital stay, however, were significantly associated with decisional regret.Conclusions: AA men were more regretful than white men, after adjusting for clinicopathologic characteristics and postoperative functional outcomes. (C) 2014 Elsevier Inc. All rights reserved.

We conducted a retrospective chart review of robotic prostatectomies done by a single surgeon between 2003 and 2012. During that time period, we identified two patients within the year 2012, with ileal pouch-anal anastomosis (IPPA) who also underwent robotic prostatectomies. The demographics and postoperative characteristics of the two patients were assessed. In both patients, prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed and the integrity of ileal pouch was maintained. There was a mean surgical time of 144.5 minutes, and an average estimated blood loss was 125 mL. Both patients were discharged on the second day postoperatively. In both patients there was a Gleason upgrade to 3 + 4, with negative margins, and preservation of fecal and urinary continence by their six-month followup. Owing to surgical modifications, these two surgeries represent the first successful robotic prostatectomies in patients with a J-pouch.

OBJECTIVES:Metabolic syndrome (MetS), the constellation of obesity and related risk factors for cardiovascular disease, is an expanding epidemiologic concern in the United States and the developed world. However, the relationship between MetS and prostate cancer remains to be definitively assessed. We evaluated the association between obesity and MetS with prostate cancer pathology and surgical and functional outcomes. MATERIALS AND METHODS:A total of 2,639 patients underwent robotic-assisted laparoscopic prostatectomy (RALP) for localized prostate cancer between March 2003 and July 2012. Of them, 186 patients met the criteria for MetS as defined by the presence of obesity (body mass index [BMI] ≥ 30 kg/m(2)) in conjunction with 2 or more of the following: hypertension (HTN), dyslipidemia (D), and diabetes (DM). Additionally, reference cohorts of (1) 663 nonobese men without HTN, D, or DM; (2) 184 obese patients without HTN, D, or DM; and (3) 211 obese men with solitary risk factors were identified for comparison. Demographic, histopathologic, and perioperative clinical parameters were compared. RESULTS:In comparison with patients without MetS, patients with MetS had larger prostates (Odds Ratio (OR) = 1.609, 95% Confidence Interval (CI) = 1.04-2.49, P = 0.03), increased blood loss (OR = 1.592, 95% CI = 1.15-2.21, P = 0.01), and surgical complexity (OR = 4.940, 95% CI = 2.29-10.69, P<0.001). There was no statistical difference observed between these groups in regard to complication rates, pathologic grade, stage, and postoperative continence or erectile function. With the exception of larger prostates found among men with MetS, men with obesity alone and obesity with 1 additional risk factor appeared similar to those with MetS. CONCLUSIONS:Patients with MetS had similar perioperative, histopathologic, and functional outcomes compared with reference cohorts undergoing RALP. RALP is safe, feasible, and efficacious in men with MetS.

You have accessJournal of UrologyProstate Cancer: Staging (II)1 Apr 2013376 ARE ALL D'AMICO INTERMEDIATE RISK PROSTATE CANCER PATIENTS EQUAL? HETEROGENEITY OF INTERMEDIATE RISK PATIENTS BY GLEASON SCORE Matthew E. Pollard, Adele R. Hobbs, Adrien N. Bernstein, Simon J. Hall, and David B. Samadi Matthew E. PollardMatthew E. Pollard New York, NY More articles by this author , Adele R. HobbsAdele R. Hobbs New York, NY More articles by this author , Adrien N. BernsteinAdrien N. Bernstein New York, NY More articles by this author , Simon J. HallSimon J. Hall New York, NY More articles by this author , and David B. SamadiDavid B. Samadi New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1764AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The D'Amico risk stratification schema is a commonly used, validated predictor of prostate cancer outcomes. However, a significant heterogeneity of patients exists within the intermediate risk (IR) group. We analyzed intermediate-term oncologic outcomes of a large cohort of patients undergoing RALP and substratified the IR patients by Gleason score. METHODS A database of 2008 consecutive RALP was stratified by standard D'Amico criteria. IR patients were then substratified by biopsy Gleason score (3+3=6, 3+4=7, 4+3=7). Pathologic outcomes and biochemical disease-free survival (BDFS) were compared among the standard and substratified groups. Biochemical recurrence (BCR) was defined as a single PSA ≥0.2 ng/ml. RESULTS The cohort had a mean age of 59.6, mean PSA of 6.2 ng/ml, and median follow-up of 13.1 months. 