ATLANTA, GA USA (UroToday) - This retrospective analysis demonstrates what many patients have long assumed to be true. In this cohort of patients undergoing RP by highly experienced oncologic surgeons, there is no evidence that surgical approach impacted rates of biochemical recurrence, regardless of patient risk.
Individual surgeon skill and experience are likely more important to oncologic outcomes than surgical approach.
This is a retrospective review of patients who underwent open radical prostatectomy (ORP) or robot-assisted radical prostatectomy (RARP) for localized prostate cancer. The procedures were performed by the highest volume surgeons at a single New York tertiary care center and compares the biochemical recurrence (BCR) rates of the different procedures in these patients from 2007 - 2010.
The inclusion required the patients to have localized disease and therefore patients were excluded from analysis if they were receiving salvage surgery, had evidence of metastatic disease. Also patients were excluded if the surgical approach was not the surgeon's majority practice pattern. BCR was defined as PSA ≥0.1 ng/ml or any detectable PSA with receipt of additional therapy. A multivariable Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (“nomogram”) for BCR based on preoperative stage, grade and PSA. To determine whether differences between groups depended on baseline risk, an interaction term between nomogram risk and procedure type was included in a second model. To confirm that the results were sensitive to the choice of covariates, analyses were repeated using AUA defined risk groups in place of nomogram probability. The authors concluded that for the 1,454 patients who met inclusion criteria, 961 (66%) received ORP and 493(34%) received RALP.
There were no important differences in tumor characteristics by group, 32% of the cohort was low-risk, 49% intermediate and 19% high-risk. Preoperatively most patients had clinical Gleason 7 tumors, (50%, n=733), 37% (n=509) had palpable disease. Postoperatively, 35% (n=506) had pT3 disease, 10% (n= 139) had Gleason ≥8 disease, and 15% (n=221) had positive surgical margins. In multivariate model adjusting for preoperative risk, there was no significant difference in the rates of BCR for RALP compared to ORP (HR 0.84; 95% CI 0.47, 1.52; p=0.6). Therefore surgeon experience and skills were the likely difference.
Source of Funding: Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers, by funds provided by David H. Koch through the Prostate Cancer Foundation, and by the National Cancer Institute T32 CA082088-11 training grant.
Presented by Jonathan Silberstein, Daniel Su, Leonard Glickman, Gal Keren-Paz, Matthew Kent, Andrew Vickers, Jonathan Coleman, James Eastham, Peter Scardino, and Vincent Laudone at the American Urological Association (AUA) Annual Meeting - May 19 - 23, 2012 - Georgia World Congress Center - Atlanta, GA USA
