Evolution and oncological outcomes of a contemporary radical prostatectomy practice in a UK regional tertiary referral centre

OBJECTIVES - To investigate the clinical and pathological trends over a ten-year period for robotic-assisted laparoscopic prostatectomy (RALP) in a UK regional tertiary referral centre.

PATIENTS AND METHODS - 1500 consecutive patients underwent RALP between October 2005 and January 2015.

Prospective data was collected on clinic-pathological details at presentation as well as surgical outcomes and compared over time.

RESULTS - The median(range) age of patients throughout the period was 62(35-78) years. The proportion of pre-operative high-grade cases (Gleason sum 8-10) rose from 4.6% in 2005-2008 to 18.2% in 2013-2015 (p<0.0001). In the same periods the proportion of clinical stage T3 cases operated on rose from 2.4% to 11.4% (p<0.0001). Median PSA at diagnosis did not alter significantly. Overall 11.6% of men in 2005-2008 were classified pre-operatively as high-risk by NICE criteria, compared to 33.6% in 2013-2015 (p<0.0001). The corresponding proportions for low-risk cases were 48.6% and 17.3% respectively. Final surgical pathology demonstrated an increase in tumour stage, Gleason grade and nodal status across time. The proportion of pT3 cases rose from 43.2% in 2005-2008 to 55.5% in 2013-15 (p=0.0007), Gleason grade 9-10 tumours increased from 1.8% to 9.1% (p=0.0002) and positive nodal status increased from 1.6% to 12.9% (p<0.0001) between the same periods. Despite this, positive surgical margin rates showed a downward trend in all pT groups across the different eras (p=0.72).

CONCLUSIONS - This study suggests that the patient profile for RALP in our unit is changing, with increasing proportions of higher-stage and more advanced disease being referred and operated on. Surgical margin outcomes however have remained good. This article is protected by copyright. All rights reserved.

BJU international. 2016 Apr 28 [Epub ahead of print]

V J Gnanapragasam, D Thurtle, A Srinivasan, D Volanis, A George, A Lophatananon, S Stearn, A Y Warren, A D Lamb, G Shaw, N Sharma, B C Thomas, M G Tran, D E Neal, N C Shah

Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK., Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK., Division of Health Sciences, Warwick Medical School, University of Warwick., Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK., Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

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