950 patients were classified as D'Amico low-risk, 887 IR and 171 high-risk. Of the 887 IR patients, 144 had a biopsy Gleason 3+3=6, 556 were 3+4=7 and 187 were 4+3=7. Among the IR patients, as the biopsy Gleason score increased there was an increasing likelihood of extracapsular extension (14%, 29% and 42%, respectively, p<0.001), seminal vesicle invasion (2%, 6%, and 11%, p=0.005) and positive surgical margins (15%, 24%, 29% p=0.012). These differences translated to progressive worsening of intermediate-term biochemical outcomes (figure). Using Cox regression analysis, BDFS of the IR Gleason 3+3=6 group was not statistically different from the standard low-risk group (p=0.36) but was significantly better than IR 3+4=7 and IR 4+3=7 patients (p=0.03 and p=0.002, respectively). BDFS was also different between IR 3+4=7 and 4+3=7 patients (p=0.047). Preoperative PSA greater than 10ng/ml was also predictive of worse BDFS when controlling for biopsy Gleason score and clinical stage (p<0.001). CONCLUSIONS D'Amico IR patients demonstrate significant heterogeneity in both pathologic outcomes and BDFS. IR patients with a biopsy Gleason sum of 6 appear to have identical intermediate term BDFS as low-risk patients. Increasing biopsy Gleason scores from 3+3 results in higher likelihood of locally-advanced disease and BCR. IR patients with a biopsy Gleason score of 4+3 have significantly worse outcomes and may be suitable for clinical trials in the neoadjuvant setting. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e152-e153 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew E. Pollard New York, NY More articles by this author Adele R. Hobbs New York, NY More articles by this author Adrien N. Bernstein New York, NY More articles by this author Simon J. Hall New York, NY More articles by this author David B. Samadi New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Previous abdominal or prostate surgery can be a significant barrier to subsequent minimally invasive procedures, including radical prostatectomy (RP). This is relevant to a quarter of prostatectomy patients who have had previous surgery. The technological advances of robot-assisted laparoscopic RP (RALP) can mitigate some of these challenges. To that end, our objective was to elucidate the effect of previous surgery on RALP, and to describe a multidisciplinary approach to the previously entered abdomen. One-thousand four-hundred and fourteen RALP patients were identified from a single-surgeon database. Potentially difficult cases were discussed preoperatively and treated in a multidisciplinary fashion with a general surgeon. Operative, pathological, and functional outcomes were analyzed after stratification by previous surgical history. Four-hundred and twenty (30 %) patients underwent previous surgery at least once. Perioperative outcomes were similar among most groups. Previous major abdominal surgery was associated with increased operative time (147 vs. 119 min, p < 0.001), as was the presence of adhesions (120 vs. 154 min, p < 0.001). Incidence of complications was comparable, irrespective of surgical history. Major complications included two enterotomies diagnosed intraoperatively and one patient requiring reoperation. All cases were performed robotically, without conversion to open-RP. There was no difference in biochemical disease-free survival among surgical groups and continence and potency were equivalent between groups. In conclusion, previous abdominal surgery did not affect the safety or feasibility of RALP, with all patients experiencing comparable perioperative, functional, and oncologic outcomes.

