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ERUS 2018: Best Papers in Prostate Cancer

Marseille, France (UroToday.com) Dr. Grivas presented five of the best papers in the last year in prostate cancer (PC). The first presented paper was published in BJUI entitled: “A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy”. The objective of this study was to create a statistical tool for the estimation of extracapsular extension (ECE) level of PC and determine the nerve-sparing approach that can be safely performed during radical prostatectomy (RP). The study included 11,794 prostate lobes analyzed from 6360 patients who underwent robotic RP between 2008 and 2016. Five different multivariable logistic models were estimated for the presence of ECE and ECE width of >1, >2, >3, and >4 mm. The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively. This is the first study to propose an evidence-based statistical tool that can be used to predict the presence and width of ECE. The tool demonstrated great accuracy and is very user-friendly. It is now also accessible through the internet (WWW.PRECE.IT) and can help support surgeons in patient counseling and preoperative planning.

The next paper presented was a paper published in Lancet Oncology entitled: “Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomized controlled study” 2. This was an Australian phase 3 controlled randomized study including men with clinically localized PC treated with surgery. Patients were randomized to either open RP or robotic RP. The primary outcomes included urinary and sexual function at 6,12 and 24 months. Additionally, the oncological outcomes were examined as well (biochemical recurrence [BCR] rates and imaging evidence of progression). A total of 326 patients were randomized. The trial demonstrated no difference in urinary and sexual function scores at all time points. BCR rates were 9% for open RP and 3% for robotic RP, p=0.019. However, no significant difference in imaging evidence of progression was seen. Despite demonstrating similar functional results in both types of procedures, caution should be exercised when interpreting the oncological results of this study. This is due to the lack of standardization in the postoperative management in the two trial groups, and the use of additional cancer treatments.

The third study presented was a paper published in European Urology Focus entitled: “Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy.”3 This was a prospective controlled non-randomized study of more than 4000 men at 14 centers. Quality of life was assessed at 3, 12, and 24 months after robotic and open RP. The results demonstrated that no difference was apparent between the two surgical modalities. Incontinence and erectile dysfunction (ED) increased the risk for poor quality of life in both groups, while BCR did not affect it.

The fourth paper presented was a study published in the World Journal of Urology entitled: “Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial.”4 This was also a prospective randomized study including 120 patients. The goal of this study was to demonstrate the benefits of fluorescence-supported (ICG) extended pelvic lymph node dissection (ePLND) compared to regular ePLND in robotic RP. Interestingly, the ICG-supported ePLND demonstrated removal of significantly more lymph nodes (25 vs. 17, p<0.001). After a median follow-up of 22.9 months, PSA levels were similar in both groups. The authors concluded that ICG-ePLND supports the understanding of lymphatic pathways and may favor a more meticulous diagnostic and thus possibly therapeutic approach.

The last paper presented was published in the Journal of Urology, entitled: “ Development and Validation of Objective Performance Metrics for Robot-Assisted Radical Prostatectomy: A Pilot Study.”5 The authors validated objective surgeon performance metrics using a novel recorder (dVLogger) to directly capture surgeon manipulations on the da Vinci Surgical System. The objective metrics revealed experts to be much more efficient and directed during preselected steps of robotic RP. The authors hope that these finding may lay the foundation for developing standardized metrics for surgeon training and assessment.

Presented by: Nikolaos Grivas, Amsterdam, Netherlands, Ioannia, Greece

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the EAU Robotic Urology Section (ERUS) Meeting - September 5 - 7, 2018 - Marseille, France

References:

1.Patel VR, Sandri M, Grasso AAC, et al. A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy. 2018; 121(3): 373-82.
2.Coughlin GD, Yaxley JW, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomized controlled study. The Lancet Oncology 2018; 19(8): 1051-60.
3.Wallerstedt A, Nyberg T, Carlsson S, et al. Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy. European urology focus 2018.
4.Harke NN, Godes M, Wagner C, et al. Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial. World journal of urology 2018.
5.Hung AJ, Chen J, Jarc A, et al. Development and Validation of Objective Performance Metrics for Robot-Assisted Radical Prostatectomy: A Pilot Study. The Journal of Urology 2018; 199(1): 296-304.