Correlación entre los índices estandarizados SUVmáx de la PET/TC con [68Ga]Ga-PSMA-I&T pre-prostatectomía radical y los resultados histopatológicos finales: un análisis en profundidad / Correlation between pre-radical prostatectomy Standardized SUVmax ratios detected on 68Ga-PSMA-I&T PET/CT and final histopathology outcomes: An in-depth analysis

Objetivo: Evaluar el potencial predictivo del valor máximo de captación estandarizada (SUVmáx) de los tumores intraprostáticos obtenidos en la PET/TC preoperatoria con [68Ga]Ga-PSMA-I&T (SUVT), así como sus relaciones con el SUVmáx en el hígado (SUVTLR) y la glándula parótida (SUVTPR) con respecto a los hallazgos histopatológicos. Material y métodos: Se evaluaron los datos de pacientes sometidos a prostatectomía radical (PR) por cáncer de próstata (CaP) en nuestra clínica entre los años 2017-2020. Se excluyeron aquellos pacientes con una neoplasia maligna secundaria, antecedentes de resección transuretral de próstata, tratamiento previo para CaP o que fueron sometidos a una PR de rescate. Dos especialistas en medicina nuclear con más de una década de experiencia cada uno revisaron las imágenes del estudio de cuerpo completo obtenidas con el mismo equipo, según protocolo, para obtener el consenso en cada lesión. Se estudiaron las relaciones entre edad, antígeno específico de la próstata (PSA), volumen de la próstata, estadio clínico, el grado de la clasificación de la Sociedad Internacional de Anatomía Patología Urológica (ISUP, por sus siglas en inglés) en la biopsia, el grupo de riesgo de D’amico, el volumen tumoral intraprostático identificado en la revisión histopatológica final de la muestra (HPTV) y el grado HP-ISUP. Se analizó la invasión de vesículas seminales (SVI), la invasión extracapsular (ECI), el margen quirúrgico positivo (PSM), SUVT, SUVTLR y SUVTPR. Resultados: La edad media de los 64 pacientes incluidos fue de 64,1±5,3 años. Se observó una correlación estadísticamente significativa entre los valores de SUVT, SUVTLR, SUVTPR y los parámetros del estadio histopatológico, como el grado ISUP de la biopsia, la clasificación de riesgo D’amico, HP-ISUP, HPTV (p<0,05). PSMATV, SUVT y SUVTLR fueron predictores estadísticamente significativos de invasión extracapsular, mientras que PSA, PSMATV y SUVTLR fueron predictores significativos de SVI (p<0,05)... (AU)

Objective: To evaluate the predictive potential of the maximum standardized uptake value (SUVmax) value of intraprostatic tumors derived from preoperative [68Ga]Ga-PSMA-I&T PET/CT (SUVT), and its ratios to SUVmax in the liver (SUVTLR) and parotid gland (SUVTPR) with respect to histopathological findings. Materials and methods: Data from patients who underwent radical prostatectomy (RP) for prostate cancer (PC) at our clinic between 2017-2020 were assessed. Patients with a secondary malignancy, a history of transurethral prostate resection, prior treatment for PC, or who received salvage RP were excluded. Whole-body images obtained using the same device, as per the guidelines, were reviewed by two nuclear medicine specialists with more than a decade of experience to reach a consensus for each lesion. The relationships between age, PSA, Prostate Volume, clinical T stage, biopsy International Society of Urological Pathology grade (ISUP), D’amico risk group, intraprostatic tumor volume (HPTV) identified in the final histopathological specimen review, HP-ISUP grade, seminal vesicle invasion (SVI), extracapsular invasion (ECI), positive surgical margine (PSM), SUVT, SUVTLR, and SUVTPR were analyzed. Results: The mean age of the 64 included patients was 64.1±5.3 y-o. A statistically significant correlation was found between SUVT, SUVTLR, SUVTPR values, and histopathologic stage parameters, such as biopsy ISUP, D’amico Risk Classification, HP-ISUP, HPTV (P<.05). PSMATV, SUVT, and SUVTLR were statistically significant predictors of extracapsular invasion, while PSA, PSMATV, and SUVTLR were significant predictors of SVI (P<.05). Conclusion: The standardized SUVT, SUVTLR, and SUVTPR values could be employed as noninvasive markers to assist in predicting postoperative histopathological findings, particularly ECI, SVI, and PSM. (AU)

The Impact of Delirium after Radical Prostatectomy on Cognitive Function and Health Perception during the Recovery Period

Objective: This study aims to investigate the influence of delirium following radical prostatectomy on cognitive function and health perception during the recovery period. Methods: Data were collected from patients who underwent radical prostatectomy at our institution between May 2020 and May 2022. Postoperative delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), categorising patients into delirium and non-delirium groups. The Montreal Cognitive Assessment (MoCA) and the Brief Illness Perception Questionnaire (BIPQ) were employed to evaluate patients’ mental health pre-and post-surgery. Comparative analyses were conducted between patients with and without delirium in the critical care unit, and correlation analyses were performed. Results: The study revealed a delirium incidence rate of 19.13%. Patients in the delirium group exhibited significantly higher age and ICU length of stay compared to those without delirium (p < 0.05). No significant differences were observed in MoCA scores one day before surgery and seven days after surgery, as well as BIPQ scores one day before surgery, five days after surgery and seven days after surgery between the delirium and non-delirium groups (p > 0.05); However, the MoCA scores in the delirium group were significantly lower than those of the non-delirium group on the second and fifth days post-surgery. Additionally, the BIPQ scores in the delirium group were significantly higher than those in the non-delirium group two days after surgery (p < 0.001). A moderate negative correlation was observed between MoCA scores and CAM-ICU scores, and a moderate positive correlation was identified between BIPQ scores and CAM-ICU scores (p < 0.001). Conclusions: Patients experiencing delirium after radical prostatectomy are at a higher risk of cognitive function impairment and disease threat perception... (AU)

