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Oncologic outcomes at 10 years following robotic radical prostatectomy.
Eur Urol. 2015 Jun; 67(6):1168-1176.EU

Abstract

BACKGROUND

Reports on long-term oncologic outcomes for patients who undergo robot-assisted radical prostatectomy (RARP) are scant, as for radical prostatectomy covering only the contemporary prostate-specific antigen (PSA) era.

OBJECTIVE

To evaluate cancer control in men who underwent RARP at least 10 yr ago.

DESIGN, SETTING, AND PARTICIPANTS

From 2001 to 2003, we followed 483 consecutive men with localized prostate cancer who underwent RARP at a high-volume tertiary center.

INTERVENTION

RARP as first-line therapy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We calculated biochemical recurrence -free survival (BCRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Actuarial rates were estimated via Kaplan-Meier. Cox proportional hazards models were used to identify variables predictive of biochemical recurrence (BCR), receipt of salvage therapy, and metastases.

RESULTS AND LIMITATIONS

There were 108 patients with BCR at a median follow-up of 121 mo (interquartile range: 97-132). Actuarial BCRFS, MFS, and CSS rates at 10 yr were 73.1%, 97.5%, and 98.8%, respectively. On multivariable analysis, D'Amico risk groups or pathologic Gleason grade, stage, and margins were the strongest predictors of BCR depending on whether preoperative or postoperative variables were considered. The value of the detectable PSAs together with disease severity were independent predictors of receipt of salvage therapy, together with a persistent PSA for metastases.

CONCLUSIONS

In contemporary patients with localized prostate cancer, RARP confers effective 10-yr cancer control. Disease severity and PSA measurements can be used to guide more personalized and cost-effective postoperative surveillance regimens.

PATIENT SUMMARY

Robot-assisted radical prostatectomy confers effective 10-yr cancer control for men with localized disease, similar to the open approach. Recurrence is best predicted by postoperative disease severity. Persistent disease signals the risk of progression likely requiring early salvage treatment; lower postoperative risk warrants protracted surveillance beyond 5 yr from surgery, and those with higher risk may require follow-up beyond 10 yr.

Authors+Show Affiliations

Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA. Electronic address: mdiazmail-web@yahoo.com.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.Department of Pathology, Henry Ford Hospital, Detroit, MI, USA.Department of Pathology, Henry Ford Hospital, Detroit, MI, USA.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; Case Western Reserve University, Cleveland, OH, USA; New York University, New York, NY, USA; University of Toledo School of Medicine, Toledo, OH, USA.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24996687

Citation

Diaz, Mireya, et al. "Oncologic Outcomes at 10 Years Following Robotic Radical Prostatectomy." European Urology, vol. 67, no. 6, 2015, pp. 1168-1176.
Diaz M, Peabody JO, Kapoor V, et al. Oncologic outcomes at 10 years following robotic radical prostatectomy. Eur Urol. 2015;67(6):1168-1176.
Diaz, M., Peabody, J. O., Kapoor, V., Sammon, J., Rogers, C. G., Stricker, H., Lane, Z., Gupta, N., Bhandari, M., & Menon, M. (2015). Oncologic outcomes at 10 years following robotic radical prostatectomy. European Urology, 67(6), 1168-1176. https://doi.org/10.1016/j.eururo.2014.06.025
Diaz M, et al. Oncologic Outcomes at 10 Years Following Robotic Radical Prostatectomy. Eur Urol. 2015;67(6):1168-1176. PubMed PMID: 24996687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oncologic outcomes at 10 years following robotic radical prostatectomy. AU - Diaz,Mireya, AU - Peabody,James O, AU - Kapoor,Victor, AU - Sammon,Jesse, AU - Rogers,Craig G, AU - Stricker,Hans, AU - Lane,Zhaoli, AU - Gupta,Nilesh, AU - Bhandari,Mahendra, AU - Menon,Mani, Y1 - 2014/07/02/ PY - 2014/03/31/received PY - 2014/06/16/accepted PY - 2014/7/6/entrez PY - 2014/7/6/pubmed PY - 2016/4/8/medline KW - Cancer control KW - Postoperative surveillance KW - Prostate cancer KW - Prostatectomy KW - Robotics SP - 1168 EP - 1176 JF - European urology JO - Eur. Urol. VL - 67 IS - 6 N2 - BACKGROUND: Reports on long-term oncologic outcomes for patients who undergo robot-assisted radical prostatectomy (RARP) are scant, as for radical prostatectomy covering only the contemporary prostate-specific antigen (PSA) era. OBJECTIVE: To evaluate cancer control in men who underwent RARP at least 10 yr ago. DESIGN, SETTING, AND PARTICIPANTS: From 2001 to 2003, we followed 483 consecutive men with localized prostate cancer who underwent RARP at a high-volume tertiary center. INTERVENTION: RARP as first-line therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We calculated biochemical recurrence -free survival (BCRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Actuarial rates were estimated via Kaplan-Meier. Cox proportional hazards models were used to identify variables predictive of biochemical recurrence (BCR), receipt of salvage therapy, and metastases. RESULTS AND LIMITATIONS: There were 108 patients with BCR at a median follow-up of 121 mo (interquartile range: 97-132). Actuarial BCRFS, MFS, and CSS rates at 10 yr were 73.1%, 97.5%, and 98.8%, respectively. On multivariable analysis, D'Amico risk groups or pathologic Gleason grade, stage, and margins were the strongest predictors of BCR depending on whether preoperative or postoperative variables were considered. The value of the detectable PSAs together with disease severity were independent predictors of receipt of salvage therapy, together with a persistent PSA for metastases. CONCLUSIONS: In contemporary patients with localized prostate cancer, RARP confers effective 10-yr cancer control. Disease severity and PSA measurements can be used to guide more personalized and cost-effective postoperative surveillance regimens. PATIENT SUMMARY: Robot-assisted radical prostatectomy confers effective 10-yr cancer control for men with localized disease, similar to the open approach. Recurrence is best predicted by postoperative disease severity. Persistent disease signals the risk of progression likely requiring early salvage treatment; lower postoperative risk warrants protracted surveillance beyond 5 yr from surgery, and those with higher risk may require follow-up beyond 10 yr. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/24996687/Oncologic_outcomes_at_10_years_following_robotic_radical_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(14)00599-5 DB - PRIME DP - Unbound Medicine ER -