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Oncological outcomes after robot‐assisted radical prostatectomy: long‐term follow‐up in 4803 patients
Author(s) -
Sukumar Shyam,
Rogers Craig G.,
Trinh Quoc Dien,
Sammon Jesse,
Sood Akshay,
Stricker Hans,
Peabody James O.,
Me Mani,
DiazInsua Mireya
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12404
Subject(s) - medicine , prostatectomy , biochemical recurrence , prostate cancer , urology , proportional hazards model , hazard ratio , surgical margin , stage (stratigraphy) , cohort , prostate specific antigen , cancer , surgery , confidence interval , paleontology , biology
Objective 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.Patients and Methods In all, 5152 consecutive patients underwent RARP from 2001 to 2010; 4803 patients comprised the study cohort after exclusions. BCR was defined as a serum prostate‐specific antigen ( PSA ) level of ≥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 K aplan– M eier method and C ox hazards regression models were generated.Results The mean preoperative PSA level was 6.1 ng/mL, pathological G leason grade and stage were ≥7 in 68% and ≥ pT3 in 34% of patients. 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. 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 G leason grade (primary G leason 5 vs 3, hazard ratio [ HR ] 5.52, P = 0.018; G leason 4 vs 3, HR 1.97, P = 0.001), preoperative PSA level (10–20 vs ≤10 ng/mL, HR 2.38, P = 0.001), and surgical margin status (positive vs negative, HR 3.84, P < 0.001)ConclusionsRARP appears to confer effective long‐term biochemical control. To our knowledge, this is the largest report of oncological outcomes in a RARP series to date.