Changing clinical trends in 10,000 robot-assisted laparoscopic prostatectomy patients and impact of the 2012 USPSTF statement against PSA screening.

To evaluate the clinical trend changes in our robot-assisted laparoscopic prostatectomy (RALP) practice and to investigate the effect of 2012 US Preventive Services Task Force (USPSTF) statement against PSA screening on these trends.

Data of 10,000 RALPs performed by a single surgeon between 2002 and 2017 were retrospectively analyzed. Time trends in successive 1,000 cases for clinical, surgical and pathological characteristics were analyzed with linear and logistic regression. Time-trend changes before and after USPSTF statement were compared using a logistic regression model and likelihood-ratio test.

Unfavorable cancer characteristics rate, including D'Amico high risk, pathological non-organ confined disease and Gleason score ≥4+4 increased from 11.5% to 23.3%, 14% to 42.5% and 7.7% to 20.9% over time, respectively (p<0.001 for all). Significant time-trend changes were detected after USPSTF statement with an increase in the positive trend of Gleason ≥4+4 and increase in the negative trends of Gleason ≤3+4 tumors. There was a significant negative trend in the rate of Full NS (nerve-sparing) with a decrease from 59.3% to 35.7%, and a significant positive trend in Partial NS with an increase from 15.8% to 62.5% over time (p<0.001 for all). Time-trend slope in "high-grade" Partial NS significantly decreased and "low-grade" Partial NS significantly increased after USPSTF statement. Overall positive surgical margin (PSM) rate increased from 14.6% to 20.3% in the first vs. last 1,000 cases (p<0.001), with a significantly positive slope after USPSTF statement.

The proportion of high-risk patients increased in our series over time with a significant impact of USPSTF statement on pathological time-trends. This stage migration resulted in decreased utilization of high-quality NS and increased performance of poor-quality NS. This article is protected by copyright. All rights reserved.

BJU international. 2019 Jul 13 [Epub ahead of print]

Fikret Fatih Onol, Hariharan Palayapalayam Ganapathi, Travis Rogers, Kenneth Palmer, Geoff Coughlin, Srinivas Samavedi, Rafael Coelho, Cathy Jenson, Marco Sandri, Bernardo Rocco, Vipul Patel

Florida Hospital Global Robotics Institute, Celebration, FL, USA., Wesley Urology Clinic, Auchenflower, QLD, Australia., University of Kansas Hays Medical Center, Hays, KS, USA., Department of Urology, Instituto do Cancer, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil., Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy., Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.