Patients treated with robot-assisted radical prostatectomy (RARP) are frequently selected according to more favorable characteristics. Such patient selection might decrease according to increasing experience.
We relied on the Martini-Clinic Prostate Cancer Center database and focused on patients treated with RARP between 2004 and 2013. Differences in clinical, pathological and surgical characteristics at RARP over time (2004-2010, 2011-2012 and 2013) were assessed.
Overall, 1,783 RARP patients were identified. Of those, 407 (22.8%), 764 (42.8%) and 612 (34.3%) were treated between 2004 and 2010, in 2011-2012 and in 2013, respectively. Unfavorable characteristics rate, such as biopsy Gleason score ≥4+4 (8 vs. 9 vs. 15%, p<0.001), D ́Amico high-risk (12 vs. 14 vs. 19%, p=0.001) and pathological Gleason score ≥4+4 (3 vs. 4 vs. 6%, p<0.001) increased over time. Pelvic lymph node dissection (PLND) was more frequently performed over time (62 vs. 83 vs. 84%, p<0.001), especially in D ́Amico intermediate or high-risk patients (82 vs. 94 vs. 96%, p<0.001). Lymph node yield increased over time in overall (7 vs. 9 vs. 13, p<0.001), D ́Amico intermediate (6 vs. 9 vs. 12, p<0.001) and D ́Amico high-risk patients (9 vs. 12 vs. 18, p<0.001). No differences in surgical margin (p=0.7) and nerve sparing rates (p=0.09) were found.
A clear trend towards more unfavorable tumor characteristics over time was recorded. Additionally, the rates and extent of PLND increased with increasing experience. RARP does not represent a barrier to PLND at our institution.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2016 Mar 09 [Epub ahead of print]
Jonas Schiffmann, Alexander Haese, Katharina Boehm, Georg Salomon, Thomas Steuber, Hans Heinzer, Hartwig Huland, Markus Graefen, Pierre I Karakiewicz
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany