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Kowalski C, Sibert NT, Hammerer P, Wesselmann S, Feick G, Carl EG, Klotz T, Apel H, Dieng S, Nyarangi-Dix J, Knoll T, Reike MJ, Duwe G, Bartolf E, Steiner T, Borowitz R, Lümmen G, Seitz AK, Pfitzenmaier J, Aziz A, Brock M, Berger FP, Kaftan BT, Grube C, Häfner T, Hamza A, Schmelz H, Haas J, Lenart S, Lafita A, Sippel C, Winter A, Kedia G, Hadaschik B, Varga Z, Buse S, Richter M, Distler F, Simon J, Wiegel T, Baltes S, Janitzky A, Sommer JP, Hijazi S, Fülkell P, Harke NN, Bolenz C, Khalil C, Breidenbach C, Tennstedt P, Burchardt M. [Urinary incontinence after radical prostatectomy for prostate cancer-data from 17,149 patients from 125 certified centers]. Urologie 2024; 63:67-74. [PMID: 37747493 DOI: 10.1007/s00120-023-02197-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND In addition to erectile dysfunction, urinary incontinence is the most common functional limitation after radical prostatectomy (RPE) for prostate cancer (PCa). The German S3 guideline recommends informing patients about possible effects of the therapy options, including incontinence. However, only little data on continence from routine care in German-speaking countries after RPE are currently available, which makes it difficult to inform patients. OBJECTIVE The aim of this work is to present data on the frequency and severity of urinary incontinence after RPE from routine care. MATERIALS AND METHODS Information from the PCO (Prostate Cancer Outcomes) study is used, which was collected between 2016 and 2022 in 125 German Cancer Society (DKG)-certified prostate cancer centers in 17,149 patients using the Expanded Prostate Cancer Index Composite Short Form (EPIC-26). Changes in the "incontinence" score before (T0) and 12 months after RPE (T1) and the proportion of patients who used pads, stratified by age and risk group, are reported. RESULTS The average score for urinary incontinence (value range: 0-worst possible to 100-best possible) was 93 points at T0 and 73 points 12 months later. At T0, 97% of the patients did not use a pad, compared to 56% at T1. 43% of the patients who did not use a pad before surgery used at least one pad a day 12 months later, while 13% use two or more. The proportion of patients using pads differs by age and risk classification. CONCLUSION The results provide a comprehensive insight into functional outcome 12 months after RPE and can be taken into account when informing patients.
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Affiliation(s)
- Christoph Kowalski
- Deutsche Krebsgesellschaft, Berlin, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland.
| | - Nora Tabea Sibert
- Deutsche Krebsgesellschaft, Berlin, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland
| | - Peter Hammerer
- Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - Simone Wesselmann
- Deutsche Krebsgesellschaft, Berlin, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland
| | - Günter Feick
- Bundesverband Prostatakrebs Selbsthilfe, Bonn, Deutschland
| | | | | | | | | | | | - Thomas Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Deutschland
| | | | - Gregor Duwe
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | | | | | | | - Gerd Lümmen
- GFO Kliniken Troisdorf, Troisdorf, Deutschland
| | - Anna Katharina Seitz
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jesco Pfitzenmaier
- Ev. Klinikum Bethel, Universitätsklinikum OWL d, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Marko Brock
- Stiftungsklinikum PROSELIS Recklinghausen, Recklinghausen, Deutschland
| | | | | | | | - Tim Häfner
- Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Amir Hamza
- Klinikum St. Georg Leipzig, Leipzig, Deutschland
| | - Hans Schmelz
- BundeswehrZentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Jürgen Haas
- Klinikum am Steinenberg, Reutlingen, Deutschland
| | | | | | | | - Alexander Winter
- Universitätsklinik für Urologie, Klinikum Oldenburg, Department für Humanmedizin, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - George Kedia
- DIAKOVERE Friederikenstift, Hannover, Deutschland
| | | | - Zoltan Varga
- SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Deutschland
| | | | - Matthias Richter
- Kliniken Maria Hilf Mönchengladbach, Mönchengladbach, Deutschland
| | - Florian Distler
- Universitätsklinik der Paracelsus, Privatuniversität am Klinikum Nürnberg, Nürnberg, Deutschland
| | - Jörg Simon
- Ortenau-Klinikum Offenburg, Offenburg, Deutschland
| | | | | | | | | | | | | | - Nina N Harke
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | | | | | - Pierre Tennstedt
- Martini Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
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Reike MJ, Raggi D, Marandino L, Patanè DA, Crupi E, Padua TCD, Black PC, Gibb E, Necchi A. Distinct gene expression patterns identify patients who relapse after neoadjuvant pembrolizumab and radical cystectomy in the PURE-01 study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
549 Background: The PURE-01 clinical trial reported the use of neoadjuvant treatment with pembrolizumab prior to radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC; cT2–3N0M0; PMID 30343614). We have previously reported that specific molecular subtypes (i.e. basal or claudin-low) and immune signatures are associated with more favorable survival. However, reports on the detailed tumor biology of patients (pts) who relapsed after neoadjuvant pembrolizumab are lacking. Herein, we provide a detailed characterization of relapsing pts and identify distinct gene expression patterns with potential utility as novel biomarkers. Methods: Microarray data from transurethral resection of the bladder tumor (TURBT; N=102) and matched RC (N=25) tissue from the PURE-01 trial were analyzed. Gene expression signatures and molecular subtypes were assigned as previously described (PMID 32165065). The Kaplan-Meier method was used to estimate differences in patient outcomes. Immune-signatures were split by median for survival analysis. All significance testing used a two-sided t-test at a threshold of 0.05. Results: Differential gene expression analysis identified KRT20 and H19 to be enriched in relapsing patients (both p<0.001). Expression below the median was predictive of favourable 3-year overall (OS) and recurrence-free (RFS) survival (OS, 37.3% vs. 21.6%, p=0.118; RFS, 35.3% vs. 21.6%, p<0.01 and OS, 41.2% vs. 17.6%, p=0.03; RFS, 39.2% vs. 17.6%, p=0.012, respectively). Distribution of molecular subtypes showed tumors with neuronal character (NE-like) were enriched in pts who relapsed. Low immune-signatures, including Interferon-gamma and -alpha, were predictive of relapse (3-year RFS, 31.4% vs. 25.5%, p<0.001 and 31.4% vs. 25.5%, p<0.01, respectively), whereas Immunophenoscore for CD4 was not. None of these markers were predictive for relapse in matched RC-samples. Conclusions: Relapsing patients demonstrated distinct biological patterns in pre-therapy tumor samples that show prognostic value, potentially making an earlier identification and therefore adapted treatment possible. Low expression of immune-related signatures was associated with relapse.
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Affiliation(s)
- Moritz Johannes Reike
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniele Raggi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Emanuele Crupi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ewan Gibb
- Veracyte Inc., Vancouver, BC, Canada
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
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