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European UrologyVolume 58, issue 6, pages e53-e62, December 2010
Biochemical Recurrence Following Robot-Assisted Radical Prostatectomy: Analysis of 1384 Patients with a Median 5-year Follow-up
Accepted 6 September 2010, Published online 15 September 2010, pages 838 - 846
- Material and methods
There is a paucity of data on long-term oncologic outcomes for patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa).
To evaluate oncologic outcomes in patients undergoing RARP at a high-volume tertiary center, with a focus on 5-yr biochemical recurrence–free survival (BCRFS).
Design, setting, and participants
The study cohort consisted of 1384 consecutive patients with localized PCa who underwent RARP between September 2001 and May 2005 and had a median follow-up of 60.2 mo. No patient had secondary therapy until documented biochemical recurrence (BCR). BCR was defined as a serum prostate-specific antigen ≥0.2 ng/ml with a confirmatory value. BCRFS was estimated using the Kaplan-Meier method. Event–time distributions for the time to failure were compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of BCR.
All patients underwent RARP.
BCRFS rates were measured.
Results and limitations
This cohort of patients had moderately aggressive PCa: 49.0% were D’Amico intermediate or high risk on biopsy; however, 60.9% had Gleason 7–10 disease, and 25.5% had ≥T3 disease on final pathology. There were 189 incidences of BCR (31 per 1,000 person years of follow-up) at a median follow-up of 60.2 mo (interquartile range [IQR]: 37.2–69.7). The actuarial BCRFS was 95.1%, 90.6%, 86.6%, and 81.0% at 1, 3, 5, and 7 yr, respectively. In the patients who recurred, median time to BCR was 20.4 mo; 65% of BCR incidences occurred within 3 yr and 86.2% within 5 yr. On multivariable analysis, the strongest predictors of BCR were pathologic Gleason grade 8–10 (hazard ratio [HR]: 5.37; 95% confidence interval [CI], 2.99–9.65; p < 0.0001) and pathologic stage T3b/T4 (HR: 2.71; 95% CI, 1.67–4.40; p < 0.0001).
In a contemporary cohort of patients with localized PCa, RARP confers effective 5-yr biochemical control.
Keywords: Laparoscopy, Outcomes, Prostate cancer, Prostatectomy, Robotics, Biochemical recurrence, Survival.
© 2010 European Association of Urology, Published by Elsevier B.V.
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