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Prostate Cancer

Oncologic Outcomes at 10 Years Following Robotic Radical Prostatectomy

By: Mireya Diaz a b lowast , James O. Peabody a , Victor Kapoor a , Jesse Sammon a , Craig G. Rogers a , Hans Stricker a , Zhaoli Lane c , Nilesh Gupta c , Mahendra Bhandari a and Mani Menon a d

European Urology, Volume 67 Issue 6, June 2015, Pages 1168-1176

Published online: 01 June 2015

Keywords: Cancer control, Prostate cancer, Prostatectomy, Robotics, Postoperative surveillance

Abstract Full Text Full Text PDF (1,1 MB) Patient Summary

Abstract

Background

Reports on long-term oncologic outcomes for patients who undergo robot-assisted radical prostatectomy (RARP) are scant, as for radical prostatectomy covering only the contemporary prostate-specific antigen (PSA) era.

Objective

To evaluate cancer control in men who underwent RARP at least 10 yr ago.

Design, setting, and participants

From 2001 to 2003, we followed 483 consecutive men with localized prostate cancer who underwent RARP at a high-volume tertiary center.

Intervention

RARP as first-line therapy.

Outcome measurements and statistical analysis

We calculated biochemical recurrence –free survival (BCRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Actuarial rates were estimated via Kaplan-Meier. Cox proportional hazards models were used to identify variables predictive of biochemical recurrence (BCR), receipt of salvage therapy, and metastases.

Results and limitations

There were 108 patients with BCR at a median follow-up of 121 mo (interquartile range: 97–132). Actuarial BCRFS, MFS, and CSS rates at 10 yr were 73.1%, 97.5%, and 98.8%, respectively. On multivariable analysis, D’Amico risk groups or pathologic Gleason grade, stage, and margins were the strongest predictors of BCR depending on whether preoperative or postoperative variables were considered. The value of the detectable PSAs together with disease severity were independent predictors of receipt of salvage therapy, together with a persistent PSA for metastases.

Conclusions

In contemporary patients with localized prostate cancer, RARP confers effective 10-yr cancer control. Disease severity and PSA measurements can be used to guide more personalized and cost-effective postoperative surveillance regimens.

Patient summary

Robot-assisted radical prostatectomy confers effective 10-yr cancer control for men with localized disease, similar to the open approach. Recurrence is best predicted by postoperative disease severity. Persistent disease signals the risk of progression likely requiring early salvage treatment; lower postoperative risk warrants protracted surveillance beyond 5 yr from surgery, and those with higher risk may require follow-up beyond 10 yr.

Take Home Message

Disease severity and postoperative prostate-specific antigen measurements can guide the determination of risk groups amenable to cost-effective long-term postoperative surveillance regimens and, if needed, secondary treatment after radical prostatectomy. A body of consistent and rigorously acquired evidence will allow formulation of such regimens.

Keywords: Cancer control, Prostate cancer, Prostatectomy, Robotics, Postoperative surveillance.

Footnotes

a Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

b Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA

c Department of Pathology, Henry Ford Hospital, Detroit, MI, USA

d Case Western Reserve University, Cleveland, OH, USA; New York University, New York, NY, USA; University of Toledo School of Medicine, Toledo, OH, USA

lowast Corresponding author. Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA. Tel.: +1 313 916 4741.

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