Tollefson, Matthew K.

74 Background: Nearly all men that experience recurrence of prostate cancer after radical prostatectomy are placed on salvage androgen deprivation therapy (sADT) in an attempt to control the disease. Yet, little is known regarding the efficacy of the treatment, the therapeutic duration or the predictors of treatment failure. Therefore, we examined our experience with sADT after radical prostatectomy in a cohort of patients with no evidence of systemic disease. Methods: We identified 1,373 patients that were treated with sADT after radical prostatectomy prior to the development of systemic disease. Clinical and pathologic variables predicting systemic progression and cancer death were evaluated using the Kaplan-Meier method and compared using the log rank test. Multivariate Cox proportional hazard regression models were used to analyze the impact of these variables on disease progression and survival. Results: Patients were treated with sADT at a median of 4.2 years after surgery. The median PSA at initiation of sADT was 1.6 ng/mL. The majority (1,234, 90%) of patients had a calculable PSA doubling time prior to the initiation of sADT. 275 patients (20.0%) experienced systemic progression at a median of 3.1 years after the start of sADT. 175 patients (12.7%) died of prostate cancer at a median of 4.7 years after the start of sADT. Factors that predicted disease progression after sADT on multivariate analysis included either neoadjuvant or adjuvant ADT (HR - 2.0, p<0.0001), increasing pathologic Gleason Score (HR - 1.18, p=0.009), increasing pathologic stage (HR - 1.3, p<0.0001), PSA at start of sADT (HR - 1.3, p<0.0001) and PSA doubling time (1.65, p<0.0001). Conclusions: Most men treated with sADT after radical prostatectomy prior to the development of systemic progression experience a lengthy disease-free interval. Multivariate predictors of treatment failure include prior adjuvant or neoadjuvant ADT, pathologic Gleason Score, pathologic stage, PSA level at initiation of sADT and PSA doubling time before sADT. No significant financial relationships to disclose.

Abstract Objectives: Hemostatic clip migration into the lower urinary tract is a potential complication of radical prostatectomy that may cause symptoms, anxiety, and functional concern. Our objective was to evaluate initial presentation, endoscopic management, and outcomes of patients with hemostatic clip migration following radical prostatectomy. Patients and Methods: We retrospectively identified all patients with hemostatic clip migration at our institution from 1977 to 2012. Patient records were then reviewed to identify causative factors, presentation, and long-term functional outcomes. Results: Seventeen patients were identified with clip migration following radical prostatectomy. Eight (47%) patients had undergone open retropubic radical prostatectomy, and 9 (53%) had received robot-assisted radical prostatectomy. Hemostatic clip migration was diagnosed at a median of 8 (range, 1–252) months after prostatectomy. The majority of patients ( n = 16, 94%) were symptomatic upon the diagnosis of clip migration. Symptoms included irritative urinary symptoms ( n = 14, 82%), perineal pain ( n = 3, 18%), hematuria ( n = 2, 12%), and infection ( n = 2, 12%). Five (29%) had concomitant bladder neck contracture. Fifteen (88%) underwent successful endoscopic clip removal, whereas 2 (13%) patients required a repeat operation for recurrent clip erosion. With a median follow-up of 1.6 years, the majority ( n = 13, 87%) had complete symptom resolution after clip removal, although 2 patients had recurrent bladder neck contracture. Conclusions: Hemostatic clip migration after prostatectomy is often symptomatic with irritative voiding complaints, perineal pain, hematuria, infection, or bladder neck contracture. Fortunately, clips can be removed endoscopically with expected symptom resolution in the vast majority of patients.