We investigated differences in treatment outcomes following radical prostatectomy (RP) between certified centers (CCs) and noncertified centers (nCCs) within the IMPROVE study group.
A validated survey assessing various factors, including stress urinary incontinence (SUI) and decision regret (DR), was administered to 950 patients who underwent RP across 19 hospitals (12 CCs and 7 nCCs) at a median follow-up of 15 months after RP (interquartile range: 11-20). The response rate was 74%, with 703 patients participating, including 480 (68%) from CCs. Multivariate binary regression models were used to analyze differences between CCs and nCCs regarding the following binary endpoints: nerve-sparing (NS), positive surgical margins (PSM), SUI (defined as >1 safety pad), complications based on the Clavien-Dindo classification (grade ≥1, grade ≥3) and DR (>15 points indicating critical DR).
Considering the multivariate analysis, the rate of NS surgery was lower in CCs than in nCCs (OR = 0.52; p = 0.004). No significant differences were observed in the PSM rate (OR = 1.67; p = 0.051), SUI (OR = 1.03; p = 0.919), and DR (OR = 1.00; p = 0.990). SUI (OR 0.39; p < 0.001) and DR (OR 0.62; p = 0.026) were reported significantly less frequently by patients treated with robotic-assisted RP, which was significantly more often performed in CCs than in nCCs (68.3% vs. 18%; p < 0.001). The total complication rate was 45% lower in CCs (OR = 0.55; p = 0.004), although the number of complications requiring intervention (Clavien-Dindo classification ≥3) did not differ significantly between CCs and nCCs (OR = 2.52; p = 0.051).
Within the IMPROVE study group, similarly favorable outcomes after RP were found in both CCs and nCCs, which, however, cannot be transferred to the general treatment landscape of PCA in Germany. Of note, robotic-assisted RP was more often performed in CCs and associated with less SUI and DR, while open prostatectomy was the treatment of choice in low-volume nCCs. Future prospective and region wide studies should also investigate the surgeon caseload and experience as well as a spillover effect of the certification process on nCCs.
Urologia internationalis. 2023 Nov 06 [Epub ahead of print]
Danijel Sikic, Christian Fiebig, Bernd Wullich, Ingmar Wolff, Bernd Hoschke, Andreas Manseck, Rolf Gillitzer, Maximilian Burger, Julie Steinestel, Nina Harke, Niklas Löbig, Florian A Distler, Matthias May, Julia Peter, Christian Gilfrich
Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany., Department of Urology, University Medicine Greifswald, Greifswald, Germany., Department of Urology and Pediatric Urology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany., Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany., Department of Urology, Klinikum Darmstadt, Darmstadt, Germany., Department of Urology, St. Josef-Hospital Regensburg, Medical University Regensburg, Regensburg, Germany., Department of Urology, University Hospital Augsburg, Augsburg, Germany., Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany., Department of Urology and Pediatric Urology, Universitätsklinikum Ulm, Ulm, Germany., Department of Urology, Paracelsus Medical University, Nuremberg, Germany., Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany.