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Urinary continence recovery and oncological outcomes after surgery for prostate cancer analysed by risk category: results from the LAParoscopic prostatectomy robot and open trial

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate urinary continence (UC) recovery and oncological outcomes in different risk-groups after robot-assisted radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP).

Patients and methods

We analysed 2650 men with prostate cancer from seven open (n = 805) and seven robotic (n = 1845) Swedish centres between 2008 and 2011 in a prospective non-randomised trial, LAPPRO. UC recovery was defined as change of pads less than once in 24 h. Information was collected through validated questionnaires. Rate of positive surgical margins (PSM) and biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) > 0.25 mg/ml, were recorded. We stratified patients into two risk groups (low-intermediate and high risk) based on the D’Amico risk classification system.

Result

Among men with high-risk prostate cancer, we found significantly higher rates of UC recovery up to 24 months after RRP compared to RALP (66.1% vs 60.5%) RR 0.85 (CI 95% 0.73–0.99) while PSM was more frequent after RRP compared to RALP (46.8% vs 23.5%) RR 1.56 (CI 95% 1.10–2.21). In the same group no significant difference was seen in BCR. Overall, however, BCR was significantly more common after RRP compared to RALP at 24 months (9.8% vs 6.6%) RR 1.43 (Cl 95% 1.08–1.89). The limitations of this study are its non-randomized design and the relatively short time of follow-up.

Conclusions

Our study indicates that men with high-risk tumour operated with open surgery had better urinary continence recovery but with a higher risk of PSM than after robotic-assisted laparoscopic surgery. No significant difference was seen in biochemical recurrence. 

Trial registration

ISRCTN06393679.

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Data availability

This manuscript has associated data which will not be deposited.

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Acknowledgements

The study was supported by research grants from the Swedish Research Council (2012-1770, 2015-02483), the Swedish Cancer Society (2010/503, 2013/497, 2016/362), Region Västra Götaland, Sahlgrenska University Hospital (ALF Grants 138751, 4307771, 718221 agreement concerning research and education of doctors), Mrs. Mary von Sydow Foundation, Anna and Edvin Berger Foundation. Dr Anna Lantz was supported by research Grants from the Stockholm County Council (20170579) and Swedish Medical Association (SLS-882441).

Funding

Peter Wiklund certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Author information

Authors and Affiliations

  1. Department of Molecular Medicine, Surgery and Pelvic Cancer, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden

    Anna Hagman, Anna Lantz, Stefan Carlsson, S. I. Tyritzis, Olof Akre & Peter Wiklund

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Anna Lantz

  3. Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA

    Peter Wiklund

  4. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Jonas Höijer

  5. Department of Urology, Institute of Clinical Science, Sahlgrenska Academy At the University of Gothenburg, Gothenburg, Sweden

    Johan Stranne & Jonas Hugosson

  6. Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden

    Johan Stranne

  7. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy At the University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden

    Eva Haglind

  8. Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden

    Eva Haglind

  9. Department of Urology, Skåne University Hospital, Lund University, Lund, Sweden

    Anders Bjartell

  10. Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy At the University of Gothenburg, Gothenburg, Sweden

    Gunnar Steineck

  11. Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Gunnar Steineck

  12. Karolinska University Hospital, Eugeniavägen 3, 171 76, Solna, Sweden

    Anna Hagman

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  1. Anna Hagman
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Contributions

NPW had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AH, AL, GS, NPW, EH. Acquisition of data: EH, AB, Carlsson, Wiklund, Steineck, Hugosson, Stranne. Analysis and interpretation of data: AH, PW, OA, AL, GS, SC, JH, JS, SIT, EH, AB, JH. Drafting of the manuscript: AH, AL, PW, OA. Critical revision of the manuscript for important intellectual content: AH, PW, OA, AL, GS, SC, JH, JS, SIT, EH, AB, JH. Statistical analysis: JH. Obtaining funding: EH. Administrative, technical or material support: GS, PW, EH. Supervision: PW.

Corresponding author

Correspondence to Anna Hagman.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The regional ethics committee in Gothenburg approved the study 2007/277-07 2007-10-19).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hagman, A., Lantz, A., Carlsson, S. et al. Urinary continence recovery and oncological outcomes after surgery for prostate cancer analysed by risk category: results from the LAParoscopic prostatectomy robot and open trial. World J Urol 39, 3239–3249 (2021). https://doi.org/10.1007/s00345-021-03662-0

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  • DOI: https://doi.org/10.1007/s00345-021-03662-0

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