Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up

• Published in: European urology focus 2018-05, Vol.4 (3), p.351-359
• Main Authors: Rajan, Prabhakar, Hagman, Anna, Sooriakumaran, Prasanna, Nyberg, Tommy, Wallerstedt, Anna, Adding, Christofer, Akre, Olof, Carlsson, Stefan, Hosseini, Abolfazl, Olsson, Mats, Egevad, Lars, Wiklund, Fredrik, Steineck, Gunnar, Wiklund, N. Peter
• Format: Article
• Language: English
• Subjects: Aged; Disease-Free Survival; Europe - epidemiology; Follow-Up Studies; Humans; Lymph Nodes - pathology; Male; Medicin och hälsovetenskap; Middle Aged; Neoplasm Grading; Outcome Assessment, Health Care; Postoperative Period; Preoperative Period; Prospective Studies; Prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Recurrence; Robot-assisted surgery; Robotic Surgical Procedures - methods; Salvage Therapy; Urology
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2016.10.007

Abstract Background Robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) treatment has been widely adopted with limited evidence for long-term (>5 yr) oncologic efficacy. Objective To evaluate long-term oncologic outcomes following RARP. Design, setting, and participants Prospective cohort study of 885 patients who underwent RARP as monotherapy for PCa between 2002 and 2006 in a single European centre and followed up until 2016. Intervention RARP as monotherapy. Outcome measurements and statistical analysis Biochemical recurrence (BCR)–free survival (BCRFS), salvage therapy (ST)–free survival (STFS), prostate cancer–specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method, and event-time distributions were compared using the log-rank test. Variables predictive of BCR and ST were identified using Cox proportional hazards models. Results and limitations We identified 167 BCRs, 110 STs, 16 PCa-related deaths, and 51 deaths from other/unknown causes. BCRFS, STFS, CSS, and OS rates were 81.8%, 87.5%, 98.5%, and 93.0%, respectively, at median follow-up of 10.5 yr. On multivariable analysis, the strongest independent predictors of both BCR and ST were preoperative Gleason score, pathological T stage, positive surgical margins (PSMs), and preoperative prostate-specific antigen. PSM >3 mm/multifocal but not ≤3 mm independently affected the risk of both BCR and ST. Study limitations include a lack of centralised histopathologic reporting, lymph node and post-operative tumour volume data in a historical cohort, and patient-reported outcomes. Conclusions RARP appears to confer effective long-term oncologic efficacy. The risk of BCR or ST is unaffected by ≤3 mm PSM, but further follow-up is required to determine any impact on CSS. Patient summary Robot-assisted surgery for prostate cancer is effective 10 yr after treatment. Very small (