San Antonio, Texas USA (UroToday.com) Peter Chang, Beth Israel Deaconess, presented their work from the Prost-QA/RP2 consortium. With rapid adoption of robotic prostatectomy (RALP) there are conflicting evidence regarding the superiority over open radical prostatectomy (RP).
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This study was prospective and longitudinally powered for RP and RALP discerning oncologic efficacy and quality of life (QOL) outcomes. Patients from 2003-2006 and 2010-2013 were included where n=1371 and n=677 were from the Prost-QA and RP2 cohorts, respectively. QOL was assessed using multivariate GEE modeling using the EPIC questionnaire. Surgical approach was not a significant predictor of longitudinal QOL change over time regardless of nerve-sparing use. Positive surgical margins was not significantly different except in cases of extraprostatic extension (p=0.053) which approached significance. Patients who underwent RALP were less likely to undergo lymphadenectomy, had decreased pain and shorter hospital stay (p<0.001) than RP patients. RALP had decreased wound infections, unplanned catheterizations and fewer deep venous thrombosis episodes (<p<0.001) than RP patients. Unfortunately, provider volume was not assessed, however, the cohorts were derived from high volume centers. With the recent level one evidence showing no difference among treatment approach, these data further support those findings. However, given the study design there are inherent limitations including for example lymphadenectomy use and determining which patients were over versus under treated. Given the surge in RALP with the current evidence it remains paramount we as urologists do not entirely abandon RP as a feasible treatment option.
Presented By: Peter Chang, Beth Israel Deaconess
Written By: Stephen B. Williams, MD and Ashish M. Kamat17th Annual Meeting of the Society of Urologic Oncology
- November 30 -December 2, 2016 – San Antonio, Texas USA