Post-Pandemic Aftermath: A Two-Year Follow-Up of the Effect of COVID-19 on Oncological Outcomes after Radical Prostatectomy for Prostate Cancer

Purpose: This study aimed to evaluate the indirect effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the surgical outcomes and oncological results of patients who underwent surgery during the lockdown period. Methods: We analysed data from 423 patients who underwent radical prostatectomy between 2016 and 2022, with a cut-off date of March 16, 2020. Patients were categorised into two groups, namely, pre-lockdown (n = 289) and during lockdown (n = 134). Perioperative variables, histopathological findings and oncological outcomes, including prostate-specific antigen (PSA) levels and biochemical recurrence (BCR), were assessed. Results: The number of radical prostatectomy increased by 24.26% during lockdown. The study included patients with a mean follow-up of 21 months. A nonsignificant trend towards a higher PSA level at presentation was found (14.22 vs. 12.53 ng/dL, p = 0.216). The International Society of Urological Pathology grade was not significantly different among radical prostatectomy specimens (p = 0.669). Lymph node involvement increased during the COVID-19 period (p = 0.046). The pT classification in prostatectomy specimens increased during the pandemic, but the difference from the pre-pandemic value was not statistically significant. The BCR rates were 24.6% pre-lockdown and 29.9% during lockdown (p = 0.136). Conclusions: The COVID-19 pandemic led to poor postoperative results. Through a 2-year follow-up, this research investigated the effect of the pandemic on the oncological outcomes, particularly BCR, of patients who underwent radical prostatectomy. Further extended investigations and multi-institutional studies should be conducted to quantify the effect of the pandemic on various cancer outcomes and inform crisis management strategies (AU)

Screening of Associated Factors for Erectile Dysfunction after Radical Prostatectomy and Construction of a Clinical Risk Assessment Model: A Retrospective Study

Objective: In this article, the associated factors for erectile dysfunction (ED) after radical prostatectomy (RP) were explored, and a clinical risk assessment model was constructed. Methods: A total of 155 patients who underwent RP in People’s Hospital of Hunan Province from November 2020, to November 2021, were selected as the study group. In accordance with the results of International Index of Erectile Function (IIEF-5) at 6 months after surgery, 88 patients were included in the ED group (IIEF-5 <22), and 67 patients were included in the non-ED group (IIEF-5 ≥22). Univariate and multivariate logistic regression analyses were conducted to screen the risk factors for ED after RP, and a risk model was constructed on this basis. In addition, 43 patients with ED after RP and 41 patients with non-ED after RP from January 2022, to January 2023, were included in the test group to evaluate the predictive efficacy of the clinical risk assessment model on the basis of the receiver operating characteristic curve. Results: The study group had a lower postoperative IIEF-5 score than before surgery (p < 0.001). The incidence of ED after RP in the study group was 56.77% (88/155). Multivariate analysis showed that advanced age (odds ratio (OR) = 1.155), large prostate volume (OR = 1.077), smoking (OR = 5.676), drinking (OR = 3.495), hypertension (OR = 8.079), diabetes (OR = 6.082), low preoperative serum testosterone (T) level (OR = 0.684) and high preoperative serum endothelin-1 (ET-1) level (OR = 1.192) were risk factors for ED after RP (p < 0.05). A risk model was constructed as follows: Z = 0.144 × (age) + 0.074 × (prostate volume) + 1.736 × (smoking) + 1.251 × (drinking) + 2.089 × (hypertension) + 1.805 × (diabetes) − 0.380 × (preoperative serum T) + 0.175 × (preoperative serum ET-1). The area under curve (AUC), sensitivity, specificity and 95% CI of this model were 0.906, 97.70%, 73.20%, and 0.848–0.964, respectively (p < 0.001)(AU)

Prostate Cancer: Management of Biochemical Recurrence after Surgery

Radical prostatectomy (RP) is one of the primary treatment options for localised prostate cancer (PCa). Despite its curativeintent, 1/3 of patients will experience biochemical recurrence (BCR) during follow-up. Experts have devoted efforts to associatethe influence of each individual factor with the risk of BCR to select the optimal treatment for each patient. Optimal managementmust aim to find a balance between delaying the onset of metastatic disease and overtreating an indolent disease with treatmentsthat can affect quality of life of the patients. Thus far, effective treatment options for men with BCR remain controversial interms of ideal treatment timing (adjuvant vs. salvage), radiotherapy (RT) fields and doses, selection and duration of systemictherapy and potential synergies between treatments and their therapeutic sequencing. Next-generation imaging techniques, suchas Prostate-Specific Membrane Antigen Positron Emission Tomography, are used for early detection of disease progression andexact site of recurrence or progression, thereby enhancing decision making for future disease management. In this review, weevaluate available evidence of controversial topics regarding BCR after RP and explore future directions, such as prognosticand/or predictive factors of response, genetic panels, second-generation hormone treatments, ultra-hypofractionated RT andongoing clinical trials in this clinical scenario. (AU)

Radical Prostatectomy on YouTube: Education or Disinformation?

