They used the Columbia University Urologic Oncology Database to identify 4,170 patients who had radical prostatectomy between 1990 and 2010. Patients were separated by pathologic stage into organ-confined disease (pT1-pT2) and non organ-confined disease (NOCD) (≥pT3). Differences in baseline characteristics between patients across the study period were assessed. Changes in NOCD rates over time were evaluated, and multivariable logistic regression models used to predict those who had NOCD.
Of 4,170 radical prostatectomy patients, 1,198 (28.7%) had NOCD. From 1990-2010, there were no overall changes in trends of pathologic stage. However, when separated into discrete 5-year intervals, it was pointed out that rates of NOCD were lowest in the period1990-1995 (26%), increased from 1995-2000 (32%), and again from 2000-2005 (29%). Trends in stage at prostatectomy have changed since 2005, with 32.7% of specimens with NOCD in 2004 and 20.6% with equivalent staging in 2010 (p=0.014). This change in pathologic stage occurred at the same time as the introduction of robotic prostatectomy (2002). Presently robotic prostatectomy now constitutes 92% of the prostatectomy caseload. While univariate analysis demonstrated that robotic prostatectomy is associated with NOCD (p<0.001), in a multivariate analysis controlling for year of surgery, surgical approach did not independently predict localized disease (p=0.1625). He concluded that while temporal trends in pathologic stage at the time of prostatectomy show a shift favoring surgical intervention for organ-confined tumors, this is independent of the widespread adoption of robotic surgery.
Presented by M. R. Kates, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria