RESUMEN
INTRODUCTION: To compare visual analog scale (VAS) pain scores between patients with a 2-minute versus 10-minute delay of peri-prostatic lidocaine injection prior to transrectal ultrasound-guided prostate biopsies (TRUS-bx). MATERIALS AND METHODS: Eighty patients who underwent standard 12-core TRUS-bx by a single surgeon were prospectively randomized into four different treatment arms: bibasilar injection with a 2-minute delay, bibasilar injection plus a single apical injection with a 2-minute delay, bibasilar injection with a 10-minute delay, and bibasilar injection plus a single apical injection with a 10-minute delay. Patients were asked to report their level of pain on the VAS (0-10, with 10 indicating unbearable pain) at the following intervals: probe insertion (baseline), after each core, and post-procedure. The primary outcome measure was mean VAS score across all 12 cores minus baseline VAS score, which we refer to baseline-adjusted mean VAS score. RESULTS: Baseline-adjusted mean VAS score was significantly higher for the 2-minute delay group compared to the 10-minute delay group (mean: -0.7 versus -1.6, p = 0.025). Subset analysis of biopsies 1-3, 4-6, 7-9 and 10-12 also demonstrated higher baseline-adjusted mean VAS scores in the 2-minute delay group (all p ≤ 0.043). CONCLUSIONS: Lower TRUS-bx VAS scores can be achieved by extending the time from lidocaine injection to onset of prostate biopsy from 2 to 10 minutes.
Asunto(s)
Anestesia Local , Anestésicos Locales , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Lidocaína , Dolor Asociado a Procedimientos Médicos/prevención & control , Próstata/patología , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/administración & dosificación , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVE: The objective of this paper is to conduct a prospective, longitudinal study employing the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) to examine the baseline and follow-up association of prostate cancer (PCa)-specific anxiety, health-related quality of life (HRQOL), and PCa aggressiveness in men with newly-diagnosed PCa undergoing prostatectomy at our institution. METHODS: From our prospective PCa registry, we identified a total of 350 men with newly-diagnosed PCa who completed the MAX-PC and the Expanded Prostate Cancer Index Composite (EPIC) at baseline and one-year following surgery. Scores on both measures were compared with clinical measure and demographics using the Wilcoxon Rank Sum, Fisher's exact, and Cochran-Armitage Trend tests. Spearman test was used to assess correlation at between the MAX-PC and EPIC at baseline and one-year. RESULTS: Baseline overall MAX-PC measures were correlated with measures at one-year (r=0.5479, p<0.001). Those reporting high anxiety at one-year were more likely to have Gleason score>6 (p=0.004), T-Stage ≥ 2C disease (p=0.004), and a postoperative prostate-specific antigen (PSA)>0.1 (p=0.002); however, this did not apply to all anxious patients. Baseline EPIC sexual function scores were predictive of follow-up EPIC sexual function scores as well (r=0.5790, p<0.001). Depression was noted as a problem in 16% of patients at follow-up. CONCLUSIONS: Our data suggests that the MAX-PC could be used at baseline as a tool to determine who may benefit from psychological intervention pre-PCa and post-PCa treatment. In terms of individualized medicine, behavioral therapy may be the most beneficial in improving HRQOL for younger patients, those with advanced stage disease, and more specifically those whose anxiety outweighs their actual prognosis.
Asunto(s)
Ansiedad/psicología , Estado de Salud , Neoplasias de la Próstata/psicología , Calidad de Vida/psicología , Sistema de Registros , Adulto , Anciano , Estudios de Cohortes , Depresión/psicología , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Estudios Prospectivos , Prostatectomía/psicología , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugíaRESUMEN
BACKGROUND: We sought to examine differences in response rates to quality of life (QoL) surveys in patients treated surgically for renal cell carcinoma (RCC) and prostate cancer (PCa) and to analyze factors associated with non-response of the surveys. METHODS: Patients who underwent surgery for RCC or PCa between 2006 and 2012 were offered enrollment in respective prospective cancer registries that included baseline and annual QoL assessments. We identified 201 RCC patients and 616 PCa patients who completed a baseline QoL survey and were mailed annual QoL surveys [RCC: SF-36, FACT-G (73 questions), PCa: EPIC, IIEF, Max-PC (80 questions)]. We compared patient characteristics between responders and non-responders using a Wilcoxon rank-sum test for continuous variables and a Fisher's Exact test for categorical variables. RESULTS: The overall response rates for the PCa and RCC groups were 63 and 48% (p < 0.001), respectively. This difference in response rates remained when we limited analysis to only those with early stage disease (pT2 for PCa and pT1 RCC, 62% vs. 52%; p = 0.03). PCa characteristics associated with response included older age (64.1 vs 62.6 years, p = 0.032) and robotic versus open surgery (56% vs 44%; p = 0.009). There were no characteristics that were associated with response in RCC patients. CONCLUSIONS: Surgically treated PCa patients have higher QoL mail-based survey response rates compared to patients treated surgically for RCC. This difference holds true for clinically localized cancers as well.