Background: YouTube is the second most popular website worldwide. It features numerous videos about radical prostatectomy.The aim of this study was to assess the quality of these videos and screen their benefit for patients and doctors.Methods: All videos on YouTube about radical prostatectomy were analysed using a specially developed software (python 2.7,numpy). According to a predefined selection process most relevant videos were analyzed for quality and reliability using SuitabilityAssessment of Materials (SAM)-Score, Global Quality Score and others.Results: Out of 3520 search results, 179 videos were selected and analysed. Videos were watched a median of 5836 times (interquartilerange (IQR): 11945.5; 18–721546). The median duration was 7.2 minutes (min). 125 of the videos were about roboticprostatectomy. 69 videos each were directly addressed to patients and doctors. Medical content generally was of low quality,while technical quality and total quality were at a high level. Reliability was good.Conclusions: Videos on radical prostatectomy on YouTube allow for patient information. While technical quality and reliabilityare classified as acceptable, medical content was low and warranted preselection. In contrast to Loeb et al. we did notobserve a negative correlation between number of views and scientific quality in different scores. Our findings support the needfor preselection of videos on YouTube as the potential benefit may vary between videos with the significant risk of low medicalquality. (AU)

Predictive Value of Preoperative Prostate Health Index and Serum Testosterone Testing for Biochemical Recurrence after Radical Prostatectomy for Non-Metastatic Prostate Cancer

Objective: To analyse the predictive value of prostate health index (PHI) combined with serum testosterone after radical prostatectomy(RP) for prostate cancer (PCa).Methods: A total of 132 PCa patients who received RP treatment from January 2016 to December 2019 were selected, retrospectively.And then these patients were divided into biochemical recurrence (BCR) group (n = 51) and non-biochemical recurrence(non-BCR) group (n = 81) based on whether BCR was present after RP. Basic data of PCa patients were collected, and preoperativeprostate health index (PHI) and serum testosterone levels were measured in both groups. Logistic regression analysiswas used to analyse the influencing factors of BCR after RP. The predictive value of PHI and serum testosterone on BCR afterRP was analysed using the receiver operating characteristic (ROC) curve. The Kaplan–Meier method was used to plot survivalcurves, and log rank test was used to analyse the differences between survival curves.Results: The BCR rate of patients in this study was 38.64% (51/132). Single-factor analysis showed that BCR after RP in PCapatients was associated with prostate-specific antigen (PSA), Gleason score, pathological stage, postoperative adjuvant therapy,testosterone and PHI (p < 0.05). Logistics regression analysis showed that PSA >20 ng/mL, Gleason score (8 scores), pathologicalstage pT3, increased PHI and increased testosterone were independent risk factors for BCR after RP. ROC curve analysisshowed that the area under curve (AUC) of PHI and serum testosterone predicting BCR after RP alone and in combination were0.769, 0.725 and 0.906, respectively. Kaplan–Meier survival analysis showed that preoperative high PHI and low testosteroneare negatively correlated with recurrence-free survival rate. (AU)

Historical Misdiagnosis of Recurrent Solitary Fibroma Tumor of the Prostate: A Cases Report and Current Evidence

Background: Solitary fibrous tumors (SFTs) manifest in various anatomical locations but are seldom encountered in the prostate. Despite their rare occurrence in this region, SFTs demonstrate a marked propensity for recurrence. This study elucidates a case of recurrent prostate SFT, previously misdiagnosed, and delineates the salient features and diagnostic criteria pertaining for SFTs. Methods: Through a meticulous analysis of the patient’s antecedent medical records and corroborative diagnostic evaluations, we hypothesized that the presenting pathology was indicative of a prostate SFT. In order to substantiate this supposition, we re-examined archival pathological specimens from the patient. The ensuing pathological assessment validated our conjecture. To address the recurrence, we conducted an open surgical procedure to excise the tumor. Subsequent postoperative pathological evaluations further corroborated the diagnosis of prostate SFT. Results: Upon re-evaluation of the patient’s earlier pathological specimens, we discerned that what had been previously classified as a “seminal vesicle tumor” was, in fact, a prostate SFT. During the surgical intervention, it was observed that the prostatic tumor had invaded the bladder, yet there was no seminal vesicle involvement. The tumor dimensions were approximately 7 × 5 × 4 cm, and the margin between the tumor and the surgical resection edge was less than 0.1 cm. The postoperative histological analysis confirmed the diagnosis of recurrent prostate SFT, substantiating our designation of the patient’s condition as such. A year-long follow-up revealed no conspicuous signs of tumor recurrence. Conclusions: Therapeutic intervention for prostate SFT is predominantly surgical. However, given the tumor’s marked predisposition for recurrence, the specific mechanisms underlying its etiology and pathogenesis remain enigmatic (AU)

Grupos de riesgo de recidiva bioquímica tras prostatectomía radical de la Asociación Europea de Urología: validación externa e identificación de factores de riesgo de progresión y mortalidad / European Association of Urology biochemical recurrence risk groups after radical prostatectomy: external validation and identification of independent risk factors for progression and death

Contexto La EAU propuso una clasificación del riesgo de progresión y muerte en pacientes con recidiva bioquímica tras prostatectomía radical (PR). Objetivo Validar la clasificación de riesgo de RB de la EAU en nuestro contexto e identificar los factores asociados con la progresión y la muerte. Material y métodos Estudio multicéntrico, retrospectivo y observacional que incluyó a 2140 pacientes sometidos a PR entre 2011 y 2015. Los pacientes con RB fueron identificados y estratificados en grupos de riesgo bajo (TD-PSA >1 año y pGS <8) o alto (TD-PSA <=1 año o pGS=>8). Se calcularon la supervivencia libre de progresión por PSA y supervivencia libre de metástasis (SLP-PSA, SLM), la supervivencia cáncer específica y la supervivencia global (curvas de Kaplan Meier y log-rank test). Se identificaron factores de riesgo independientes (regresión de Cox). Resultados Un total de 427 pacientes experimentaron RB (32,3% de bajo riesgo y 67,7% de alto riesgo). La mediana de SLP-PSA fue de 135,0 m (IC 95% 129,63-140,94) y 115,0 m (IC 95% 104,02-125,98) (p < 0,001) para los grupos de bajo y alto riesgo, respectivamente. Hubo diferencias significativas en la SLM y la supervivencia global entre ambos grupos. El grupo de riesgo de RB de la EAU fue un factor independiente de progresión del PSA (HR 2,55; p 0,009). El tiempo transcurrido entre la PR y la RB fue un factor independiente de aparición de metástasis (HR 0,43; IC 95%: 0,18-0,99; p 0,044) y muerte (HR 0,17; IC 95%: 0,26-0,96; 23 p 0,048). Se hallaron diferencias en la SLM (p 0,001) y la supervivencia cáncer específica (p 0,004) para <12, ≥ 12-<36 y ≥36 meses transcurridos entre la PR y la RB. Otros factores independientes fueron la radioterapia de rescate precoz y el PSA en el momento de aparición de la RB (AU)

