Localized prostate cancer can be treated with either robot-assisted laparoscopic prostatectomy (RALP) or open retropubic radical prostatectomy (RRP). This study aimed to analyze all-cause and prostate cancer-specific mortality 12 yr after surgery.
The nonrandomized multicenter LAParoscopic Prostatectomy Robot Open (LAPPRO) trial enrolled patients from 2008 to 2011. The eligibility criteria included age <75 yr, prostate-specific antigen <20 ng/ml, clinical stage <T4, nonmetastatic disease, and informed consent. Data were collected through validated questionnaires at baseline and clinical record forms repeatedly up to 12 yr after surgery, with mortality information retrieved from Sweden's National Cause of Death Register. The main outcomes were all-cause and prostate cancer-specific mortality.
Of the 4003 patients enrolled in LAPPRO, 3583 were eligible for the current analysis, of whom 2698 (75%) underwent RALP and 885 (25%) RRP. At 12 yr after surgery, prostate cancer-specific mortality was significantly lower after RALP than after RRP (55/2698 [2.0%] vs 40/885 [4.5%]; adjusted hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23-0.55). The numbers of all-cause deaths were 371/2698 (14%) in the RALP group and 145/885 (16%) in the RRP group (adjusted HR 0.81, 95% CI 0.66-0.99). The study is limited by its nonrandomized design.
At 12 yr after surgery, prostate cancer-specific mortality was significantly lower in patients undergoing robotic prostatectomy than in those undergoing open prostatectomy. Cautious interpretation is suggested for the possible causal effect, but the results suggest that the robotic technique is associated with a better oncological outcome.
European urology oncology. 2025 May 23 [Epub ahead of print]
Anna Lantz, Ying Li, Stefan Carlsson, Johan Stranne, Eva Angenete, Olof Akre, Anders Bjartell, Mehbod Mansoori, Carolina Ehrencrona, Peter Wiklund, Eva Haglind
Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: ., Department of Surgery, Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden., Department of Surgery, Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden., Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Lund, Sweden., Department of Surgery, Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA.