There has been much discussion of whether surgical outcomes following robot-assisted laparoscopic prostatectomy (RALP) are comparable to those observed after open surgery. The 5-year outcome data from the Vattikuti Urology Institute at Henry Ford Hospital in Detroit may help us to make such a determination.
Menon et al. have published data from their cohort of 1,384 consecutive patients with localized prostate cancer who were treated using RALP between September 2001 and May 2005. The full text of this article is available on line. No patient received any type of second-line treatment until biochemical recurrence was clearly documented, and biochemical recurrence in these patients was defined as a two serum PSA levels ≥ 0.2 ng/ml.
The top-line data from this patient cohort are reported as follows:
- Overall, these patients had moderately aggressive, localized forms of prostate cancer.
- 49.0 percent had D’Amico intermediate- or high-risk disease at the time of biopsy.
- 60.9 percent had a Gleason score of 7 or higher.
- 25.5 percent had pathologic T3 disease based on post-surgical pathology.
- Median follow-up was 60.2 months (interquartile range, 37.2 to 69.7 months).
- Biochemical recurrence occurred in 189/1,384 patients (13.7 percent).
- Median time to biochemical recurrence was 20.4 months.
- 65 percent of biochemical recurrences occurred within 3 years.
- 86.2 percent of biochemical recurrences occurred within 5 years.
- Actuarial biochemical recurrence-free survival was
- 95.1 percent at 1 year
- 90.6 percent at 3 years
- 86.6 percent at 5 years
- 81.0 percent at 7 years
- The strongest predictors of biochemical recurrence were
- A pathologic Gleason grade of 8-10 (hazard ratio [HR] = 5.37)
- A pathologic stage of T3b/T4 (HR = 2.71)
The authors conclude that, in this contemporary cohort of patients with localized prostate cancer, RALP “confers effective 5-yr biochemical control” of the patients’ disease. A media release from Henry Ford Hospital is also available.
As is widely appreciated, 5-year outcome data after treatment of localized prostate cancer is interesting, but 10-year follow-up data are usually considered to be more accurate, and patients may continue to demonstrate recurrence for 15 years and more. These data from Menon and his colleagues are therefore helpful in understanding the long-term outcomes after RALP, but longer-term data will be needed.
It is informative to note the relatively high risk of the patients in this cohort. The full published version of this paper includes outcomes over time broken out by D’Amico risk categories (see Figure 2) and by Gleason score for patients with organ-confined and non-organ-confined status (see Figure 3). Clearly, these risk factors have a significant impact on biochemical recurrence over time. For example, about half of the patients with non-organ-confined disease and a Gleason score of 8 or higher had biochemical recurrence within 2 years and about 75 percent of these patients had biochemical recurrence at 5 years. It would have been interesting to know how well these 5-year outcomes correlated with those predicted by the Kattan nomograms (which were developed on the basis of open surgical data).