Background The EAU proposed a progression and death risk classification in patients with biochemical recurrence after radical prostatectomy (PR). Objective To validate the EAU BCR-risk classification in our setting and to find factors related to progression and death. Material and methods Multicenter, retrospective, observational study including 2140 patients underwent RP between 2011 and 2015. Patients with BCR were identified and stratified in low risk (PSA-DT>1 yr and pGS <8) or high-risk (PSA-DT <=1 yr or pGS=>8) grouping. PSA and metastatic free survival (PSA-PFS, MFS), cancer specific survival and overall survival were calculated (Kaplan Meier curves and log-rank test). Independent risk factors were identified (Cox regression). Results 427 patients experienced BCR (32.3% low-risk and 67.7% high-risk). Median PSA-PFS was 135.0 mo (95% CI 129.63-140.94) and 115.0 mo (95% CI 104.02-125.98) (p < .001), for low and high-risk groups, respectively. There was also significant differences in MFS and overall survival. The EAU BCR risk grouping was independent factor for PSA-progression (HR 2.55, p 0.009). Time from PR to BCR, was an independent factor for metastasis onset (HR 0.43, 95% CI 0.18-0.99; p 0.044) and death (HR 0.17, 95% CI 0.26.0.96; 23 p 0.048). Differences in MFS (p 0.001) and cancer specific survival (p 0.004) were found for <12, ≥12-<36 and≥36 months from PR to BCR. Others independent factors were early salvage radiotherapy and PSA at BCR. Conclusions High-risk group is a prognostic factor for biochemical progression, but it has a limited accuracy on MP and death in our setting. The inclusion of other factors could increase its predictive power (AU)

Bilateral subgaleal hematoma after a robot-assisted radical prostatectomy: an uncommon complication / Hematoma subgaleal bilateral tras prostatectomía radical robótica: una complicación infrecuente

Robotassisted radical prostatectomy is a relatively recent technique. Its advantages include less invasiveness and better pain management, but has specific anesthesia requirements, such as steep Trendelenburg position and pneumoperitoneum. Mild complications are common, e.g., transient hypotension or soft tissue edema. We present a case of a 62 year old male who developed subgaleal hematoma associated with transient neurologic impairment after surgery. Jugular vein insufficiency was suspected as the most likely cause. The patient recovered fully.Robotassisted radical prostatectomy can be a challenging procedure due to the anesthesia requirements, but most complications are mild and transient. However, patients should be carefully assessed before surgery. We identified potential factors that may have led to this complication: the abnormal prolonged surgical time, the steep Trendelenburg, a nonassessed jugular vein insufficiency, and/or patient’s obesity.(AU)

La prostatectomía robótica radical es una técnica relativamente reciente. Sus ventajas son una menor invasividad y mejor control del dolor. Tiene algunas peculiaridades anestésicas, como Trendelenburg extremo y neumoperitoneo. Son frecuentes las complicaciones leves, como la hipotensión transitoria o el edema de partes blandas. Presentamos el caso de un varón de 62 años que desarrolló un hematoma subgaleal asociado a deterioro neurológico transitorio tras la intervención. Se sospechó como causa más probable una incompetencia venosa yugular. El paciente se recuperó completamente.La prostatectomía robótica radical puede ser un reto debido a los requisitos anestésicos, pero la mayoría de las complicaciones son leves y transitorias. No obstante, los pacientes deben ser estudiados cuidadosamente antes de la intervención. En este caso podemos encontrar varios factores que pueden haber influido, como el tiempo quirúrgico anormalmente prolongado, el Trendelenburg extremo, una insuficiencia de la vena yugular no evaluada y/o la obesidad del paciente.(AU)

Cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Revisión sistemática de la literatura científica / Cytoreductive surgery in patients with oligometastatic prostate cancer. systematic review of the scientific literature

Introducción La aparición de pruebas de imagen más específicas y sensibles, junto con el empleo cada vez más extendido de técnicas mínimamente invasivas, ha centrado el interés urológico sobre el cáncer de próstata oligometastásico. A pesar de esto, aún queda por determinar el manejo óptimo de esta patología. Objetivo Evaluar la eficacia y seguridad de la cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Adquisición de la evidencia Revisión sistemática de la literatura científica (01/01/2010-31/12/2021) en las bases de datos Medline, Embase, Cochrane Library, CINAHL, Scopus, Agencias de Evaluación de Tecnologías Sanitarias y ClinicalTrials.gov. Los descriptores utilizados han sido prostatectomy, prostatic neoplasm, radical prostatectomy, y los términos de búsqueda libre prostatectomy y oligomestastasicprostate. Los criterios de inclusión fueron estudios con pacientes con cáncer de próstata oligometastásico e intervenidos mediante prostatectomía radical citorreductora (CRP). Síntesis de la evidencia La revisión sistemática incluyó cuatro estudios observacionales, dos ensayos clínicos y dos series de casos, de calidad moderada. Los resultados observados sugieren un beneficio en cuanto a eficacia en aquellos pacientes oligometastásico sometidos a una cirugía de próstata citorreductora. Por otro lado, la mayoría de estos estudios revelan una reducción en el número de las complicaciones locales cuando se compara con los mejores tratamientos sistémicos. Conclusiones La cirugía citorreductora en este grupo de pacientes, es un procedimiento seguro que reduce las complicaciones locales, que ofrece resultados prometedores en cuanto a supervivencia. Hasta la fecha, la falta de ensayos prospectivos limita el papel de esta opción terapéutica a entornos experimentales (AU)

