The Effect of Evolving Strategies in the Surgical Management of Organ-Confined Prostate Cancer: Comparison of Data from 2005 to 2014 in a Multicenter Setting.

The objective of this study was to evaluate changes of patient characteristics and surgical techniques in radical prostatectomy in Germany within the last decade.

Data from 44 German prostate cancer centers were included in the study. Patients' characteristics (age, initial PSA value), surgical techniques (open vs. minimally invasive approaches), perioperative parameters (operating time, rate of nerve-sparing (NS) radical prostatectomies (RPs), hospitalization time, catheter indwelling time, surgical margin status, number of dissected lymph nodes (LN)), and pathological findings (tumor stage, Gleason score) were analyzed.

Data from 11,675 patients who underwent RP between 2005 and 2014 were analyzed. The rate of open RP approaches decreased by 1.7% (p = 0.0164), the rate of minimally invasive approaches increased by 1.8% (p = 0.0164). Robot-assisted RPs (RARP) increased by 4.6% (p < 0.0001). The number of NS procedures and pelvic lymphadenectomy (LA) increased by 4.5% (p < 0.0001) and 4.7% (p < 0.0001), respectively. Catheter indwelling time and hospitalization time decreased by 1 day (p < 0.0001). No change in the rate of positive surgical margins (p = 0.5061) and the ratio of positive lymph nodes removed (p = 0.4628) was observed. The number of Gleason ≤6 tumors decreased significantly (p < 0.0001).

The number of RARP has significantly increased over the past decade and there is a trend towards surgeries on more advanced tumors with higher yields of lymph nodes dissected. At the same time, the rate of nerve-sparing procedures has significantly increased.

Advances in therapy. 2017 Jan 04 [Epub ahead of print]

Margit Pohle, Ahmed Magheli, Tom Fischer, Carsten Kempkensteffen, Jonas Busch, Hannes Cash, Kurt Miller, Stefan Hinz

Charité Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany. ., Vivantes Klinikum Am Urban, Klinik für Urologie, Berlin, Germany., Vivantes Klinikum im Friedrichshain, Klinik für Urologie, Berlin, Germany., Franziskus-Krankenhaus Berlin, Klinik für Urologie, Berlin, Germany., Charité Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany.