Analysis Of Changes In Clinical Features And Treatment Of 579 Prostate Cancer Inpatients And Preoperative Factors Of Continence Recovery After Radical Prostatectomy

Part I Changes in clinical features and treatment of 579 inpatients with prostate cancerObjective:To investigate the changes of clinical features and treatment of 579 inpatients with prostate cancer in our hospital.Methods:A total of 579 patients with complete follow-up data of histological-proven prostate cancer diagnosed during period from 2007 to 2013 in Affiliated First Hospital of Suzhou University.According to the time of diagnosis,all the patients were sorted into seven groups:2007、2008、2009、2010、2011、2012、2013,the average age of patients in this cohort was 72.6 years old(range 38—94 years old). The ages、tumor stages、bone metastasis symptom、LUTS symptom and primary treatment options were reviewed,analysis the change trend respectively.Result:The differences of ages between seven groups were significant(P<0.05),the proportion of locally advanced cancer cases is becoming heavy,while advanced prostate cancer cases is becoming light.Among the treatment choices during follow-up in the inpatients, the proportion of radical prostatectomy increased. In contrast, the proportion of transurethral resection of prostate combined with hormone therapy decreased. For the reason of out-patients clinic,the proportion of physical examination increased from 6.7% in 2007 to 31.1% in 2013,in contrast the proportion of bone metastasis symptom decreased from 15.5% to 8.2%,but the LUTS symptom was always occupying the mass out-patients(59.6%).Conclusion:With the development of our medical care insurance and people’s health consciousness,the number of prostate cancer patients who were found by physical examination increase by years.Tumor staging will be more accuracy according to the improvement of diagnostic technique such as 12 needles prostate biopsy and MRI.Besides,the main treatment modality changed from non-surgical treatment to radical prostatectomy.Part Ⅱ Preoperative Factors Predictive of Continence Recovery after Laparoscopic Radical ProstatectomyObjective:Discussed whether membranous urethral length and other factors on preoperative magnetic resonance imaging (MRI) is predictive of urinary continence after laparoscopic radical prostatectomy(LRP).Methods:Between January 2009 and December 2013, there were 81 cases of patients underwent LRP have detailed preoperative MRI data,Patients were devided into two groups according to membranous urethral length(MUL), age, body mass index (BMI),prostate volume, prostate-specific antigen level,membranous-posterior urethral length ratios and prostatic-posterior urethral length ratios.Patients were also categorized into four different groups according to the overlying pattern of the prostatic apex.Continence status was evaluated by direct patient questioning or telephone calls at 1,3,6,12 months after the operation. All statistical analyses were performed with IBM SPSS ver.20.0. Measurement data was analyzed by t test.The comparision of recurrence rate was analyzed by Chi-squared test.Binary logistic regression were used to analysis each variable.P-values of less than 0.05 were considered as risk factors.Result:All patients completed operation successfully in LRP.The membranous urethral length and the overlying pattern of the prostatic apex were a significant predictive factors of the continence rate at 1,3,6 months and 12months respectively after the operation (P<0.05),the age was associated with recovery duration at 1 month after the operation. Other predictive factors were not significant. Patients with no overlapping observed between the prostatic apex and membranous urethra had higher rates of recovery of continence compared with other groups.Conclusion:Longer membranous urethra lengths and younger age could be associated with faster recovery of urinary continence,especially for early recovery(1,3 months)of continence after LRP.The shape of the prostatic apex as assessed by preoperative MRI are significantly associated with 12 months recovery of urinary continence after surgery. While Combining with the urine dynamics test assess risk factors for postoperative urinary incontinence after LRP is our next working direction.