Introduction Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. Objective Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. Evidence gathering Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastaticprostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. Evidence synthesis The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. Conclusions Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments (AU)

Electrical Acupoint Stimulation with Low-Frequency Pulse in the Treatment of Urinary Incontinence after Prostatectomy

Objective: This study aimed to explore the clinical effect of electrical acupoint stimulation with low-frequency pulse in the treatment of urinary incontinence after prostatectomy. Methods: This study selected 104 patients who underwent radical prostatectomy in Pujiang People Hospital from April 2019 to April 2022 as the research subjects, and they were divided into the study group (SG, n = 51, electrical acupoint stimulation with low-frequency pulse) and the control group (CG, n = 53, traditional pelvic floor muscle exercise) in accordance with the therapeutic regimen. In addition, clinical and follow-up data were analysed, and the number of urine pads used before and after treatment, recovery time of urinary continence, scores of 36-Item Short-form Health Survey (SF-36), clinical curative efficacy and incidence of adverse reactions in both groups were compared. Results: Before treatment, no remarkable difference in the number of urine pads used was observed between the two groups (p > 0.05). After treatment, the number of urine pads used in the two groups was less than that before treatment, and the number of urine pads used in the SG was less than that in the CG (p < 0.001). The SG had overtly shorter recovery time of urinary continence, higher scores in eight dimensions of SF-36 and higher treatment efficiency than the CG (all p < 0.05), with no remarkable difference in the incidence of adverse reactions in both groups (p > 0.05). Conclusions: Electrical acupoint stimulation with low-frequency pulse, as a safe and ideal treatment, can shorten the recovery time of postoperative urinary continence ability, reduce the incidence of urinary incontinence and improve the quality of life of patients (AU)

Calidad de vida y salud autoevaluada de pacientes sometidos a prostatectomía radical y determinantes sociales de la salud / Qualidade de vida e autopercepção de saúde de pacientes submetidos à prostatectomia radical e os determinantes sociais de saúde / Quality of life and self-perceived health of patients subjected to radical prostatectomy and the social determinants of health

Introducción: La autopercepción de salud y calidad de vida de los hombres sometidos a prostatectomía radical puede ser influenciada por los determinantes sociales de la salud (DSS), por lo tanto, explorar esa relación contribuye al desarrollo de medidas de atención a la salud. Objetivo: Identificar asociaciones entre DSS y calidad de vida y autopercepción de salud en hombres sometidos a prostatectomía radical. Método: Estudio transversal, con análisis cuantitativo, tuvo como participantes hombres sometidos a prostatectomía radical, entrevistados mediante instrumentos para caracterizar el DSS, Calidad de Vida (CV) y autopercepción de salud. Los datos se analizaron mediante estadística descriptiva y correlacional. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: Participaron 33 hombres, con una edad media de 66,8 años, en su mayoría blancos, con cónyuge, religión y primaria completa o incompleta. Presentaron niveles conservados de CV y autopercepción de salud. La autopercepción de salud se asoció con la religión y la posesión de vivienda, la CV se asoció con la religión, tipo de abordaje quirúrgico, estado civil, tener algún familiar con cáncer de próstata y escolaridad. Conclusión: Hubo una asociación entre DSS y QoL y la salud autopercibida de los hombres sometidos a prostatectomía radical. (AU)

Introdução: A autopercepção de saúde e a qualidade de vida de homens submetidos a prostatectomia radical podem ser influenciadas pelos determinantes sociais de saúde (DSS), portanto, explorar esta essa relação contribui para desenvolver medidas de cuidado em saúde. Objetivo: Identificar as associações dos DSS com a qualidade de vida e autopercepção de saúde de homens submetidos a prostatectomia radical. Método: Estudo transversal, de análise quantitativa, teve como participantes homens submetidos a prostatectomia radical, entrevistados por meio de instrumentos para caracterização dos DSS, Qualidade de Vida (QV) e autopercepção de Saúde. Os dados foram analisados pela estatística descritiva e correlacional. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Participaram 33 homens, com média de idade de 66,8 anos, a maioria brancos, com cônjuge, religião e ensino fundamental completo ou incompleto. Apresentaram níveis preservados de QV e autopercepção de Saúde. A autopercepção de saúde foi associada a religião e possuir casa própria, a QV foi associada a religião, tipo de abordagem cirúrgica, estado civil, possuir alguém na família com câncer de próstata e escolaridade. Conclusão: Houve associação dos DSS na QV e autopercepção de saúde de homens submetidos a prostatectomia radical. (AU)

Introduction: The self-perception of health and quality of life in men subjected to radical prostatectomy can be influenced by the Social Determinants of Health (SDHs); therefore, exploring this relationship contributes to the development of health care measures. Objective: To identify associations between the SDHs and quality of life and self-perceived health in men subjected to radical prostatectomy. Method: A cross-sectional study with quantitative analysis, which had men subjected to radical prostatectomy as participants, interviewed using instruments to characterize the SDHs, Quality of Life (QoL) and self-perceived health. The data were analyzed using descriptive and correlational statistics. The study was approved by the Research Ethics Committee. Results: The participants were 33 men with a mean age of 66.8 years old, mostly white-skinned, with a spouse, professing some religion and with complete or incomplete Elementary School. They presented preserved levels of QoL and self-perception of health. Self-perceived health was associated with religion and with owning a house; QoL was associated with religion, type of surgical approach, marital status, having someone in the family with prostate cancer and schooling. Conclusion: There was an association between the SDHs and QoL and self-perceived health in men subjected to radical prostatectomy. (AU)

