Emerging evidence suggests that preoperative administration of 5-alpha Reductase Inhibitors (5-ARI) in men undergoing radical prostatectomy for prostate cancer may influence postoperative outcomes. The implications are particularly significant in terms of patient-reported continence recovery and overall health-related quality of life, adding new dimensions to the considerations for pre-surgical treatment plans.
Study Design and Methods
In a comprehensive analysis conducted within a prospectively maintained institutional database, 99 patients treated with preoperative 5-ARI were identified out of a total of 5899 men who underwent radical prostatectomy between 2008 and 2021. A propensity-score matched analysis was performed on 442 men to balance the cohorts, with 90 receiving 5-ARI therapy and 352 not receiving it. The primary endpoint evaluated was continence recovery, measured by daily pad usage and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Health-related quality of life (HRQOL) was assessed using the EORTC QLQ-C30 and PR25 questionnaires.
Key Findings and Analysis
The study’s results indicated a significant disparity in continence recovery between the two groups. At 24 months postoperatively, 68.6% of patients without 5-ARI therapy had achieved full continence recovery, compared to only 55.7% in the 5-ARI cohort. This difference was statistically significant (p = 0.002). Furthermore, multivariable Cox regression models identified preoperative 5-ARI use as an independent predictor for impaired continence recovery (HR 0.50, 95% CI 0.27-0.94, p = 0.03). However, no significant impact was observed on erectile function, biochemical recurrence-free survival, and metastasis-free survival.
From a market access perspective, these findings highlight the need for careful evaluation of preoperative treatments and their long-term impacts on postoperative quality of life. Healthcare providers and policy-makers must consider these outcomes when recommending 5-ARI therapy before prostatectomy.
Implications for Clinical Practice
Inferences:
- Preoperative 5-ARI therapy could be a determinant in prolonged urinary recovery periods post-prostatectomy.
- Healthcare providers should weigh the benefits of 5-ARI therapy against potential long-term continence issues.
- Policies around preoperative 5-ARI use require reevaluation in light of these findings to optimize patient outcomes.
Overall, the study provides crucial insights into the long-term effects of preoperative 5-ARI treatment on urinary function recovery. These findings advocate for a more personalized approach in pre-surgical treatment plans to enhance patient quality of life post-prostatectomy.
Original Article:
World J Urol. 2024 Jul 22;42(1):432. doi: 10.1007/s00345-024-05108-9.
ABSTRACT
OBJECTIVES: While the impact of treatment with 5-alpha Reductase Inhibitors (5-ARI) on the risk of cancer-related mortality in men with prostate cancer (PC) has been extensively studied, little is known about the impact of preoperative 5-ARI use on patient-reported outcomes (PROs) following radical prostatectomy (RP).
METHODS: Within our prospectively maintained institutional database of 5899 patients treated with RP for PC (2008- 2021), 99 patients with preoperative 5-ARI therapy were identified. A 1:4 propensity-score matched analysis of 442 men (n = 90 5-ARI, n = 352 no 5-ARI) was conducted. Primary endpoint was continence recovery using daily pad usage and ICIQ-SF. Health-related quality of life (HRQOL) was assessed using the validated EORTC QLQ-C30 and PR25 questionnaires. Multivariable Cox-regression-models tested the effect of preoperative 5-ARI treatment on continence-recovery (p < 0.05).
RESULTS: Patients were followed up perioperatively, followed by annual assessments up to 60mo postoperatively. Preoperative mean ICIQ-SF score (2.2 vs. 0.9) was significantly higher in the 5-ARI cohort (p = 0.006). 24mo postoperatively, 68.6% (no 5-ARI) vs. 55.7% (5-ARI) had full continence recovery (p = 0.002). Multivariable Cox regression analysis, revealed preoperative 5-ARI treatment as an independent predictor for impaired continence recovery (HR 0.50, 95% CI 0.27-0.94, p = 0.03) In line, general HRQOL was significantly higher for patients without 5-ARI only up to 24mo postoperatively (70.6 vs. 61.2, p = 0.045). There was no significant impact of preoperative 5-ARI treatment on erectile function, biochemical recurrence-free survival and metastasis-free survival.
CONCLUSIONS: Pre-RP 5-ARI treatment was associated with impaired continence outcomes starting 24mo postoperatively, suggesting that preoperative 5-ARI treatment can impair the long-term urinary function recovery following RP.
PMID:39037579 | DOI:10.1007/s00345-024-05108-9

This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.