SAN DIEGO — Radical prostatectomy may offer the added benefit of urinary symptom reduction in prostate cancer patients who have concomitant lower urinary tract symptoms (LUTS), according to a study reported here.
The proportion of men who had clinically significant LUTS declined by almost 50% following radical prostatectomy, reported Vinay Prabhu, a medical student at New York University in New York City, and colleagues at the American Urological Association meeting.
The mean American Urological Association Symptoms Score (AUASS) decreased by a similar magnitude, they added.
Also, men who had minimal LUTS symptomatology prior to surgery had a short-lived spike, followed soon after by a decline and then stabilization of symptoms during long-term follow-up.
“Radical prostatectomy reduces the percentage of men with clinically significant LUTS 10 years after surgery compared to baseline,” Prabhu said. “Radical prostatectomy achieves durable relief of LUTS in men with baseline clinically significant LUTS and prevents long-term development of LUTS in men with baseline clinically insignificant LUTS.”
The prevalence of LUTS increases with age and adversely affects quality of life, increases healthcare resource utilization, decreases productivity, and impairs functional ability and activity. Radical prostatectomy reportedly improves LUTS in men who have clinically significant LUTS, but the effect of prostatectomy on age-related progression of LUTS had not been evaluated previously in men with clinically significant or insignificant LUTS prior to surgery.
To examine the prevalence and severity of LUTS after prostatectomy, Prabhu and colleagues evaluated medical records of 1,788 men who underwent radical prostatectomy by a single surgeon from October 2000 through September 2012. Each patient completed the AUASS at follow-up visits through 120 months after radical prostatectomy.
Investigators controlled for baseline AUASS, age, prostate-specific antigen (PSA) level, Gleason score, cancer grade, type of nerve-sparing surgery, race, and marital status. They stratified LUTS outcomes by clinically significant LUTS (AUASS >7) or clinically insignificant symptoms (AUASS ≤7).
The study population included 151 men who were ages 40 to 49 at surgery and 107 who were ages 70 to 79. The remaining 1,500 were evenly divided between the age groups of 50 to 59 and 60 to 69.
Mean AUASS ranged from 5.42 in the youngest men to 7.95 in the oldest. The proportion of men with clinically significant LUTS increased from 27% to 46% across the age groups.
Overall, the preoperative mean AUASS was almost 7 and increased to 8.5 to 9 immediately after surgery, then declined to baseline levels within a few months. The AUASS continued to decline gradually through the first 2 postoperative years and remained stable between 5.5 and 6 years during follow-up to 10 years.
About 35% of the men had AUASS >7 before surgery, increasing to almost 50% soon after surgery and then declined below the baseline value within the first year and continued to decline out to year 4, reaching a low of <25% of patients. The proportion of men with AUASS >7 then remained stable between 25% to 30% for the remainder of follow-up (P=0.02 for year 10 versus baseline).
Men with clinically significant LUTS before surgery continued to have more symptomatology (by AUASS) out to year 10 compared with men who had clinically insignificant LUTS. However, AUASS declined similarly in both groups after radical prostatectomy and showed no signs of age-related LUTS progression over time.
The findings suggest that the prostate is the major contributor to age-related LUTS in men.
“We think that men with LUTS prior to prostatectomy had more irritative symptoms associated with [benign prostate hyperplasia] and encroachment of the prostate,” Prabhu told MedPage Today. “Once the prostate was removed, obviously it couldn’t enlarge anymore and the symptoms decreased.”
Source: MedPage Today