Prostate Cancer Smart Surgery Treatment Trifecta

Robotic Prostatectomy Oncologic Outcomes

Risk Stratification and Early Oncologic Outcomes Following Robotic Prostatectomy.


Ardavan Akhavan, MD, Adam W. Levinson, MD, Paul Muntner, PhD, Fatima Nabizada-Pace, MPH, David B Samadi, MD

Introduction
The American Cancer Society estimated that 186 320 new prostate cancer cases would be diagnosed in 2008, making it the most common form of cancer in men.1 Because treatment of localized prostate cancer can be curative, accurate preoperative risk stratification is paramount in choosing optimal treatment. In 1998, D’Amico et al2 retrospectively examined the outcomes of a large cohort of men with prostate cancer who underwent open radical prostatectomy, external beam radiation, and interstitial radiation with or without neoadjuvant androgen deprivation. The authors proposed a risk stratification scheme based on preoperative Gleason sum, prostatic-specific antigen (PSA), and clinical staging to predict biochemical failure.

This risk stratification scheme has subsequently been externally validated following treatment with these same modalities.3,4 To our knowledge, no studies have compared the preoperative risk stratification with outcomes of men undergoing robot-assisted laparoscopic prostatectomy (RALP). Since its introduction in the United States in 2000, RALP has become one of the most popular treatments for localized prostate cancer. Although numerous reports of perioperative and short-term functional outcomes exist,5–10 due to the novel nature of robotics and the indolent natural history of prostate cancer, there is a paucity of literature on oncologic outcomes.10–12 In this study, we report the early oncologic outcomes in patients who underwent RALP by a single surgeon over a recent 4-year period. Specifically, we assess the association between biochemical failure and perioperative variables, including D’Amico risk stratification in patients undergoing RALP with up to 55 months of follow-up.

Methods

Study Population

We queried an IRB-approved database of 802 consecutive patients who underwent RALP by a single surgeon (DBS), between January 2003 and November 2007. Patients with insufficient clinical data to allow D’Amico risk stratification were excluded from the current analysis. Additionally, to ensure adequate oncologic follow-up, patients with less than 6 months of documented PSA data were also excluded, though all patients who failed biochemically prior to this time point were included.