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European UrologyVolume 62, issue 5, pages e83-e94, November 2012
Biochemical Recurrence After Robot-assisted Radical Prostatectomy in a European Single-centre Cohort with a Minimum Follow-up Time of 5 Years
Accepted 9 May 2012, Published online 19 May 2012, pages 768 - 774
Robot-assisted radical prostatectomy (RARP) is an increasingly commonly used surgical treatment option for prostate cancer (PCa); however, its longer-term oncologic results remain uncertain.
To report biochemical recurrence–free survival (BRFS) outcomes for men who underwent RARP ≥5 yr ago at a single European centre.
Design, setting, and participants
A total of 944 patients underwent RARP as monotherapy for PCa from January 2002 to December 2006 at Karolinska University Hospital, Stockholm, Sweden. Standard clinicopathologic variables were recorded and entered into a secure, ethics-approved database made up of those men with registered domiciles in Stockholm. The median follow-up time was 6.3 yr (interquartile range: 5.6–7.2).
Outcome measurements and statistical analysis
The outcome of this study was biochemical recurrence (BCR), defined as a confirmed prostate-specific antigen (PSA) of ≥0.2 ng/ml. Kaplan-Meier survival plots with log-rank tests, as well as Cox univariable and multivariable regression analyses, were used to determine BRFS estimates and determine predictors of PSA relapse, respectively.
Results and limitations
The BRFS for the entire cohort at median follow-up was 84.8% (95% confidence interval [CI], 82.2–87.1); estimates at 5, 7, and 9 yr were 87.1% (95% CI, 84.8–89.2), 84.5% (95% CI, 81.8–86.8), and 82.6% (95% CI, 79.0–85.6), respectively. Nine and 19 patients died of PCa and other causes, respectively, giving end–of–follow-up Kaplan-Meier survival estimates of 98.0% (95% CI, 95.5–99.1) and 94.1% (95% CI, 90.4–96.4), respectively. Preoperative PSA >10, postoperative Gleason sum ≥4 + 3, pathologic T3 disease, positive surgical margin status, and lower surgeon volume were associated with increased risk of BCR on multivariable analysis. This study is limited by a lack of nodal status and tumour volume, which may have confounded our findings.
This case series from a single, high-volume, European centre demonstrates that RARP has satisfactory medium-term BRFS. Further follow-up is necessary to determine how this finding will translate into cancer-specific and overall survival outcomes.
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