The impact of obesity on health related quality of life before and after radical prostatectomy (data from CaPSURE)
ABSTRACT Health related quality of life (HRQOL) is an important measure of outcomes among patients with prostate cancer due to disease related and treatment related effects on physical and emotional health. We determined if there are differences in the HRQOL of obese men at diagnosis and after radical prostatectomy compared to the HRQOL of men with normal body mass index (BMI).
Data were abstracted from Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), a disease registry of 10,018 men with prostate cancer. A total of 1,884 men were included in study who were treated with radical prostatectomy between 1989 and 2002, had BMI information available and had completed 1 initial HRQOL questionnaire. Of these men 672 who completed at least 2 followup questionnaires were assessed further.
The BMI (kg/m) distributions were 24% normal (less than 24.9 kg/m), 56% overweight (25 to 29.9), 16% obese (30 to 34.9) and 4% very obese (greater than 35 kg/m). Higher BMI was associated with worse physical function, bodily pain, general health, vitality and role physical, but better bowel bother at diagnosis independent of race. Higher BMI was also associated with worse HRQOL after radical prostatectomy for physical function, general health and vitality, but better bowel bother. HRQOL differences between BMI groups were similar among times for all measured variables. Compared to the normal group, the higher BMI groups had similar HRQOL after radical prostatectomy.
In the majority of domains men with higher BMI had lower HRQOL at diagnosis than men of normal BMI. Obese men have a similar recovery pattern of HRQOL after radical prostatectomy, with minimal additive long-term impairment in HRQOL relative to men of normal weight.
- SourceAvailable from: Alchiede Simonato
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- "Anast et al. found a significantly lower rate of continence in obese men than in normal weight men. CaPSURE reported that post-treatment urinary function scores at 24 months were highest in normal weight men and lowest in the very obese . In contrast, several investigators found no difference in PPI rates in relation to obesity  . "
ABSTRACT: Abstract Objective. This study aimed to evaluate the impact of abdominal obesity on preoperative features, complications and functional outcomes of men treated with radical prostatectomy (RP) for prostate cancer. Material and methods. In 2006 a multicentre Italian report on RP evaluated the surgical and functional characteristics of prostate cancer and RP outcomes. Age and waist circumference (WC) were recorded. Abdominal obesity was defined as a WC of at least 102 cm. International Index of Erectile Function (IIEF) score, prostate-specific antigen, prostate volume, tumour characteristics, presence/absence of perioperative complications and the number of blood units transfused were recorded. Preoperative and postoperative continence status was evaluated. Spearman correlation coefficient and binary logistic regression analyses were conducted. Results. In total, 470 men were recruited. A significant negative correlation between WC and preoperative IIEF scores was observed (r = -0.032, p < 0.001). Non-obese patients presented a preoperative IIEF score of 18.8 ± 6.0 and obese patients an IIEF score of 16.0 ± 7.0 (p < 0.001). Obese men are at three-fold greater risk of intraoperative complications and blood transfusions than those with a WC below 102 cm [adjusted odds ratio (OR) = 3.116, 95% confidence interval (CI) 0.281-16.348, p < 0.001, and OR = 2.763, 95% CI 0.518-3.843, p < 0.050, respectively]. A significant positive correlation between WC and postprostatectomy incontinence severity was observed. The risk of needing at least two pads per day is two and a half times greater in men with a WC of at least 102 cm than in those with a WC below 102 cm (adjusted OR = 2.435, 95% CI 0.321-7.668, p = 0.007). Conclusion. Abdominal obesity in a multicentre Italian cohort of patients treated with RP was associated with an increased risk of intraoperative and perioperative complications and with a worse functional outcome.06/2013; 48(2). DOI:10.3109/21681805.2013.803151
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ABSTRACT: Studies are limited regarding the impact of obesity on early erectile functional outcomes after robotic radical prostatectomy. Our goal was to determine this impact using patient-reported validated questionnaires. International Index of Erectile Function (IIEF-6) scores were prospectively collected with institutional review board approval, for patients who underwent robotic radical prostatectomy with bilateral nerve sparing from February 2007 to October 2009. The data were categorized into nonobese and obese groups and subsequently into 2 subgroups based on risk for postprostatectomy erectile dysfunction. Low risk is preoperative IIEF-6 ≥19 and high risk is IIEF-6 <19. The groups and subgroups were compared using chi-square analysis. Of 190 consecutive patients, 67 were excluded for preoperative severe erectile dysfunction (IIEF-6<7), or lack of IIEF-6 scores, or both. There were 69 nonobese patients of which 88% were potent preoperatively and 20% regained potency at 12 months postoperatively. Of 54 obese patients, 85% were potent preoperatively and 25% at 12 months. There was no difference in erectile function recovery rates between the groups (P=0.755). In both groups, patients with low risk of postoperative erectile dysfunction had statistically similar postoperative mean IIEF-6 scores at 6 and 12 months (P=0.580 and P=0.389, respectively), and no difference in erectile function recovery rates existed at 12 months (P=0.735). Obesity has no major contribution to the rate of early erectile function recovery after robotic radical prostatectomy. Preoperative erectile function remains the determining factor in postradical prostatectomy erectile dysfunction.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2011; 15(1):32-7. DOI:10.4293/108680810X12924466009203 · 0.79 Impact Factor
Article: Postprostatectomy incontinence[Show abstract] [Hide abstract]
ABSTRACT: Postprostatectomy incontinence is a bothersome complication of radical prostatectomy. Although most men recover from initial postprostatectomy incontinence, some do not. It is important to understand the natural history of postprostatectomy incontinence as well as conservative measures to hasten continence. This article reviews our current understanding of postprostatectomy incontinence with an emphasis on diagnosis and management.Current Bladder Dysfunction Reports 12/2009; 4(4):205-211. DOI:10.1007/s11884-009-0029-8