Oncologic outcomes at 10 years following robotic radical prostatectomy

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.

Keywords: Cancer control; Postoperative surveillance; Prostate cancer; Prostatectomy; Robotics.