Impact of Periurethral Inflammation on Continence Status Early After Robot-Assisted Radical Prostatectomy.

INTRODUCTION: The aim of this study was to investigate the effect of periurethral inflammation on the continence status after robot-assisted radical prostatectomy (RARP). METHODS: This study included 101 consecutive prostate cancer patients treated with RARP. To evaluate the status of periurethral inflammation, most apical urethral tissues in RARP specimens from these patients were immunohistochemically stained with antibodies for tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß). Masson trichrome staining (MTS) of these specimens was also performed to determine the degree of periurethral fibrosis. Uni- and multivariate logistic regression analyses were performed to analyze the correlation between several factors and the postoperative continence status. RESULTS: Of the 101 patients, urinary continence was achieved in 37 and 62 at 1 and 3 months after RARP, respectively. Immunohistochemical study revealed that 59, 41, and 56 patients were positive for TNF-α, IL-1ß, and MTS, respectively, and the findings on MTS were significantly correlated with those on TNF-α and IL-1ß expressions. At 1 month after RARP, the proportions of patients positive for TNF-α expression and MTS, but not for IL-1ß expression, in the incontinence group were significantly greater than those in the continence group, whereas at 3 months after RARP, a significantly greater proportion of patients in the incontinence group was judged to be positive for TNF-α and IL-1ß expressions, but not for MTS, than in the continence group. The following factors were identified as independent predictors of the continence status: preoperatively observed detrusor overactivity and TNF-α expression at 1 month after RARP, and TNF-α expression at 3 months after RARP. CONCLUSIONS: Periurethral inflammation, particularly that evaluated by TNF-α staining, could be a useful predictive parameter of the continence status early after RARP.

Significance of urethral fibrosis evaluated by preoperative magnetic resonance imaging as a predictor of continence status after robot-assisted radical prostatectomy.

BACKGROUND: The objective of this study was to assess the impact of urethral fibrosis on the continence status following robot-assisted radical prostatectomy (RARP). METHODS: The findings of fibrosis of the urethral wall and periurethral tissue in 185 patients undergoing RARP were each divided into grade 0 to 3 based on preoperative T2-weighted magnetic resonance imaging. Urethral fibrosis was defined as the sum of both grades, and scores ≤ 2 and ≥ 3 were considered as 'no/mild' and 'severe' fibrosis, respectively. RESULTS: The incidences of continence in patients with no/mild fibrosis were significantly higher at 3, 6, and 12 months after RARP than those with severe fibrosis. Furthermore, urethral fibrosis was identified as an independent predictor of the postoperative continence status at 3, 6, and 12 months after RARP. CONCLUSIONS: Assessment of urethral fibrosis could be a significant predictor of recovery of the urinary continence status after RARP. Copyright © 2015 John Wiley & Sons, Ltd.

Clinical outcomes of anti-androgen withdrawal and subsequent alternative anti-androgen therapy for advanced prostate cancer following failure of initial maximum androgen blockade.

The present study aimed to investigate the significance of anti-androgen withdrawal and/or subsequent alternative anti-androgen therapy in patients with advanced prostate cancer (PC) who relapsed after initial maximum androgen blockade (MAB). The present study evaluated the clinical outcomes of 272 consecutive advanced PC patients undergoing anti-androgen withdrawal and/or subsequent alternative anti-androgen therapy with flutamide following the failure of initial MAB using bicalutamide. With the exception of 41 patients (15.1%) who did not undergo anti-androgen withdrawal due to the characteristics of PC suggesting aggressive diseases, prostate-specific antigen (PSA) declined from the baseline value in 83 patients (35.9%), including 18 (7.8%) with PSA decline >50%, but not in the remaining 148 (64.1%). No significant difference in the overall survival (OS) or cancer-specific survival (CSS) among the three groups was observed based on the response to anti-androgen withdrawal. Following the introduction of alternative anti-androgen therapy with flutamide, PSA decline was observed in 185 patients (68.0%), including 103 (37.9%) who achieved a PSA reduction of >50%; however, the PSA level continued to elevate in the remaining 87 (32.0%). Furthermore, of the numerous factors examined, only the duration of the initial MAB therapy was shown to be significantly correlated with the PSA decline following alternative anti-androgen therapy. Multivariate analysis of several factors identified revealed that only PSA decline following alternative anti-androgen therapy was an independent predictor of CSS and OS. If initial MAB is effective, the introduction of alternative anti-androgen therapy may be considered; however, anti-androgen withdrawal should be omitted, irrespective of the characteristics of advanced PC.