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Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy.
Eur Urol. 2018 02; 73(2):215-223.EU

Abstract

BACKGROUND

Identifying the optimal surgical approach for patients with localized prostate cancer (PCa) managed in the community setting remains controversial due to the lack of robust, prospective data.

OBJECTIVE

To assess surgical outcomes and changes in urinary and sexual quality of life (QOL) over time in patients undergoing radical prostatectomy (RP).

DESIGN, SETTING, AND PARTICIPANTS

Our study included patients enrolled in Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a large, prospective, mostly community-based, nationwide PCa registry, who underwent RP between 2004 and 2016.

INTERVENTION

Open (ORP) versus robot-assisted radical prostatectomy (RARP) for localized PCa.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Demographic and clinicopathologic data and surgical outcomes were compared between ORP and RARP. Self-reported, validated questionnaires (scaled 0-100 with higher numbers indicating better function) were used to evaluate urinary and sexual QOL at different time points. Repeated measures mixed-models assessed changes in function and bother over time in each domain.

RESULTS AND LIMITATIONS

Among 1892 men (n = 1137 ORP; n = 755 RARP), Cancer of the Prostate Risk Assessment score, Gleason grade at biopsy and RP, and pT-stage were lower in ORP patients (all p < 0.01). Men undergoing RARP had comparable surgical margin rates, lymph node yields, and biochemical recurrence rates. In a subset analysis with 1451 men reporting baseline and follow-up QOL data, ORP patients reported superior scores in urinary incontinence (ORP mean ± standard deviation 69 ± 26 vs RARP 62 ± 27) and bother (ORP 75±29 vs RARP 68±28, both p < 0.01) only in the 1st yr after RP. Differences in sexual outcomes did not differ between groups, nor did any QOL scores beyond 1 yr. Limitations include a decrease in the rate of questionnaire response during follow-up, potential selection biases in terms of patient assignment to ORP versus RARP and survey completion rates, and the fact that RARP cases likely included the initial learning curve for the CaPSURE surgeons.

CONCLUSIONS

Most patients experienced changes in urinary and sexual QOL in the 1st 3 yr following RP. The pattern of recovery over time was similar between ORP and RARP groups. Patients should not expect different oncologic or QOL outcomes based on surgical approach.

PATIENT SUMMARY

Aside from a small, early, and temporary advantage in terms of urinary incontinence and bother favoring open surgery, minimal differences in outcomes are observed when comparing men who undergo open versus robot-assisted prostatectomy in the community setting.

Authors+Show Affiliations

Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany.Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. Electronic address: mcooperberg@urology.ucsf.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

28499617

Citation

Herlemann, Annika, et al. "Community-based Outcomes of Open Versus Robot-assisted Radical Prostatectomy." European Urology, vol. 73, no. 2, 2018, pp. 215-223.
Herlemann A, Cowan JE, Carroll PR, et al. Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy. Eur Urol. 2018;73(2):215-223.
Herlemann, A., Cowan, J. E., Carroll, P. R., & Cooperberg, M. R. (2018). Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy. European Urology, 73(2), 215-223. https://doi.org/10.1016/j.eururo.2017.04.027
Herlemann A, et al. Community-based Outcomes of Open Versus Robot-assisted Radical Prostatectomy. Eur Urol. 2018;73(2):215-223. PubMed PMID: 28499617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy. AU - Herlemann,Annika, AU - Cowan,Janet E, AU - Carroll,Peter R, AU - Cooperberg,Matthew R, Y1 - 2017/05/09/ PY - 2016/12/01/received PY - 2017/04/19/accepted PY - 2017/5/14/pubmed PY - 2019/1/5/medline PY - 2017/5/14/entrez KW - Cancer of the Prostate Strategic Urologic Research Endeavor KW - Comparative effectiveness research KW - Prostate cancer KW - Quality of life KW - Radical prostatectomy KW - Robot-assisted KW - Urinary and sexual outcomes SP - 215 EP - 223 JF - European urology JO - Eur. Urol. VL - 73 IS - 2 N2 - BACKGROUND: Identifying the optimal surgical approach for patients with localized prostate cancer (PCa) managed in the community setting remains controversial due to the lack of robust, prospective data. OBJECTIVE: To assess surgical outcomes and changes in urinary and sexual quality of life (QOL) over time in patients undergoing radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS: Our study included patients enrolled in Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a large, prospective, mostly community-based, nationwide PCa registry, who underwent RP between 2004 and 2016. INTERVENTION: Open (ORP) versus robot-assisted radical prostatectomy (RARP) for localized PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Demographic and clinicopathologic data and surgical outcomes were compared between ORP and RARP. Self-reported, validated questionnaires (scaled 0-100 with higher numbers indicating better function) were used to evaluate urinary and sexual QOL at different time points. Repeated measures mixed-models assessed changes in function and bother over time in each domain. RESULTS AND LIMITATIONS: Among 1892 men (n = 1137 ORP; n = 755 RARP), Cancer of the Prostate Risk Assessment score, Gleason grade at biopsy and RP, and pT-stage were lower in ORP patients (all p < 0.01). Men undergoing RARP had comparable surgical margin rates, lymph node yields, and biochemical recurrence rates. In a subset analysis with 1451 men reporting baseline and follow-up QOL data, ORP patients reported superior scores in urinary incontinence (ORP mean ± standard deviation 69 ± 26 vs RARP 62 ± 27) and bother (ORP 75±29 vs RARP 68±28, both p < 0.01) only in the 1st yr after RP. Differences in sexual outcomes did not differ between groups, nor did any QOL scores beyond 1 yr. Limitations include a decrease in the rate of questionnaire response during follow-up, potential selection biases in terms of patient assignment to ORP versus RARP and survey completion rates, and the fact that RARP cases likely included the initial learning curve for the CaPSURE surgeons. CONCLUSIONS: Most patients experienced changes in urinary and sexual QOL in the 1st 3 yr following RP. The pattern of recovery over time was similar between ORP and RARP groups. Patients should not expect different oncologic or QOL outcomes based on surgical approach. PATIENT SUMMARY: Aside from a small, early, and temporary advantage in terms of urinary incontinence and bother favoring open surgery, minimal differences in outcomes are observed when comparing men who undergo open versus robot-assisted prostatectomy in the community setting. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/28499617/Community_based_Outcomes_of_Open_versus_Robot_assisted_Radical_Prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(17)30335-4 DB - PRIME DP - Unbound Medicine ER -