Effect of Individualized PEEP on Perioperative Pulmonary Complications in Elderly Patients with Prostate Cancer Undergoing General Anesthesia in Trendelenburg Position: A Single-Center Retrospective Study

Objective: This study aimed to explore the effect of individualized positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in elderly patients with prostate cancer undergoing general anesthesia in Trendelenburg position (low-head and high-foot position at about 45° when patients were in supine position). Methods: The clinical data of 96 elderly patients undergoing Leonardo’s robotic-assisted laparoscopic radical prostatectomy in Zhejiang Provincial People’s Hospital from October 2021, to April 2023, were selected for retrospective analysis. Sixteen patients who had interrupted follow-up or did not meet the inclusion criteria were excluded, and 80 patients were finally included. The patients were divided into group A (lung-protective strategy using routine PEEP value, n = 40) and group B (lung-protective strategy using individualized PEEP value, n = 40) on the basis of different inversion methods. The PEEP value of group A was set as 5 cmH2O, whereas that of group B was determined under the guidance of static lung compliance. The incidences of PPCs on postoperative day 7 were statistically analyzed, and the serum levels of interleukin (IL) 6 (IL-6) and IL-8 in both groups were measured by enzyme-linked immunoadsordent assay (ELISA). Results: The incidence of pulmonary complications was obviously lower in group B than in group A on postoperative day 7 (p < 0.001). Group B had lower levels of serum IL-6 and IL-8 at the end of surgery (T1) and 12 h after surgery (T2, p < 0.001); Higher oxygenation index values 10 min after successful titration of individualized PEEP (A3), 1 h after individualized PEEP ventilation (A4), 2 h after individualized PEEP ventilation (A5), 10 min after recovery of supine position (A6), and 30 min after tracheal extubation (A7); And lower hospitalization time (all p < 0.001) than group A (AU)

Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria / Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen

Objetivo Reportar nuestra experiencia inicial de prostatectomía radical robótica (PRR) en régimen ambulatorio. Material y métodos Análisis retrospectivo de los pacientes intervenidos de PRR en cirugía mayor ambulatoria (CMA) en nuestro centro entre marzo de 2021 y mayo de 2022. Recopilamos las características basales de los pacientes, los resultados intraoperatorios y los datos del postoperatorio (necesidad de asistencia médica no planificada y complicaciones al mes de la cirugía). Se recogieron las características oncológicas al diagnóstico de la enfermedad (PSA, estadificación, ISUP, RMN) y el resultado anatomopatológico tras la intervención. Resultados Identificamos un total de 35 pacientes, con una edad promedio de 60,8 ±6,88 años y un IMC de 27 ±2,9kg/m2. Todos presentaban un riesgo anestésico bajo y un 25,71% tenían alguna cirugía abdominal previa. El tiempo quirúrgico fue de 151,66 ±42,15 minutos y el sangrado promedio fue de 301,2 ±184,38mililitros. Dos pacientes (5,7%) ingresaron la primera noche de la cirugía y 7 pacientes (20%) consultaron en urgencias en el mes siguiente, de los cuales 3 (8,57%) reingresaron. Registramos una complicación intraoperatoria, 7 complicaciones postoperatorias leves (ClavienI-II) y una complicación grave (ClavienIIIb). La complicación grave transcurrió al octavo día postoperatorio y no tuvo relación con la ambulatorización del procedimiento. Conclusión La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en régimen de CMA como una técnica segura dirigida a pacientes seleccionados (AU)

Objective To report our initial experience with robotic radical prostatectomy (RRP) as an outpatient procedure. Material and methods Retrospective analysis of patients who underwent RRP as major ambulatory surgery (MAS) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. Results We identified a total of 35 patients with an average age of 60,8 ±6,88years and a BMI of 27 ±2,9kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ±42,15minutes and the average blood loss was 301,2 ±184,38milliliters. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, 7 mild postoperative complications (ClavienI-II) and one severe complication (ClavienIIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. Conclusion The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients (AU)

La prostatectomía radical retropúbica abierta es todavía una técnica quirúrgica bien establecida para el tratamiento del cáncer de próstata / Open retropubic radical prostatectomy: Still a well-established surgical technique for prostate cancer management

Introducción Las opciones de tratamiento quirúrgico del cáncer de próstata han experimentado cambios significativos gracias a la expansión de la robótica. Sin embargo, la prostatectomía radical retropúbica abierta (PRA) seguirá realizándose en aquellos entornos con limitaciones económicas o con escaso acceso a la robótica. El objetivo de este estudio fue determinar los resultados oncológicos a largo plazo, clasificar las tasas de complicaciones y examinar las tasas de recuperación temprana de la continencia en pacientes tratados con PRA. Métodos Identificamos a todos los pacientes sometidos a PRA en nuestra institución entre 2000 y 2020. Se utilizó un pad test (prueba de la compresa) estandarizado para determinar las tasas de continencia precoz tras la retirada del catéter; la continencia tardía, alrededor de un año después de la cirugía, se determinó mediante el número de compresas por día. Se utilizó la clasificación de Clavien-Dindo para informar las tasas de complicaciones. Las tasas de supervivencia libre de recidiva bioquímica (RB) y de supervivencia global (SG) se definieron mediante el método de Kaplan-Meier y el análisis log-rank. Se utilizaron modelos multivariantes de regresión de Cox para comprobar el efecto de los distintos factores sobre la recidiva bioquímica. Resultados Se analizaron los datos de 1.095 pacientes. La mediana de seguimiento fue de 93,4 meses. Se encontró una supervivencia global libre de RB a 10años y una SG del 73% y del 82%, respectivamente. Se observó una tasa de complicaciones de Clavien Dindo ≥3 en el 4,8% de los pacientes. La tasa de continencia precoz fue del 81,4% y la tasa de continencia tardía fue del 89,1%. El nivel de PSA preoperatorio, la suma de la puntuación de Gleason, el estadio pT, el estado de los ganglios linfáticos y el estado de los márgenes quirúrgicos fueron predictores independientes de RB (p<0,001). Entre las limitaciones del estudio están su diseño retrospectivo y unicéntrico (AU)

