Prabhakar Rajan1, Anna Hagman2, Prasanna Sooriakumaran3, Tommy Nyberg4, Anna Wallerstedt2, Christofer Adding2, Olof Akre5, Stefan Carlsson6, Abolfazl Hosseini2, Mats Olsson2, Lars Egevad7, Fredrik Wiklund8, Gunnar Steineck9, N Peter Wiklund10. 1. Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, London, UK; Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: p.rajan@qmul.ac.uk. 2. Department of Urology, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 4. Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden. 5. Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. 6. Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden. 7. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. 8. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 9. Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden. 10. Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden. Electronic address: peter.wiklund@karolinska.se.
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 >3mm/multifocal but not ≤3mm 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 ≤3mm 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 (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer.
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 >3mm/multifocal but not ≤3mm 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 ≤3mm 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 (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer.
Authors: Antonio Benito Porcaro; Marco Sebben; Paolo Corsi; Alessandro Tafuri; Tania Processali; Marco Pirozzi; Nelia Amigoni; Riccardo Rizzetto; Giovanni Cacciamani; Arianna Mariotto; Alberto Diminutto; Matteo Brunelli; Vincenzo De Marco; Salvatore Siracusano; Walter Artibani Journal: J Robot Surg Date: 2019-04-05
Authors: Antonio B Porcaro; Alessandro Tafuri; Marco Sebben; Paolo Corsi; Tania Processali; Marco Pirozzi; Nelia Amigoni; Riccardo Rizzetto; Aliasger Shakir; Giovanni Cacciamani; Arianna Mariotto; Matteo Brunelli; Riccardo Bernasconi; Giovanni Novella; Vincenzo De Marco; Walter Artibani Journal: Arab J Urol Date: 2019-05-30
Authors: André N Vis; Roderick C N van den Bergh; Henk G van der Poel; Alexander Mottrie; Philip D Stricker; Marcus Graefen; Vipul Patel; Bernardo Rocco; Birgit Lissenberg-Witte; Pim J van Leeuwen Journal: BJUI Compass Date: 2021-11-09
Authors: Elin Axén; Rebecka Arnsrud Godtman; Anders Bjartell; Stefan Carlsson; Eva Haglind; Jonas Hugosson; Anna Lantz; Marianne Månsson; Gunnar Steineck; Peter Wiklund; Johan Stranne Journal: Eur Urol Open Sci Date: 2021-06-19