Oncological outcomes after robot‐assisted radical prostatectomy: long‐term follow‐up in 4803 patients. (December 2014)

• Record Type: Journal Article
• Authors: Sukumar, Shyam; Rogers, Craig G.; Trinh, Quoc Dien; Sammon, Jesse; Sood, Akshay; Stricker, Hans; Peabody, James O.; Menon, Mani; Diaz‐Insua, Mireya
• Is Part Of: BJU international. Volume 114:Number 6(2014:Dec.)
• Page Start: 824
• Page End: 831
• Publication Date: 2014-12
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12404
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12404-sec-1001" sec-type="section"> <title>Objective</title> <p> <list id="bju12404-list-0001" list-type="bullet"> <list-item> <p>To evaluate oncological outcomes in patients undergoing robot‐assisted radical prostatectomy (RARP) at a high‐volume tertiary centre with focus on biochemical recurrence (BCR); previous studies on oncological outcomes for patients undergoing RARP for prostate cancer are limited to small series.</p> </list-item> </list> </p> </sec> <sec id="bju12404-sec-1002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12404-list-0002" list-type="bullet"> <list-item> <p>In all, 5152 consecutive patients underwent RARP from 2001 to 2010; 4803 patients comprised the study cohort after exclusions.</p> </list-item> <list-item> <p>BCR was defined as a serum prostate‐specific antigen (PSA) level of ≥0.2 ng/mL with a confirmatory value.</p> </list-item> <list-item> <p>BCR‐free survival (BCRFS), metastasis‐free survival (MFS) and cancer‐specific survival (CSS) were estimated using the Kaplan–Meier method and Cox hazards regression models were generated.</p> </list-item> </list> </p> </sec> <sec id="bju12404-sec-1003" sec-type="section"> <title>Results</title> <p> <list id="bju12404-list-0003" list-type="bullet"> <list-item> <p>The mean preoperative PSA level was 6.1 ng/mL, pathological Gleason grade and stage were ≥7 in 68% and ≥pT3 in 34% of patients.</p> </list-item> <list-item> <p>There was BCR in 470 patients (9.8%), 31 patients developed metastatic disease (0.7%) and 13 patients died from prostate cancer (0.3%) during a mean (range) follow‐up of 34.6 (1–116.7) months.</p> </list-item> <list-item> <p>Actuarial 8‐year BCRFS, MFS and CSS were 81%, 98.5% and 99.1%, respectively. In patients with node‐positive disease, actuarial 5‐year BCRFS, MFS, and CSS were 26%, 82%, and 97%.</p> </list-item> <list-item> <p>For organ‐confined disease, predictors of BCR included pathology Gleason grade (primary Gleason 5 vs 3, hazard ratio [HR] 5.52, <italic>P</italic> = 0.018; Gleason 4 vs 3, HR 1.97, <italic>P</italic> = 0.001), preoperative PSA level (10–20 vs ≤10 ng/mL, HR 2.38, <italic>P</italic> = 0.001), and surgical margin status (positive vs negative, HR 3.84, <italic>P</italic> < 0.001)</p> </list-item> </list> </p> </sec> <sec id="bju12404-sec-1004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12404-list-0004" list-type="bullet"> <list-item> <p>RARP appears to confer effective long‐term biochemical control.</p> </list-item> <list-item> <p>To our knowledge, this is the largest report of oncological outcomes in a RARP series to date.</p> </list-item> </list> </p> </sec> </abstract>