Diapositive 1

1
Introducing a new and simple scoring system to
evaluate oncological and functional outcome
after radical prostatectomy Salomon L., De La
Taille A., Vordos D., Hoznek A., Yiou R., Abbou
C.C. Department of Urology, Henri Mondor
Hospital, Créteil, France
Introduction Objectives To create a scoring
system, which takes into account oncological
outcome and functional results (continence and
erectile function) of patients after radical
prostatectomy. Material Methods Three hundred
and eleven consecutive men underwent radical
prostatectomy for localized prostate cancer from
1999 to 2004 and were evaluated one year after
surgery. Biochemical recurrence was defined as a
single postoperative PSA level gt0.2 ng/ml.
Continence, defined as using no pad, and potency,
defined as the ability to achieve and maintain an
erection suitable for sexual intercourse, were
evaluated by a prospective, self-administered
questionnaire. Each patient received - 4 points
(if PSA lt0.2 ng/ml) or 0 points (if PSA gt0.2
ng/ml) for oncological outcome, - 2 points (if
continent) or 0 points (if not continent) for
urinary continence and - 1 point (if potent) or
0 points (if not potent) for erectile function.
The total score represented the sum of all
points, higher scores indicating a better
outcome. The unique feature of this scoring
system is that each particular score represents a
particular clinical status regarding oncological
and functional outcome. Results One year after
surgery, 284 (91.3) patients had PSA levels lt0.2
ng/ml, 243 (78.1) were continent and 113 (36.3)
were potent. Patients with a total score gt4 had
good cancer control and could be further
subdivided into patients being continent and
potent (score 421, 22.5), being continent but
having erectile dysfunction (ED) (score 420,
34.1), being incontinent and potent (score 401
points 9.3), and being incontinent and having ED
(score 400, 22.5). Similarly, patients with
score lt4 had no cancer control and could be
further subdivided into patients being continent
and potent (score 021, 1.9), being continent
but having ED (score 020 6.1), being
incontinent and potent (score 001 point, 1.6),
and and being incontinent and having ED (score
000, 1.2). Conclusions This score includes
the three most important outcomes after radical
prostatectomy, cancer control, continence and
erectile function. It could allow us to better
evaluate and compare the results of radical
prostatectomy in a multinational, multicenter
setting.
pT2
Introduction
Results
Radical prostatectomy is a major, potentially
curative procedure for the treatment of
organ-confined prostate cancer. It can be
performed by retropubic or perineal approaches
(1,2) and since 1997 by laparoscopic approach
(3). The majority of urologists use the radical
retropubic approach, due to familiarity with
surgical anatomy, as well as the nerve sparing
technique first described by Walsh et al. (4). As
stated by Walsh, the goals of radical
prostatectomy are cancer control, urinary
continence, and eventually potency with low
morbidity (5). However, the presentation of men
with localized prostate cancer during the past
10-20 years has changed More men are presenting
with localized prostate cancer, low PSA, Gleason
score lt 6 and normal digital examination
(clinical T1c stage) (6). With the resulting
improvement of oncological outcome, functional
results such as postoperative urinary continence
and potency are major concerns for many patients.
Although many men are willing to trade their
sexual life and even their continence for a
chance to cure cancer, this does not mean that
these functions are unimportant for them (7,8).
Results of radical prostatectomy (cancer
control, continence and potency) are usually
presented separately. Postoperative PSA levels
allow us to detect progression (9), continence is
evaluated by the number of pads used and potency
is evaluated according to the status of
preservation of neurovascular bundles
(10-12). However, the success of radical
prostatectomy should be the combination of cancer
control, good urinary continence and maintenance
of potency. Although a plethora of data regarding
postoperative outcome exists in the literature,
we are often not able to distinguish if patients
with good cancer control also have satisfactory
functional results regarding their urinary
continence or erectile function (13). We propose
a new method to evaluate oncological and
functional results after radical prostatectomy
together, using a simple scoring system.
Biochemical recurrence PSA gt 0.2 ng/ml

• 4 points (if PSA lt0.2 ng/ml) or 0 point (if PSA
  gt 0.2 ng/ml)
• 2 points (if continent) or 0 point (if
  incontinent)
• 1 point (if potent) or 0 point (if not potent)

Functional results prospective self-administered
questionnaire - Continence (ICS) no
pad - Potency (IEFF5) erection suitable for
sexual intercourse
Score sum oncological continence
potency From 0 (000) to 7 (421) Each
particular score represents a particular clinical
status regarding oncological and functional
outcome
One Year
34.1
91.3
22.55
22.5
Methods

• 1999-2004 311 radical prostatectomies
• Perineal approach 9
• Retropubic approach 58
• Laparoscopic approach
• Transperitoneal 148
• Extraperitoneal 85
• Robotic 11

Disease progression (PSA failure PSA gt 0.2 ng/ml)
9.3
1.2
Continence (no pad) (ICS questionnaire)
243 (78.1)
1.9
1.2
1.6
Pathological results
Weight (g) 57.9 24.7 (20-210)
Gleason score 6 7 8-10 6.7 10.9 116 (37.3) 148 (47.5) 47 (15.1)
pT2a pT2b pT2c pT3a pT3b pT4 N 6. 17 (5.4) 20 (6.4) 175 (56.3) 67 (21.5) 28 (9) 4 (1.3) 5 (1.6)
Positive margins pT2a pT2b pT2c pT3a pT3b pT4 75 (24.1) 0 (0) 2 (10) 33 (18.8) 22 (32.8) 16 (57) 2 (50)
Potency (erection with sexual intercourse) (IIEF5
)
Preoperative demographic data
113 (36.3)
Salomon L. et al. Eur. Urol. 2003 44 656-660
Age (years) 64.2 6.1 (46.-77.1)
PSA (ng/ml) 10.11 8.1 (0.8-80)
Clinical stage T1a-T1b T1c T2a T2b T2c 9 (2.8) 223 (71.7) 68 (21.8) 4 (1.3) 7 (2.2)
Gleason score of positive biopsie 6 7 8-10 6 1.0 230 (73.9) 64 (20.6) 17 (5.4)
References
Conclusions
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• We have introduced a score which allows us to
  evaluate the outcome of radical prostatectomy in
  terms of cancer control, continence and potency
• These results are depending on preoperative
  evaluation, patient selection, intraoperative
  techniques (eg. neurovascular preservation) and
  pathological results. Nevertheless, this score
  can change with time, as changes the clinical
  situation of the patient, eg. after improvement
  of urinary continence or erectile function.
• The most important use of this score is to
  present all results of radical prostatectomy in a
  single figure, This could be useful for the
  comparison between the different surgical
  techniques of radical prostatectomy.
• The score could be useful to communicate and
  compare the results of radical prostatectomy
  between many centers in an efficient way, even in
  a multinational setting. Rassweiler tested this
  score and obtained 22.1 of score 7 and 47.9 of
  score 6 with laparoscopic approach (14)