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Minerva Urologica e Nefrologica 2019 February;71(1):38-46

DOI: 10.23736/S0393-2249.18.03285-X


lingua: Inglese

Oncologic outcomes in prostate cancer patients treated with robot-assisted radical prostatectomy: results from a single institution series with more than 10 years follow up

Lorenzo BIANCHI 1, 2, 3 , Giorgio GANDAGLIA 2, 3, 4, Nicola FOSSATI 2, 3, 4, Alessandro LARCHER 2, 3, 4, Cristian PULTRONE 1, 5, Filippo TURRI 2, 3, 6, Cesare SELLI 6 , Ruben de GROOTE 2, Geert de NAEYER 2, Marco BORGHESI 1, 2, 3, 4, 5, Riccardo SCHIAVINA 1, 2, 3, 4, 5, Eugenio BRUNOCILLA 1, 2, 3, 4, 5, Alberto BRIGANTI 4, Francesco MONTORSI 4, Alexandre MOTTRIE 2, 3

1 Department of Urology, University of Bologna, Bologna, Italy; 2 Department of Urology, OLV, Aalst, Belgium; 3 ORSI Academy, Melle, Belgium; 4 Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 5 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy; 6 Department of Urology, University of Pisa, Pisa, Italy

BACKGROUND: Robot-assisted radical prostatectomy (RARP) has gained increasing diffusion as standard of care in the surgical treatment of prostate cancer (PCa) patients, even in the absence of robust long-term oncologic comparative data. This article is a report of oncologic outcomes of RARP at more than 10 years follow-up.
METHODS: We retrospectively evaluated 173 consecutive PCa patients underwent RARP between 2002 and 2005 at a single European center with complete clinic and pathologic data and potential follow-up of at least 10 years. Kaplan-Meier analyses assessed biochemical recurrence free survival (BCR-FS), clinical recurrence free survival (CR-FS), cancer specific mortality free survival (CSM-FS), other causes mortality free survival (OCM-FS) in the overall population and CR-FS after stratification according to pathologic stage and Gleason score. Multi-variable Cox regression analyses were performed to assess the predictors of BCR and CR.
RESULTS: Median follow-up (Interquatile Range [IQR]) was 133 (123-145) months. The BCR-FS, CR-FS, CSM-FS and OCM-FS rates at median follow-up were 73.4%, 81.1%, 95.7%, and 68.6%, respectively. Patients staged as pT3b-T4 and men with Gleason score 8-10 experienced significantly lower CR-FS rates as compared to those with less aggressive pathologic features (all P≤0.001). At multivariable analysis, pathologic Gleason score 8-10 (Hazard Ratio [HR]: 2.85), pathologic stage pT3b-pT4 (HR: 2.76) and adjuvant therapy (HR: 2.09 for radiotherapy [RT] and HR: 13.66 for androgen deprivation therapy [ADT]) were independent predictors of BCR (all p≤0.02). While, pathologic Gleason score 8-10 (HR: 4.05) and pathologic stage pT3b-pT4 (HR: 6.78) were found to be independently related to higher risk of CR (all P≤0.03). Retrospective data and limited number of patients included could have affected our analyses.
CONCLUSIONS: In experienced centers, RARP allows optimal oncologic outcomes at long term follow-up. Adverse pathologic characteristics are independent predictors of BCR and CR.

KEY WORDS: Prostatectomy - Robotics - Disease-free survival - Follow-up studies

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