Longitudinal Comparison of Patient-Level Outcomes and Costs Across Prostate Cancer Treatments With Urinary Problems

The effect of transvesical laparoscopic radical prostatectomy on sexual function and urinary continence

OBJECTIVE

To analyze the effect of transvesical laparoscopic radical prostatectomy (TVLRP) on sexual function and urinary continence.

METHOD

The data of 72 patients diagnosed with low-risk and localized prostate cancer, who underwent treatment at our hospital between January 2017 and June 2022, were retrospectively analyzed. All these patients underwent TVLRP under general anesthesia. Their serum prostate-specific antigen (PSA), urinary continence and erectile function were statistically analyzed.

RESULTS

The operation went well with no intraoperative difficulties. The average surgical duration of 102 ± 22 min, coupled with the minimal intraoperative blood loss of 100 ± 32 mL, underscored the precision and efficacy of the surgical techniques employed. Following surgery, postoperative pathological assessments confirmed staging, revealing pT2a in 18 cases and pT2b in 54 cases, suggestive of localized tumors. Gleason scores ≤ 6 further indicated well-differentiated tumors, while consistently negative surgical margins affirmed the complete resection of tumors, reducing the likelihood of disease recurrence. Subsequent to the surgical intervention, the the average hospital stay was 13.94.1 days. A comprehensive 12-month follow-up revealed exceptionally high urinary continence rates, with 97.8% and 100% of patients achieving continence at 1 and 3 months postoperatively, respectively. Moreover, progressive improvement in erectile function recovery was observed, with recovery rates at 3, 6, and 12 months postoperatively reaching 82.2%, 88.4%, and 93.5%, respectively. There was no biochemical regression.

CONCLUSION

Treatment of low-risk and localized prostate cancer by TVLRP has a satisfactory urinary continence and recovery of erectile function after operation, less and complications and definite tumor-control effect.

Financial toxicity associated with treatment of localized prostate cancer

Financial toxicity is a broad term to describe the economic consequences and subjective burden resulting from a cancer diagnosis and treatment. As financial toxicity is associated with poor disease outcomes, recognition of this problem and calls for strategies to identify and support those most at risk are increasing. Men with localized prostate cancer face treatment choices including active surveillance, prostatectomy or radiotherapy. The fact that potential patient out-of-pocket costs might influence decision making has rarely been acknowledged and, overall, the risk of financial toxicity for men with localized prostate cancer remains poorly studied. This shortfall requires a work-up in the context of prostate cancer and a multidimensional framework for considering a patient's risk of financial toxicity. The major elements of this framework are direct and indirect costs, patient-specific values, expectations of possible financial burdens, and individual economic circumstances. Current data indicate that total cost patterns probably differ by treatment modality: surgery might have an increased short-term effect, whereas radiotherapy might have an increased long-term risk of financial toxicity. Specific thresholds of patient income levels or out-of-pocket costs that predict risk of financial toxicity are difficult to identify. Compared with other malignancies, prostate cancer might have a lower overall risk of financial toxicity, but persistent post-treatment urinary, bowel or sexual adverse effects are likely to increase this risk.