Evidence on long-term oncological efficacy is available only for open radical prostatectomy but remains scarce for robot-assisted radical prostatectomy (RARP).
To validate the long-term survival rates after RARP and provide stratified outcomes based on contemporary prostate cancer (PCa) risk-stratification tools.
A retrospective analysis of the European Association of Urology (EAU) Robotic Urology Section Scientific Working Group international multicenter database for RARP was performed. Patients who underwent RARP at seven pioneer robotic urology programs in Europe and the USA between 2002 and 2012 were included.
The primary outcomes were PCa-specific mortality and all-cause mortality. The probability of cancer-specific survival (CSS) was estimated with the competing risks method, and the probability of overall survival (OS) was estimated with the Kaplan-Meier method.
A total of 9876 patients who underwent RARP between 2002 and 2012 were included. Within follow-up, 1071 deaths occurred and 159 were due to PCa. At 15 yr of follow-up, CSS and OS were 97.6% (97.2%, 98.0%) and 85.5% (84.6%, 86.4%), respectively. Stratified analyses based on EAU risk groups at diagnosis and pT stage showed favorable survival rates, with low-risk (n = 4601, 46.6%), intermediate-risk (n = 4056, 41.1%), and high-risk (n = 1219, 12.3%) patients demonstrating CSS rates of 99%, 98%, and 90% at 15 yr, respectively. Notably, patients with pT3a disease had similar survival outcomes to those with pT2 disease, with worse CSS in patients with pT3b PCa (98.9% vs 97.4% vs 86.5%). Multivariable analyses identified age, prostate-specific antigen, biopsy Gleason grade group, clinical T stage, and treatment year as independent predictors of worse oncological outcomes.
Our multicenter study with long-term follow-up confirms favorable survival outcomes after RARP for localized PCa. Patients with low- and intermediate-risk disease face a higher risk of mortality from causes other than PCa. On the contrary, high-risk patients have a significantly higher risk of PCa-specific mortality.
In the present study, we reported the outcomes of patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy between 10 and 20 yr ago, and we found a very low probability of dying from PCa in patients with low- and intermediate-risk PCa.
European urology oncology. 2023 Sep 01 [Epub ahead of print]
Ugo Giovanni Falagario, Sophie Knipper, Francesco Pellegrino, Alberto Martini, Olof Akre, Lars Egevad, Henrik Grönberg, Marcio Covas Moschovas, Carlo Andrea Bravi, Joshua Tran, Yasmin Heiniger, Antonius von Kempis, Robin Schaffar, Giuseppe Carrieri, Charles-Henry Rochat, Alexandre Mottrie, Thomas E Ahlering, Hubert John, Vipul Patel, Markus Graefen, Peter Wiklund, ERUS Scientific Working Group on Prostate Cancer of the European Association of Urology
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, University of Foggia, Foggia, Italy. Electronic address: ., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden., Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden., Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden., AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA., Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK., Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA., Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland., Department of Urology, Clinique Générale Beaulieu, Geneva, Switzerland., Department of Urology, University of Foggia, Foggia, Italy., Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium., Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.