Douglas Skarecky

Objective: The aim of this study was to evaluate the effects of robot‐assisted radical prostatectomy (RARP) on uroflowmetry (UF) parameters among men with baseline peak flow rates (PFR) P < .001). Improvement in PFR remained stable for >5 years, but mean postoperative PFR was 20% lower in men with baseline PFR P = .016), seminal vesicle invasion (P = .010), and lymph node invasion (0.029).Conclusions: After RARP, PFR improved significantly, with the improvement persisting over long‐term follow‐up. However, men with baseline PFR <10 mL/s had a 20% lower postoperative PFR over 5 years, suggesting permanent damage to the bladder and the need for early treatment to maintain bladder health. There appears to be an association between baseline PFR ≤7 mL/s and adverse pathologic features.

Physicians need practical methods to accurately estimate life expectancy when counseling older men with comorbidities regarding treatment of prostate cancer. Although numerous nomograms exist for prediction of life expectancy (LE), few are used in practice due to the difficulty of integration into busy clinical workflows. We sought to determine if survival could be accurately predicted if reduced to a count of several common comorbidities that pose a high risk to mortality. In selecting these comorbidities, we aimed to balance frequency and risk in order to maximize identification of men at risk for overtreatment based on <10-year LE.

We evaluated whether a simple postcard reporting the date of becoming pad-free is accurate compared to a daily log of pad use to determine time to pad-free status after robot-assisted radical prostatectomy. Prospectively at the time of discharge home we gave 439 men treated with robot-assisted radical prostatectomy between April 2010 and September 2014 a self-addressed stamped postcard to mark the date they attained pad-free urinary continence. In addition, we concurrently asked the men to fill out a daily urinary log of pad use to be faxed or emailed. Of the 439 men 193 (44%) reported their pad-free status via postcard and pad use log. The correlation of time to pad-free status via postcard compared to daily log was R² = 0.98 (p <0.0001). Overall of the 439 men 292 (66%) returned a postcard and 309 men (70.4%) returned a urinary log. However, only 239 (54.4%) of the logs contained the date of pad-free status and, thus, the continence cards were more likely to report pad status correctly (p <0.001). In addition to the 66.5% continence card rate 7.7% of the logs provided additional pad-free dates, resulting in a combined pad-free return rate of 74.3%. Patient reported continence postcards or pad use logs are a simple, inexpensive and reliable way to determine pad-free continence after radical prostatectomy. Either method offers surgeons a low cost, dependable and easy way to track pad-free continence outcomes and their combined use resulted in a nearly 75% response rate.