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Intermediate-term cancer control outcomes in prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy: a multi-institutional analysis

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Abstract

Purpose

Cancer control outcomes following robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) remain inadequately addressed over intermediate-term (≥5-year) follow-up. We examined biochemical recurrence-free survival (BCRFS), clinical recurrence-free survival (CRFS), and cancer-specific survival (CSS) in a multi-institutional cohort of men undergoing RARP for localized PCa.

Materials and methods

A total of 5670 PCa patients undergoing RARP ± pelvic lymph node dissection as primary treatment modality at three tertiary care centers between 2001 and 2010 were analyzed. BCRFS, CRFS, and CSS were estimated using the Kaplan–Meier method. Cox proportional hazards model tested their association with available preoperative and postoperative parameters.

Results

43.6 and 15.1 % of patients had D’Amico intermediate- and high-risk disease, respectively. Over a mean (median) follow-up of 56 (50.4) months, 797 men had a BCR, 78 men had CR, and 32 men died of PCa. Actuarial BCRFS, CRFS, and CSS, respectively, were 83.3, 98.6, and 99.5 % at 5-year; 76.5, 97.5, and 98.7 % at 8-year; and 73.3, 96.7, and 98.4 % at 10-year follow-ups. Only 1.7 % of patients received any adjuvant treatment. Preoperative prostate-specific antigen (PSA) and biopsy Gleason score (GS) were independent clinical predictors of BCRFS, CRFS, and CSS, while postoperatively positive surgical margin, pathological GS, pathological stage, and lymph node invasion were significantly associated with BCR and CR (all p < 0.05).

Conclusions

Cancer control outcomes of RARP appear comparable to those reported for open and laparoscopic RP in previous literature, despite low overall rate of adjuvant treatment. Disease severity and preoperative PSA may aid in risk prognostication and defining postoperative follow-up protocols.

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Author contributions

FA, DD, AS, JS, BB, NF, AH, FM, AB, MG, and MM were involved in protocol/project development; FA, AH, NF, and DD collected or managed the data; DD and FA analyzed the data; all authors wrote and edited the manuscript; FM, AB, MM, and MG obtained funding; FM, MG, MM, and AB were responsible for administrative, technical or material support; and FM, MG, and MM were involved in supervision.

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    Authors and Affiliations

    1. Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA

      Firas Abdollah, Deepansh Dalela, Akshay Sood, Jesse Sammon, Wooju Jeong, Craig G. Rogers, Mireya Diaz-Insua, James Peabody & Mani Menon

    2. Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

      Burkhard Beyer, Alexander Haese & Markus Graefen

    3. Department of Urology, Vita Salute San Raffaele University, Milan, Italy

      Nicola Fossati, Francesco Montorsi & Alberto Briganti

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    1. Firas Abdollah
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    2. Deepansh Dalela
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    Correspondence to Firas Abdollah.

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    Additional information

    Firas Abdollah and Deepansh Dalela have contributed equally to this work.

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    Supplementary Figure 1

    Cancer-specific survival (overall [A] and stratified by D Amico risk criteria [B]) in 5670 patients treated with robot-assisted radical prostatectomy at three academic centers between 2001 and 2010 (PDF 332 kb)

    Supplementary material 2 (DOC 79 kb)

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    Abdollah, F., Dalela, D., Sood, A. et al. Intermediate-term cancer control outcomes in prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy: a multi-institutional analysis. World J Urol 34, 1357–1366 (2016). https://doi.org/10.1007/s00345-016-1781-y

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    • DOI: https://doi.org/10.1007/s00345-016-1781-y

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