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Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up

  • Prabhakar Rajan
    Correspondence
    Corresponding authors. Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London EC1M 6BQ, UK. Tel. +44 20 78823094; Fax: +44 20 78823884. Department of Urology, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden. Tel. +46 8 51774541; Fax: +46 8 51773599.
    Affiliations
    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
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  • Anna Hagman
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden
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  • Prasanna Sooriakumaran
    Affiliations
    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
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  • Tommy Nyberg
    Affiliations
    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
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  • Anna Wallerstedt
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden
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  • Christofer Adding
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden
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  • Olof Akre
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden

    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
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  • Stefan Carlsson
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden

    Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden
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  • Abolfazl Hosseini
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden
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  • Mats Olsson
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden
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  • Lars Egevad
    Affiliations
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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  • Fredrik Wiklund
    Affiliations
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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  • Gunnar Steineck
    Affiliations
    Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
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  • N. Peter Wiklund
    Correspondence
    Corresponding authors. Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London EC1M 6BQ, UK. Tel. +44 20 78823094; Fax: +44 20 78823884. Department of Urology, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden. Tel. +46 8 51774541; Fax: +46 8 51773599.
    Affiliations
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden

    Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden
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Published:November 02, 2016DOI:https://doi.org/10.1016/j.euf.2016.10.007

      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 >3 mm/multifocal but not ≤3 mm 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 ≤3 mm 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 (<3 mm) 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.

      Keywords

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