Introduction The surgical treatment options for prostate cancer have changed rapidly, given the expansion of robotics. However, open retropubic radical prostatectomy (ORP) will continue to be performed in areas with financial limitations or with limited access to robotics. The purpose of this study was to determine the long-term oncological outcomes, to categorize complication rates and to examine the early continence rates in patients treated with ORP. Methods We identified all patients who underwent ORP at our institution between 2000 and 2020. A standardized pad test was used to determine the early continence rates upon catheter removal, the late continence around a year after surgery was determined by the number of pads per day. The Clavien-Dindo classification was used to report the complication rates. The biochemical recurrence (BCR)-free survival and overall survival (OS) rates were defined using the Kaplan-Meier method and log-rank analysis. Multivariable Cox-regression models were used to test the effect of different factors on biochemical recurrence. Results We analyzed 1095 patients. The median follow-up was 93.4months. An overall 10-year BCR-free survival and OS of 73% and 82% respectively was found. A complication rate for Clavien Dindo ≥3 was seen in 4.8% of patients. The early continence rate was 81.4% and the late continence 89.1%. Preoperative PSA level, Gleason score sum, pT stage, lymph node status, and surgical margin status were independent predictors of BCR (P<.001). Limitations include retrospective and single centre study design. Conclusions ORP is a surgical procedure that provides excellent oncological- and early continence-rates (AU)

Impacto de la distribución del tejido adiposo en la recidiva del cáncer de próstata tras la prostatectomía radical / Impact of adipose tissue distribution on prostate cancer recurrence after radical prostatectomy

Objetivo El objetivo de nuestro estudio es correlacionar la distribución del tejido adiposo en la TC y el riesgo de recurrencia del cáncer de próstata (CaP) después de la prostatectomía radical (PR). Además, evaluamos la asociación del tejido adiposo y la agresividad del CaP. Materiales y métodos Identificamos dos grupos de pacientes en función de la presencia (grupoA) y la ausencia (grupoB o grupo de control) de recidiva bioquímica (RBQ) tras la PR. Se utilizó una función semiautomática capaz de reconocer los valores de atenuación típicos del tejido adiposo para el tejido adiposo subcutáneo (TAS), visceral (TAV), total (TAT) y periprostático (TAP). Para ambos grupos de pacientes se realizó un análisis descriptivo de las variables continuas y categóricas. Resultados Al comparar los dos grupos, hubo una diferencia estadísticamente significativa para el TAV (p<0,001) y para la proporción TAV/TAT (p=0,013). No se encontró una correlación estadísticamente significativa para el TAP y el TAS, aunque se encontraron valores más altos en los pacientes con tumores de grado alto. Conclusión Este estudio confirma que el tejido adiposo visceral es un parámetro de imagen cuantitativo relacionado con el riesgo oncológico de desarrollo de recidiva del CaP, y el papel de la distribución de la grasa abdominal en la TC antes de la PR como una herramienta importante en la predicción del riesgo de recidiva del CaP, particularmente en pacientes con tumores de alto grado (AU)

Objective The aim of our study is to correlate the CT adipose tissue distribution and recurrence risk of prostatic cancer (PCa) after radical prostatectomy (RP). Furthermore, we evaluated the association of adipose tissue and PCa aggressiveness. Materials and methods We identified two groups of patients based on presence (groupA) and absence (groupB or control group) of bio-chemical recurrence (BCR) after RP. A semi-automatic function able to recognize the typical attenuation values of adipose tissue was used for subcutaneous (SCAT), visceral (VAT), total (TAT) and periprostatic (PPAT) adipose tissues. For both groups of patients, a descriptive analysis of continuous variables and categorical variables was performed. Results After comparing between groups, a statistically significant difference was found for VAT (P<.001) and for VAT/TAT ratio (P=.013). No statistically significant correlation was found for PPAT and SCAT, even if higher values were found in patients with high grade tumors. Conclusion This study confirms visceral adipose tissue as a quantitative imaging parameter related to oncological risk of PCa recurrence development, and the role of abdominal fat distribution measured with CT before RP as an important tool to predict the PCa recurrence risk, particularly in patients with high grade tumors (AU)

Identificación de parámetros pronósticos relativos a la técnica quirúrgica en pacientes tratados mediante prostatectomía radical robótica / Identifying prognostic parameters related to surgical technique in patients treated by robotic radical prostatectomy