You have accessJournal of UrologyProstate Cancer: Advanced (I)1 Apr 2013723 RISK-ADJUSTED ACTUAL HOSPITAL COSTS OF THE PRIMARY TREATMENT OF PROSTATE CANCER: A CONTEMPORARY EXPERIENCE OF A MULTIDISCIPLINARY CANCER CENTER Adrien N. Bernstein, Adele R. Hobbs, Dov Sebrow, Nelson Stone, Richard Stock, Russell B. McBride, and David B. Samadi Adrien N. BernsteinAdrien N. Bernstein New York, NY More articles by this author , Adele R. HobbsAdele R. Hobbs New York, NY More articles by this author , Dov SebrowDov Sebrow New York, NY More articles by this author , Nelson StoneNelson Stone New York, NY More articles by this author , Richard StockRichard Stock New York, NY More articles by this author , Russell B. McBrideRussell B. McBride New York, NY More articles by this author , and David B. SamadiDavid B. Samadi New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.282AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical prostatectomy (RP) and radiotherapy provide comparable health related quality of life (HRQOL) and oncologic outcomes in the treatment of localized prostate cancer (PCa), but have wide cost variations. Prior cost studies of these treatments have not been risk-adjusted for oncological characteristics, which are hypothesized as a potential explanation for the cost discrepancies. We set to evaluate risk-adjusted hospital costs associated with modern PCa therapies. METHODS An institutional data repository was queried for hospital patients from 2005 to 2009 with a primary admission code for PCa and primary procedure codes for RP, brachytherapy (BT), intensity modulated radiotherapy (IMRT), or combination treatment. All hospital costs related to the primary procedure were analyzed as assigned by the hospital, a multidisciplinary PCa program at a tertiary care, urban academic center. All patients with complete clinical and billing information were included. Total hospital costs were adjusted to 2009 USD and analyzed per patient overall and by D?Amico risk classification. RESULTS 1871 localized PCa patients (median age: 62) were identified. BT was the least expensive treatment with a total cost of $7,483, but was not routinely used as monotherapy for high-risk patients. The median total costs for IMRT monotherapy ($17,595) and BT+IMRT ($22,386) combination therapy was significantly higher than any other treatment type, although these patients had worse pathologic features. Costs of RP in combination with IMRT in the adjuvant or salvage setting were higher than the BT+IMRT group ($24,897). These trends remained consistent when stratified by risk group. CONCLUSIONS In a high volume setting, RALP and BT are the least expensive modalities for treating low and intermediate risk PCa. For high risk patients, all forms of RP and IMRT alone were less expensive than combination therapy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e297 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Adrien N. Bernstein New York, NY More articles by this author Adele R. Hobbs New York, NY More articles by this author Dov Sebrow New York, NY More articles by this author Nelson Stone New York, NY More articles by this author Richard Stock New York, NY More articles by this author Russell B. McBride New York, NY More articles by this author David B. Samadi New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Purpose: Previously we reported the development of a novel, inexpensive, online method to collect health related quality of life information to facilitate responses among patients and decrease loss to followup. We validated the practice by comparing responses to the SHIM (Sexual Health Inventory for Men), a representative validated instrument, when administered on line and in the traditional paper form.Materials and Methods: Consented patients were administered validated health related quality of life instruments, including the SHIM, in office and via e-mail. Responses to the SHIM were compared between the administration formats. Paired sample testing was done to analyze test-retest reliability, concordance was assessed by intraclass analysis and a Bland-Altman plot, and the Cronbach alpha was used to examine internal reliability. Criterion validity was measured using SHIM defined erectile function categories and a dichotomized potency definition (SHIM 17 or greater).Results: Of the 508 men who consented to participate 359 (71%) completed the SHIM in person, 277 (55%) completed the online form (p < 0.001) and 116 (23%) contemporaneously completed each instrument. Comparison of scores revealed little variation and strong correlation (r(2) = 0.83, p < 0.001). Intraclass and Bland-Altman analysis revealed strong agreement between the media. The Cronbach alpha was excellent (0.97) for the online tool. Erectile function classification was identical in 73% of patients with only 7% differing by more than 1 class. Dichotomized potency was consistently defined in 94% of patients.Conclusions: The online administered SHIM maintains validity and provides consistent responses. Online administration can capture patients who do not complete paper questionnaires and may serve as a reliable adjunct to paper administration for validated outcomes research.

