Safety of robot-assisted radical prostatectomy in an Italian spoke hospital: Long-term oncologic and functional outcomes with median 11.3 years follow-up

Abstract

Introduction:

Robot-assisted radical prostatectomy (RARP) long-term oncologic outcomes were published in few studies. This paper provides a complete overview of RARP long-term oncologic and functional results produced in an Italian spoke hospital.

Methods:

From December 2004 to December 2010, 300 consecutive patients with prostate cancer were treated with extraperitoneal RARP. Biochemical recurrence-free survival (BCRFS), salvage therapy-free survival (STFS), prostate cancer specific survival (PCa-SS), and overall survival (OS) were estimated using the Kaplan–Meier analysis and log-rank test. Cox proportional hazard regression analysis was performed to identify predictors of BCR and ST. Crude rates of continence and potency recovery after surgery were reported.

Results:

Median follow-up was 135.6 months (IQR 20–184). At 15 years, BCR-FS, ST-FS, PCa-SS, and OS rates were 78% (95% CI 0.73–0.83), 85% (95% CI 0.81 −0.89), 98% (95% CI 0.97–100), and 89% (95% CI 0.84–0.94), respectively. On multivariate analysis, biopsy ISUP grade ⩾2, clinical stage ⩾pT3a, D’Amico high-risk patients subgroup, pathologic ISUP grade ⩾2, and multifocal/extensive positive margins were independent predictors of BCR. The same risk factors plus D’Amico intermediate risk patients subgroup were independent predictors of ST. After surgery, 280 (93.3%) and 93 (35.2%) patients experienced continence and potency recovery, respectively. The retrospective nature of the analysis and some selection biases represent the principal limitations of the study.

Conclusion:

The results showed in the present study match those obtained in referral centers and this is an evidence against the general belief that best prostate cancer care in provided in high volume hospitals and against centralization. Adverse characteristics of the tumor remain the best predictors of BCR and ST.