AUA 2017: Erectile-function and Oncologic Outcomes After Open Retropubic and Robot-assisted Radical Prostatectomy: Results From a Large, Prospective Swedish Trial

Boston, MA (UroToday.com) In Sweden, prostatectomies are quasi-randomized for open prostatectomy (RP) vs. robot assisted RP. Though, the technique use of robot-assisted laparoscopy compared to an open approach on surgeon performance continues to remain a topic of debate. This study assessed the pros and cons of the respective techniques by analyzing separated data for high and low-risk tumors.

This trial prospectively recruited men with prostate cancer from fourteen centers (seven open and seven robot-assisted surgery centers). Data on patient-reported erectile-function was collected before, three, twelve and twenty-four months after surgery. Neurovascular bundle preservation was subjectively reported by the respective urologists, while rates of positive surgical margins were defined by pathologists. Lastly, biochemical recurrence rate was measured at three, twelve, and twenty-four months. Despite long-term follow up, high completion rates (>90%) were present.

Data was collected from a total of 2545 men (1792 robot-assisted and 743 open surgery). Among preoperatively potent men, 1702 presented enhanced erectile-function recovery in the robot assisted group at three months with smaller differences at 12 and 24 months. For patients with high-risk tumors, point estimates for erectile-function recovery were higher in the open prostatectomy group. PT2 margin rates were better for the open group compared to the robot assisted group. There was no significant difference in biochemical recurrence (BCR) for pT2 disease. PT3 and pT4 margin rates were found to be worse for the open group compared to the robot assisted group. Moreover, the study found worse BCR rates for pT3 and pT4 disease among the open group.
In conclusion, tumor characteristics can be used as a distinguishing factor when assessing erectile-function recovery and oncologic outcomes among the two surgical techniques common to the prostatectomy. This study ultimately suggests the improvement of surgery plane irrespective of technique used.

Presented By: Prasanna Sooriakumaran

Authors: Prasanna Sooriakumaran*, Oxford, United Kingdom; Gio Pini, Milan, Italy; Tommy Nyberg, Maryam Derogar, Stefan Carlsson, Stockholm, Sweden; Johan Stranne, Gothenburg, Sweden; Anders Bjartell, Lund, Sweden; Jonas Hugosson, Gothenburg, Sweden; Gunnar Steineck, Peter Wiklund, Stockholm, Sweden

Written By: Rita Derderian, University of California, Irvine for UroToday.com

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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