e15164 Background: Radical prostatectomy (RP) and radiotherapy (RT) provide comparable HRQOL and oncologic outcomes of localized prostate cancer (PCa), yet no studies have evaluated their relative costs when investigated by risk group. We evaluated hospital costs associated with modern PCa therapies at a multidisciplinary program. Methods: Institutional billing data was queried for hospital patients from 2005 to 2009 with a primary admission for prostate cancer and primary procedure codes for RP, brachytherapy (BT), intensity modulated RT (IMRT) or combination treatment. All hospital costs related to the primary procedure were analyzed as assigned by the hospital. Costs were adjusted to 2009 USD and analyzed per patient and pretreatment D’Amico risk group. Results: 1969 localized PCa patients with a median age of 62 were identified with complete clinical information. There was a marked increase in the use of robotic-assisted laparoscopic prostatectomy (RALP) starting in 2007. The median total hospital costs for IMRT monotherapy ($16,673), BT+IMRT ($22,145) and RP+ adjuvant IMRT ($24,380) combination therapies were significantly higher than any other treatment type, although these patients had worse pathologic features. BT was the least expensive treatment with a total cost of $7,506, but was not routinely used as monotherapy for high-risk patients. The total cost of RALP ($7,676) was lower than open radical prostatectomy (RRP) ($8,991, p<0.001) and similar to laparoscopic radical prostatectomy (LRP) ($7,769).These trendsremained consistent when stratified by risk group (Table). Conclusions: In a high volume setting, RALP and BT are the least expensive modalities for treating low and intermediate risk PCa. For high risk patients, all forms of RP and IMRT alone were less expensive than combination therapy. [Table: see text]

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 20121630 IMPROVEMENT OF SEVERE BASELINE LOWER URINARY TRACT SYMPTOMS FOLLOWING PROSTATECTOMY Nizar Bou Diab, Adrien Phalen, Adele Hobbs, and David B. Samadi Nizar Bou DiabNizar Bou Diab New York, NY More articles by this author , Adrien PhalenAdrien Phalen New York, NY More articles by this author , Adele HobbsAdele Hobbs New York, NY More articles by this author , and David B. SamadiDavid B. Samadi New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1447AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have shown improvement of lower urinary tract symptoms (LUTS) following prostatectomy, specifically in men with large obstructive prostates. However, improvement of severe preoperative LUTS after robotic assisted laparoscopic radical prostatectomy (RALP) has not been emphasized. The purpose of this study was to examine the relationship between preoperative LUTS and postoperative urinary functioning following RALP. METHODS 529 patients underwent RALP between May 2007 and September 2010 and completed International Prostate Symptom Score (IPSS) surveys at baseline and after a minimum of 6 months follow-up. Patients preoperative LUTS were categorized as mild, moderate, and severe according to the original IPSS validation. An IRB-approved database was queried for patient demographics, clinical and pathologic outcomes. Continence was defined as zero or one security pad daily. RESULTS 99% of patients were preoperatively continent: 58% of patients presented with mild, 34% with moderate and 8% with severe LUTS. Postoperatively, there was an overall shift toward milder LUTS with 65%, 32%, and 3% of patients having mild, moderate and severe symptoms, respectively. Increased prostate size trended with increased LUTS severity (p<0.001). The mean IPSS scores decreased from 8.0 at baseline to 6.9 after surgery. 25% of patients experienced a clinical improvement while only 16% clinically worsened. The group of patients who had severe pre-operative LUTS witnessed a 60% reduction in IPSS (23.9 to 9.46, p< 0.001). Men with moderate preoperative LUTS also saw a significant decrease in postoperative LUTS (12.0 to 7.9, p<0.001). At 6 months post-op, 88% of all patients were continent including 89% of patients with mild or moderate LUTS and 80% of patients with severe LUTS (p< 0.001). CONCLUSIONS The majority of patients with moderate or severe LUTS improved significantly following RALP, with the largest improvements seen in the severe group. Patients with severe LUTS should be counseled on the beneficial role of prostatectomy in their voiding dysfunction without concern of increased incontinence. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e659 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nizar Bou Diab New York, NY More articles by this author Adrien Phalen New York, NY More articles by this author Adele Hobbs New York, NY More articles by this author David B. Samadi New York, NY More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...