OBJECTIVE: To evaluate oncologic outcomes in patients undergoing robot-assisted radical prostatectomy (RARP) at a high-volume tertiary center with focus on biochemical recurrence (BCR).
Previous studies on oncologic outcomes for patients undergoing RARP for prostate cancer (PCa) are limited to small series.
MATERIALS AND METHODS: A total of 5,152 consecutive patients underwent RARP from 2001-2010; 4,803 patients comprised the study cohort after exclusions. BCR was defined as a serum prostate-specific antigen (PSA) ≥ 0.2 ng/ml with a confirmatory value. 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.
RESULTS: Mean preoperative PSA was 6.1 ng/ml, pathologic Gleason grade and stage were ≥ 7 in 68% and ≥ pT3 in 34% of patients. BCR was noted in 470 patients (9.8%), 31 patients developed metastatic disease (0.7%) and 13 patients died of PCa (0.3%) during a mean follow-up of 34.6 months (range 1-116.7 months). 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%. For organ-confined disease, predictors of BCR included pathology Gleason grade (primary Gleason 5 vs. 3, HR: 5.52, p=0.018; Gleason 4 vs. 3, HR: 1.97, p =0.001), preoperative PSA (10-20 vs. ≤ 10, HR: 2.38, p=0.001) surgical margin status (positive vs. negative, HR: 3.84, p< 0.001).
CONCLUSIONS: RARP appears to confer effective long-term biochemical control. To our knowledge, this is the largest report of oncologic outcomes in a RARP series to date.
Written by:
Sukumar S, Rogers CG, Trinh QD, Sammon J, Sood A, Stricker H, Peabody JO, Menon M, Diaz-Insua M. Are you the author?
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Reference: BJU Int. 2013 Aug 12. Epub ahead of print.
doi: 10.1111/bju.12404
PubMed Abstract
PMID: 24053586
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