Hernia repair more common after prostate surgery than radiotherapy
By Sarah Guy
23 November 2010
Int J Radiat Oncol Biol Phys 2010; Advance online publication

MedWire News: Men treated with radical prostatectomy (RP) for prostate cancer are more likely to require inguinal hernia (IH) repair than their counterparts treated with external beam radiotherapy (EBRT), study findings show.

Complications of IH involve pain and discomfort, altered bowel function, and sometimes incarceration and subsequent emergency surgery, explains the Canadian research team.

"This discrepancy may represent an important advantage for EBRT relative to RP," say Pierre Karakiewicz (University of Montreal Health Center, Quebec) and colleagues.

"The possibility of IH repair after RP should be included in the clinical decision making, as well as in informed consent considerations," they add, in the International Journal of Radiation Oncology Biology Physics.

Using data from the Quebec Health Plan, Karakiewicz et al compared rates of IH repair in 6422 men treated with RP, 4685 men treated with RT, and 6933 men who underwent a prostate biopsy.

At 1, 2, 5, and 10 years of follow-up, IH repair-free rates were 96.8%, 94.3%, 90.5%, and 86.2% versus 98.9%, 98.0%, 95.4%, and 92.2% for RP versus EBRT, respectively, giving respective absolute IH repair rate differences of 2.1%, 3.7%, 4.9%, and 6.0% in favor of RP.

The researchers adjusted these results for potential confounding factors including patient age, year of therapy, and comorbidity status, and found that RP patients had a significant 2.3-fold increased risk for requiring IH repair compared with EBRT patients.

Even when patients who received androgen deprivation therapy - which may predispose to IH - were included, the rate of IH repair remained 2.3 times higher among RP patients.

IH repair-free survival rates for prostate biopsy patients were 98.3%, 97.1%, 94.9%, and 90.2% at 1, 2, 5, and 10 years follow-up, respectively.

Age also independently predicted the need for IH repair, notes the research team, with patients between the ages of 65 and 69 years having a 1.4-fold higher rate compared with those younger than 60 years old.

"Our data indicated that, even when IH repair represents the endpoint of interest, RP holds a disadvantage relative to EBRT," conclude the authors.

"The risk for an additional surgery after RP may persuade some individuals to choose alternative treatment modalities that are unrelated to IH risk."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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