RISK FACTORS AND POST-PROSTATECTOMY PROGNOSIS: MULTIVARIABLE ANALYSIS OF 415 PATIENTS OPERATED IN A SINGLE INSTITUTION

Summary Objective: To analyze the surgical and oncological outcomes of radical prostatectomies, establishing risk factors for the surgical procedure and prognostic factors for overall survival. Methods: Retrospective descriptive comparative study. For patients with prostate cancer submitted to radical prostatectomy during the period from January 2009 to Dec-2015 at Hospital Erasto Gaertner de Curitiba-PR. Statistical analyses were performed by the SPSS 23.0 and STATA 15 programs, and p<0.05 were considered statistically significant. Results: The group presented median age of 65 years with a majority in good general condition, Performance Status 0 in 205 (54.7%) cases. Family history of cancer was reported in 63 (24.5%) cases. Rectal examination of the prostate was normal in 144 (34.7%) patients. Mean value of PSA in the initial evaluation was 9.2 ng/ml, and after surgical treatment was 0.22 ng/ ml. After surgery, 170 (48.6%) patients had PSA lower than 0.2 ng/ml. The initial Gleason classification was equal to or lower than 6 in 260 (62.7%) patients, and in 155 (37.3%) patients it was higher than 6. The same evaluation performed after treatment showed 141 (34%) and 274 (66%), respectively. Tumors were confined to the prostate in 268 (64.6%) cases. The seminal vesicle was infiltrated by a tumor in 52 (12.7%) cases. The operative procedure was performed by the Open Approach in the great majority of cases 384 (92.5%), only 31 (7.5%) by the Laparoscopic Approach. The overall survival in 5 years was 95.4%. Univariate analysis showed that risk factors for worse prognosis were tumors with extracapsular invasion, compromised surgical margins, invasion of seminal vesicles, positive lymph nodes and Gleason above 6. In multivariate analysis, only extracapsular invasion and Gleason above 6 were significant. As for long-term complications (1 year) after the procedure, we found 40 (9.9%) of Urinary Incontinence, 69 (17.6%) of Erectile Dysfunction and 4 (1%) of Urethral Stenosis. Conclusions: Extra capsular invasion and degree of tumor differentiation above Gleason 6 represent the main factors influencing post-prostatectomy survival.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019