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Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer

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Abstract

Purpose

The extent of variation in urinary and sexual functional outcomes after radical prostatectomy (RPE) between prostate cancer (PC) operating sites remains unknown. Therefore, this analysis aims to compare casemix-adjusted functional outcomes (EPIC-26 scores incontinence, irritative/obstructive function and sexual function) between operating sites 12 months after RPE.

Materials and methods

Analysis of a cohort of 7065 men treated with RPE at 88 operating sites (prostate cancer centers, “PCCs”) between 2016 and 2019. Patients completed EPIC-26 and sociodemographic information surveys at baseline and 12 months after RPE. Survey data were linked to clinical data. EPIC-26 domain scores at 12 months after RPE were adjusted for relevant confounders (including baseline domain score, clinical and sociodemographic information) using regression analysis. Differences between sites were described using minimal important differences (MIDs) and interquartile ranges (IQR). The effects of casemix adjustment on the score results were described using Cohen’s d and MIDs.

Results

Adjusted domain scores at 12 months varied between sites, with IQRs of 66–78 (incontinence), 89–92 (irritative/obstructive function), and 20–29 (sexual function). Changes in domain scores after casemix adjustment for sites ≥ 1 MID were noted for the incontinence domain (six sites). Cohen’s d ranged between − 0.07 (incontinence) and − 0.2 (sexual function), indicating a small to medium effect of casemix adjustment.

Conclusions

Variation between sites was greatest in the incontinence and sexual function domains for RPE patients. Future research will need to identify the factors contributing to this variation.

Trial Registry.

The study is registered at the German Clinical Trial Registry (https://www.drks.de/drks_web/) with the following ID: DRKS00010774.

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Notes

  1. Although, all patients received an RPE, the kind of surgery (open, robotic or laparoscopic) varied within the study cohort and even those different surgical modalities differ within their procedures. The surgery type however is mostly affected by the provider’s choice. Consequently, for those analysis it is considered as a provider characteristic and as such not included in the casemix adjustment models (otherwise the EPIC-26 scores would be over-adjusted).

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Funding

Funding was received from the Movember Foundation through Help for Prostate Cancer Patients, the collaborating partner of the Movember Foundation in Germany. The analysis and interpretations are those of the authors and not of the Movember Foundation.

Author information

Authors and Affiliations

  1. German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany

    Nora Tabea Sibert, Clara Breidenbach, Simone Wesselmann & Christoph Kowalski

  2. Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany

    Holger Pfaff

  3. Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany

    Rebecca Roth

  4. Federal Association of German Prostate Cancer Patient Support Groups, Bonn, Germany

    Günther Feick & Günter Carl

  5. OnkoZert GmbH, Neu-Ulm, Germany

    Sebastian Dieng

  6. Urologische Klinik, Carl-Thiem-Klinikum Cottbus, Thiemstr. 111, 03048, Cottbus, Germany

    Amr A. Gaber

  7. Klinik für Urologie und Kinderurologie, Klinikum Fürth, Jakob-Henle-Strasse 1, 90766, Fürth, Germany

    Andreas Blana

  8. Klinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany

    Christopher Darr

  9. Klinik für Urologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Standort Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1 (Haus 22), 90419, Nuremberg, Germany

    Florian Distler

  10. Department of Urology and Pediatric Urology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany

    Frank Kunath

  11. Klinik für Urologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Jens Bedke

  12. Prostatakarzinomzentrum Tauber-Franken, Uhlandstr. 7, 97980, Bad Mergentheim, Germany

    Jörg Erdmann

  13. Hegau-Bodensee-Klinikum GmbH, Virchowstraße 10, 78224, Singen, Germany

    Jörg Minner

  14. Klinik für Urologie und Kinderurologie, Ortenau Klinikum, Ebertplatz 12, 77654, Offenburg, Germany

    Jörg Simon

  15. Kantonsspital Aarau AG, Onkologiezentrum Mittelland, Tellstrasse 25, 5001, Aarau, Switzerland

    Maciej Kwiatkowski

  16. Klinik und Poliklinik für Urologie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany

    Martin Burchardt

  17. Klinikum Dortmund, Münsterstraße 240, 44145, Dortmund, Germany

    Nino Harz

  18. DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany

    Stefan Conrad

  19. Klinik und Poliklinik für Urologie und Kinderurologie, UNIVERSITÄTSMEDIZIN der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Thomas Höfner

  20. Kliniken Sindelfingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany

    Thomas Knoll

  21. Martini-Klinik Prostate Cancer Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany

    Burkhard Beyer

  22. Städtisches Klinikum Braunschweig, Freisestraße 9/10, 38118, Braunschweig, Germany

    Peter Hammerer

Authors
  1. Nora Tabea Sibert
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  2. Holger Pfaff
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  5. Rebecca Roth
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  6. Günther Feick
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  7. Günter Carl
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  13. Frank Kunath
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  14. Jens Bedke
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  15. Jörg Erdmann
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  16. Jörg Minner
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  17. Jörg Simon
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  18. Maciej Kwiatkowski
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  19. Martin Burchardt
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  20. Nino Harz
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  21. Stefan Conrad
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  22. Thomas Höfner
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  23. Thomas Knoll
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  24. Burkhard Beyer
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  26. Christoph Kowalski
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Contributions

Study concept and design: CK, SW. Acquisition of data: AAG, AB, CD, FD, FK, JB, JE, JM, JS, MK, NH, SC, TH, TK, PH, BB. Analysis and interpretation of data: NTS, CK, RR. Drafting of the manuscript: NTS. Critical revision of the manuscript for important intellectual content: NTS, CK, CB, SW, HP, GF, GC, MB, PH. Statistical analysis: NTS. Obtaining funding: GC, GF, SD, SW, CK. Administrative, technical, or material support: SD. Supervision: CK, SW, HP. Other: None.

Corresponding author

Correspondence to Nora Tabea Sibert.

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Conflict of interest

Breidenbach, Dieng, Kowalski, Sibert, Wesselmann are employees of the two institutions in charge of the certification system. Conrad reports personal fees from Janssen Cilag GmbH outside the submitted work. Edeling reports grants and personal fees from Proctoring Intuitive Surgical outside the submitted work. All other authors have nothing to declare.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of the Medical Association of Berlin (Eth-12/16) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Sibert, N.T., Pfaff, H., Breidenbach, C. et al. Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer. World J Urol 40, 1437–1446 (2022). https://doi.org/10.1007/s00345-022-03985-6

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  • DOI: https://doi.org/10.1007/s00345-022-03985-6

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