Oncological outcomes after robot‐assisted radical prostatectomy: long‐term follow‐up in 4803 patients

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.