Impact of Pelvic Radiation Therapy on Inflatable Penile Prosthesis Reoperation Rates.

INTRODUCTION: Considering that radiation therapy (RT) compromises soft tissue microvasculature, impairs wound healing, and causes cavernosal fibrosis, inflatable penile prosthesis (IPP) outcomes may be adversely affected in men treated with RT. AIM: To compare IPP outcomes among those who had undergone prior RT vs a cohort who underwent radical prostatectomy (RP) before insertion of IPP. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare Database was queried for men with prostate cancer (PCa) who underwent RT (n = 83,277) or RP (n = 32,608) with subsequent IPP insertion between 2002 and 2013. Men who had undergone both RT and RP were excluded from the analysis. MAIN OUTCOME MEASURE: The primary outcome was reoperation, defined by removal, revision, or replacement of the IPP. RESULTS: We identified 350 men who received an IPP following RT and 653 who received an IPP following RP. Men who underwent RT were older (P < .01) and had more comorbidities (P < .01). There were no significant differences in overall reoperation rates at 90 days (P = .78), 1 year (P = .52), or 3 years (P = .48). Time-to-event analysis demonstrated that RT was not associated with an increased likelihood of overall reoperation (hazard ratio [HR] 1.46, 95% confidence interval [CI] 0.94-2.29, P = .09). There was no association between time from RT to IPP and overall reoperation rates. CLINICAL IMPLICATIONS: Prior RT for the treatment of PCa does not impact the revision or removal rates of IPPs as compared with a cohort of non-radiated patients who underwent RP. STRENGTH & LIMITATIONS: The strength includes the analysis of outcomes among a contemporary, nationwide cohort with robust follow-up. Using diagnosis and procedure codes, we were thoroughly able to capture reoperations. Limitations include the lack of specific indications for reoperation and inability to control for surgeon experience or technique. CONCLUSION: IPP is a safe and effective treatment of erectile dysfunction that should be offered to men with a history of pelvic radiation who have failed medical therapy. Golan R, Patel NA, Sun T, et al. Impact of pelvic radiation therapy on inflatable penile prosthesis reoperation rates. J Sex Med 2018;15:1653-1658.

Increased resource use in men with metastatic prostate cancer does not result in improved survival or quality of care at the end of life.

BACKGROUND: Cancer care and end-of-life (EOL) care contribute substantially to health care expenditures. Outside of clinical trials, to our knowledge there exists no standardized protocol to monitor disease progression in men with metastatic prostate cancer (mPCa). The objective of the current study was to evaluate the factors and outcomes associated with increased imaging and serum prostate-specific antigen use in men with mPCa. METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data from 2004 to 2012, the authors identified men diagnosed with mPCa with at least 6 months of follow-up. Extreme users were classified as those who had either received prostate-specific antigen testing greater than once per month, or who underwent cross-sectional imaging or bone scan more frequently than every 2 months over a 6-month period. Associations between extreme use and survival outcomes, costs, and quality of care at EOL, as measured by timing of hospice referral, frequency of emergency department visits, length of stay, and intensive care unit or hospital admissions, were examined. RESULTS: Overall, a total of 3026 men with mPCa were identified, 791 of whom (26%) were defined as extreme users. Extreme users were more commonly young, white/non-Hispanic, married, higher earning, and more educated (P<.001, respectively). Extreme use was not associated with improved quality of care at EOL. Yearly health care costs after diagnosis were 36.4% higher among extreme users (95% confidence interval, 27.4%-45.3%; P<.001). CONCLUSIONS: Increased monitoring among men with mPCa significantly increases health care costs, without a definitive improvement in survival nor quality of care at EOL noted. Monitoring for disease progression outside of clinical trials should be reserved for those in whom findings will change management. Cancer 2018;124:2212-9. © 2018 American Cancer Society.