A retrospective study to evaluate the effect of preoperative hormonal therapy on continence recovery

Yuwen Wang; Shun Zhang; Haifeng Huang; Xuefeng Qiu; Yao Fu; Xiaoyu Lyu; Linfeng Xu; Junlong Zhuang; Hongqian Guo

doi:10.3389/fonc.2022.1059410

A retrospective study to evaluate the effect of preoperative hormonal therapy on continence recovery

Front Oncol. 2023 Jan 13:12:1059410. doi: 10.3389/fonc.2022.1059410. eCollection 2022.

Authors

Yuwen Wang^{1

2}, Shun Zhang^{1

3}, Haifeng Huang^{1

3}, Xuefeng Qiu^{1

3}, Yao Fu⁴, Xiaoyu Lyu^{1

3}, Linfeng Xu^{1

3}, Junlong Zhuang^{1

3}, Hongqian Guo^{1

2

3}

Affiliations

¹ Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
² Medical School of Southeast University Nanjing Drum Tower Hospital, Nanjing, China.
³ Institute of Urology, Nanjing University, Nanjing, China.
⁴ Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.

Abstract

Objective: To evaluate whether different preoperative hormonal therapy options affect postoperative continence and to identify risk/protective factors for continence recovery.

Methods: This is a retrospective analysis of several clinical trials (NCT04356430, NCT04869371, NCT04992026 and NCT05406999). Data from patients treated with hormonal therapy followed by RARP were collected and analyzed. Continence was defined as 0 pad/day or one safety pad.

Results: The study included 230 patients with adequate information. The median time to continence recovery is 8 weeks. A total of 216 (93.9%) participants recovered to urinary continence within 12 months after surgery. 21 (9.1%) participants achieved immediate continence. 69, 85, 27 and 14 participants restored continence at 1 month, 1-3 month, 3-6 month, 6-12 month, accounting for 30.0%, 40.0%, 11.7% and 6.1% accordingly. No difference in continence recovery was found among different preoperative hormonal treatment options (p=0.821). Cox regression showed that membranous urethral length (MUL) was the only independent factor influencing urinary continence recovery either in the univariate analysis (OR=1.13, 95%CI: 1.04-1.22, p=0.002) or in the multivariate analysis (OR=1.12, 95%CI: 1.04-1.20, p=0.002). Different preoperative treatment options were not associated with urinary recovery. More advanced preoperative T stage (OR=0.46, 95%CI: 0.24-0.85, p=0.014) delayed the recovery of immediate continence. MUL was associated with continence restoring at 1 month (OR=1.20, 95%CI: 1.03-1.39, p=0.017), 3 month (OR=1.27, 95%CI: 1.07-1.51, p=0.006), 6 month (OR=1.34, 95%CI: 1.07-1.67, p=0.011) and 12 month (OR=1.36, 95%CI: 1.01-1.84, p=0.044).

Conclusion: There is no difference in postoperative continence recovery among ADT, ADT+Docetaxel and ADT+Abiraterone preoperative treatment options. More advanced T stage indicated poor immediate continence recovery. Longer membranous urethral length was a promotional factor for both short-time and long-time continence recovery.

Keywords: continence; hormonal therapy; locally advanced prostate cancer; oligometastatic prostate cancer; prostatectomy.

Grants and funding

This work was funded by the National Natural Science Foundation of China (81974394 to JZ, 82172639 to XQ, and 81972388 to HG), Natural Science Foundation of Jiangsu Province for Excellent Young Scholars (BK20200051 to JZ), Nanjing Medical Science and technique Development Foundation (GRX17127 to JZ), the Project of Invigorating Health Care through Science, Technology, and Education, Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKB2016014 to HG).