Introducción y objetivo Los factores más estudiados en pacientes tratados mediante prostatectomía radical robótica son antígeno prostático específico (PSA) y las características patológicas de la biopsia y la pieza de prostatectomía. Los factores asociados a la técnica quirúrgica han sido poco estudiados y con resultados controvertidos. El objetivo es identificar todos los factores posibles de la cirugía y su relación con la supervivencia libre de enfermedad (SLE) y de metástasis. Pacientes y métodos Estudio prospectivo aprobado por el Comité de Ética, en pacientes intervenidos de prostatectomía radical robótica desde enero del 2009 con seguimiento mínimo de cinco años. Analizamos como posibles factores pronósticos: el cirujano, el tiempo quirúrgico, la pérdida sanguínea, el acceso fascial, las técnicas de continencia, la preservación de la fascia, las bandeletas neurovasculares, el cuello vesical, la uretra, la curva de aprendizaje y las complicaciones quirúrgicas. Realizamos comparaciones univariables y emparejadas de supervivencia mediante la estimación de Kaplan-Meier y long-rank tests. El nivel de significancia para comparaciones múltiples se estableció con ajuste False Discovery Rate (p ajustada [padj]). Resultados Cohorte de 667 pacientes con mediana de seguimiento de 69 meses. En el análisis univariante, el cirujano (padj = 0,018), la conservación de ligamentos puboprostáticos (padj = 0,02), la preservación de fascia endopélvica (padj = 0,001) y realizar suspensión parauretral (padj < 0,001) son factores de mal pronóstico para la SLE. La preservación de la fascia también afecta negativamente a la supervivencia libre de metástasis (SLM) (padj = 0,04). Las cirugías previas abdominales, la próstata, el tiempo de intervención, el sangrado, el tipo de uretra residual, el lóbulo medio, el acceso fascial, la conservación de bandeletas o cuello vesical, no tienen significancia estadística (AU)

Introduction and objective The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival. Patients and Method Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p). Results Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp = 0.018), preservation of puboprostatic ligaments (adjp = 0.02), preservation of endopelvic fascia (adjp = 0.001) and performing periurethral suspension (adjp < 0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp = 0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance. Conclusions The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival (AU)

Estudio poblacional de casuística y morbimortalidad de la prostatectomía radical en España / Population based study of morbidity and mortality rates associated to radical prostatectomy cases in Spain

Introducción: No existe ningún estudio poblacional que contabilice en número de prostatectomías radicales (PR) realizadas España, ni la morbimortalidad de dicha intervención.Nuestro objetivo es estudiar la morbimortalidad de la PR en España desde el 2011 al 2015 y evaluar la variabilidad geográfica. Material y métodos: Diseñamos un estudio observacional retrospectivo de todos los pacientes intervenidos de PR en España durante cinco años consecutivos (2011-2015) a partir de los datos registrados en el Conjunto Mínimo Básico de Datos (CMBD).Hemos estudiado la distribución del número de casos y la variabilidad intercomunitaria en términos de morbilidad y de estancia hospitalaria, así como el impacto del volumen quirúrgico medio anual por cada centro en dichas variables. Resultados: Entre los años 2011-2015 se han realizado un total de 37.725 PR en 221 hospitales españoles públicos del sistema nacional de salud. La edad media de la serie fue 63,9 ± 3,23 años. El 50% de las PR se han realizado por vía abierta, y un 43,4% se han intervenido en hospitales de < 500 camas. Encontramos una gran variabilidad en la distribución de los casos intervenidos en las distintas Comunidades Autónomas (CCAA Las comunidades que realizan un mayor número de prostatectomías son Andalucía, Cataluña, Galicia y Madrid. La tasa de complicaciones a nivel nacional es de 8,6%, siendo las más frecuentes la hemorragia y necesidad de transfusión (5,3 y 4%, respectivamente). Encontramos importantes diferencias en las tasas de hemorragia y en la estancia hospitalaria entre las distintas CCAA, que se mantienen tras ajustar por las características del paciente y del tipo de hospital. Al estudiar el volumen quirúrgico anual de cada hospital vemos que el impacto en la tasa de hemorragia o transfusión es lineal sin embargo en la estancia a partir de 60 PR/año la estancia se mantiene estable en torno a cinco días. (AU)

Introduction: There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention.Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation. Material and methods: We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos» (CMBD).We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables. Results: Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9 ± 3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with < 500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year (AU)

Impacto de la patología psiquiátrica en el pronóstico y supervivencia de los varones con cáncer de próstata tratados mediante prostatectomía radical / The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy

Introducción y objetivo: La ansiedad específica del cáncer (CSA) es la reacción psicológica más frecuente tras la prostatectomía radical (PR). Evaluamos la prevalencia de la patología psiquiátrica pretratamiento de cáncer de próstata mediante PR e identificamos la influencia de los diagnósticos psiquiátricos en la supervivencia y pronóstico en los pacientes. Material y métodos Estudio retrospectivo multicéntrico observacional, 1.078 varones intervenidos mediante PR por cáncer de próstata órgano-confinado. Grupos: GP: pacientes con patología psiquiátrica previa a la PR; GNP: pacientes sin patología psiquiátrica previa a la PR, variables urológicas, oncológicas y psiquiátricas, estadística descriptiva y análisis multivariante. Resultados El 37,94% presentó algún diagnóstico psiquiátrico. Fue necesario tratamiento adyuvante de radioterapia (RT) en 27,83% y hormonoterapia (HT) en 23,38%; más frecuentes en GP. La supervivencia cáncer-específica fue superior en GNP. La ansiedad, depresión, insomnio, tabaquismo, psicosis y alcoholismo fueron los más frecuentes. La baja estadificación Tumor-Ganglios-Metástasis (TNM) y poca presencia de síntomas del tracto urinario inferior (STUI) e incontinencia urinaria de esfuerzo (IUE) incrementó la probabilidad de ausencia de patología psiquiátrica. En GP aumentó la fatiga, disfunción eréctil y deterioro cognitivo tras la PR junto con RT y/o HT. A mayor edad y mayor antígeno prostático específico (PSA) al diagnóstico, aumentó el riesgo relativo de patología psiquiátrica y peor evolución. Los factores más relacionados fueron la PR, PSA, la edad y el tiempo de supervivencia. Conclusiones La patología psiquiátrica está presente en pacientes tratados mediante PR debido a cáncer de próstata, teniendo alto impacto en los resultados de supervivencia y pronóstico (AU)

Introduction and Objective: Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. Material and Methods Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. Results 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. Conclusions Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes (AU)