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Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Neoplasias de la Próstata/cirugía , Calidad de Vida/psicología , Sistema de Registros , Anciano , Carcinoma de Células Renales/psicología , Femenino , Florida/epidemiología , Humanos , Neoplasias Renales/psicología , Masculino , Nefrectomía/psicología , Nefrectomía/estadística & datos numéricos , Prostatectomía/psicología , Prostatectomía/estadística & datos numéricos , Neoplasias de la Próstata/psicología , Estudios Retrospectivos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Cancer-specific anxiety (CSA) can affect treatment decisions and is common in men following surgery for prostate cancer (PCa). We hypothesized that CSA is also associated with factors affecting quality of life. Herein, we examine the association of CSA with psychosocial factors and PCa aggressiveness in a cohort of men 1 year after prostatectomy for localized PCa. METHODS: From our prospective PCa Registry, we identified 365 men who underwent prostatectomy for localized PCa who completed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and Expanded Prostate Cancer Index Composite at 1-year follow-up. We evaluated the association of scores on the MAX-PC with demographics, clinicopathologic features, sexual function, and depression scores using Wilcoxon Rank Sum and Kendall's tau correlation tests. RESULTS: Higher scores on the MAX-PC (i.e., higher anxiety) are associated with younger age (p < 0.01) and non-Caucasian race (p < 0.01). Men with higher MAX-PC scores also reported poor sexual satisfaction/function (p < 0.01) and increasing depressive symptoms (p < 0.01). Finally, although higher anxiety is associated with several pathologic features of aggressiveness (stage, positive margins, PSA at 1 year; all p-values < 0.01), we noted several men with clinically indolent disease who reported significant anxiety. CONCLUSIONS: Our data suggest that higher levels of CSA are associated with poor sexual function and increased depressive symptoms 1 year after prostatectomy. Moreover, we noted demographic and pathologic features associated with higher CSA as well. If confirmed, our data support development of models to predict men at high risk of CSA following PCa surgery and targeted referral for additional counseling.
Asunto(s)
Ansiedad/etiología , Depresión/etiología , Neoplasias de la Próstata/psicología , Neoplasias de la Próstata/cirugía , Factores de Edad , Anciano , Ansiedad/diagnóstico , Ansiedad/psicología , Depresión/diagnóstico , Depresión/psicología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Prostatectomía , Neoplasias de la Próstata/complicaciones , Calidad de Vida , Índice de Severidad de la Enfermedad , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Psicológicas/etiología , Estadísticas no Paramétricas , Estrés Psicológico , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVES: We examined 1-year functional and oncologic outcomes for robotic-assisted laparoscopic prostatectomy (RALP) from a single surgeon entering practice directly from fellowship training. METHODS: We prospectively analyzed the first 100 RALPs performed by one fellowship-trained robotic surgeon. Data included resident involvement during the procedure, perioperative data, and surgical complications (scored using the Clavien grading system). Health-related quality of life (HRQOL) data were captured using the EPIC questionnaire at baseline (prior to surgery) and at 1-year follow-up. RESULTS: Eighty-two patients (82%) had hospital stays of 2 days or less without any postoperative complications, urethral catheter removal was within 14 days of surgery, and none required readmission to the hospital. The overall positive margin rate was 21% (19% for patients with T2 disease). Clavien grades 1 through 4 complication rates, respectively, were 4%, 10%, 1%, and 1%. There were no deaths, reoperations, or bladder neck contractures. One patient (1%) required a blood transfusion within the 90-day perioperative period. At 1-year follow-up, 78% of patients reported wearing no pads; 41.3% of patients with baseline and 1-year follow-up data reported having intercourse. CONCLUSIONS: We provide baseline data pertaining to the morbidity, oncologic efficacy, continence results, and potency outcomes of new surgeons performing RALP.
Asunto(s)
Competencia Clínica , Becas , Prostatectomía/educación , Robótica/educación , Urología/educación , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Prostatectomía/efectos adversos , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento , Incontinencia Urinaria/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Investigators have reported that men undergoing radical retropubic prostatectomy (RRP) for prostate cancer (PCa) can experience significant changes in nocturia after surgery. We examined the effect of robot-assisted laparoscopic prostatectomy (RALP) on nocturia symptoms in men with PCa from baseline to 1-year follow-up. PATIENTS AND METHODS: Between August 2006 and August 2010, 116 patients undergoing RALP for clinically localized PCa had baseline and 1-year Expanded Prostate Cancer Index Composite (EPIC) questionnaire data obtained. Patients were divided into three groups with respect to nocturia: N1 (0 or 1 episode per night), N2 (2 episodes per night), and N3 (3 or more episodes per night). RESULTS: N1 (63 patients) had stable or worsened nocturia with 78% of patients retaining their N1 status, 21% progressed to N2 status, and 2% progressed to N3. N2 (29 patients) were 52% N1, 34% N2, and 14% N3 after surgery. The N3 (24 patients) had 29% improved to N1, 38% improved to N2, and 33% remained N3. EPIC urinary function and incontinence subscale scores were 92.3 and 91.3 preintervention and 85.2 and 76.6, (P=<0.001 for both), respectively, at follow-up. The combination of improved obstructive symptomatology and continence after RALP resulted in no net change in urinary bother. CONCLUSIONS: RALP is associated with improved symptomatology in patients with the greatest level of preinterventional nocturia. Patients with minimal preoperative nocturia may experience worsening of nocturia.