More than 170 participants gathered today in Riga, Latvia for the 4th North Eastern European Meeting (NEEM) with the first-day agenda tackling key issues in surgical treatment options for prostate cancer (PCa) such as managing complications after radical prostatectomy.
EAU Secretary General Per Anders Abrahamsson opened the first-day session. “The NEEM occupies a special role in gathering together both young urologists and veteran specialists. We also aim to bridge the various research efforts done in the region be it clinical, basic or translational research work,” said Abrahamsson.
During the opening session on PCa surgery, E. Vjaters discussed treatment options for PT3a, while G. Ahlgren tackled lymph node dissection in prostate cancer. Meanwhile, Prof. Tammela (Tampere, Finland) talked on how to reach best surgical and functional results in radical prostatectomy.
Mindaugas Jievaltas (Kaunas University of Medicine, Lithuania) lectured on surgical margin positivity followng radical prostatectomy. Jievaltas focused on the impact of positive surgical margin (PSM) on patient outcome. “It can be generally claimed that patients with higher grade disease are at higher risk of PSM,” Jievaltas noted. He added that there is a two-fold higher incidence of PSM among obese men.
For patients who had undergone radical prostatectomy, Jievaltas said that PSM might impact or cause three events, mainly biochemical recurrence, use of second therapies, and perhaps mortality.
Regarding the management of PSM, Jievaltas said that treatment is complex and that the urologist should take into account the patient’s age, expected functional results, site and extent of PSM, and individual risk for PSM progression. Treatment options include adjuvant hormonal therapy or radiation therapy, observation or salvage therapy in case of disease progression.
Key messages: urinary incontinence
Meanwhile Martin Kivi (Talinn, Estonia) spoke on stress urinary incontinence prevention following radical prostatectomy. Amongst his key messages are:
* Meticulous apical dissection and urethral length preservation are the most important steps in urinary continence recovery;
Non-invasive therapy is the first-line treatment for early incontinence in the first 6-12 months;
*Pelvic floor muscle training can reduce the frequency of incontinent episodes by up to 72%
* 2.5% of patients require surgical treatment for postoperative urine leakage;
*The gold standard for treating severe stress urinary incontinence is the artificial urinary sphincter;
*Optimising sphincter support with funtional retrourethral slings is one of many treatment possibilities with a high rate of improvement.