Of ORPs and RALPs: data from the Victorian Prostate Cancer Registry


Data from just over 2,000 prostate cancer patients in the Victorian Prostate Cancer Registry (VPCR, from the State of Victoria, Australia) suggest some difference in outcomes between men receiving open and robot-assisted laparoscopic surgery for localized prostate cancer. But interpreting the reasons for those differences is more difficult

This is one of the first published sets of data (reported by Ong et al. in BJU International) from the VPCR and is based on a prospective analysis of data from 2,002 prostate cancer patients who underwent radical prostatectomies in Victoria between January 2009 and June 2012. The study was designed to compare the short-term oncological and quality of life outcomes of the patients at up to 2 years post-treatment.

Here are the core study findings:

  • The study database included 1,117 men treated by open radical prostatectomy (ORP) and 885 men treated by robot-assisted, laparosopic prostatectomy (RALP).
  • Average (median) patient follow-up was
    • 19 months for men treated by ORP
    • 17 months for men treated by RALP
  • Slightly more men with low-risk prostate cancer were treated in the RALP cohort.
    • 21 percent of ORP patients were low risk.
    • 26 percent of RALP patients were low risk.
  • Patients treated by RALP were more likely to be treated by surgeons with an annual case-load of > 20 cases/year.
    • 65 percent of RALP patients were treated by higher case-load surgeons.
    • 53 percent of ORP patients were treated by higher case-load surgeons.
  • Risk for positive surgical margins was lower (OR = 0.56) among patients treated by RALP as compared to patients treated by ORP.
  • Risk for biochemical recurrence was also lower (OR = 0.73) among patients treated with RALP as compared to patients treated by ORP.
  • With respect to risk for side effects and complications of surgery
    • 61 percent of ORP patients reported a high degree of sexual bother at 1 year of follow-up.
    • 59 percent of RALP patients reported a high degree of sexual bother at 1 years of follow-up.
    • 14 percent of ORP patients reported a moderate or high degree of urinary bother at 1 year of follow-up.
    • 11 percent of RARP patients reported a moderate or high degree of urinary bother at 1 year of follow-up.
    • Sexual and urinary bother were similar among ORP and RALP patients at 2 years of follow-up.
  • There were no statistically significant differences in the quality of life outcomes between ORP and RALP patients on multivariate analysis at 1 or 2 years of follow-up.

The authors note that while there were better short-term oncological outcomes for the RALP patients compared to the ORP patients in this study, there were no significant differences in the quality of life outcomes. They also note that since the patients treated by RALP tended to be treated by surgeons who operated on higher numbers of patients on an annual basis, one has to be cautious about over-interpreting the differences in rates of positive surgical margins and biochemical recurrence since this may have more to do with surgical skill and experience than it does with whether the surgeon was using ORP as opposed to RALP.

The “New” Prostate Cancer InfoLink would also note that da Vinci equipment for the conduct of laparoscopic surgery was probably not available to surgeons in the vast majority of hospitals in Victoria during the time frame of this study (and may still not be today).  We would also note that the “higher case-load” criterion used in this study of > 20 cases/year isn’t even close to what we would consider to be a high case-load here in the USA (which is arguably more like 100+ cases/year).

American readers might like to bear in mind that the State of Victoria — which is the smallest mainland state in Australia —  is nearly 88,000 square miles in area (a little larger than Utah), with a population of just under 6 million (about twice that of Utah). What’s more, most of the population of Victoria is concentrated in or close to Melbourne (Australia’s second-largest city, with a population of 4.4 million). As a consequence, it is easy to see why a relatively small number of specialized urologists in the Melbourne area probably do the vast majority of the radical prostatectomies in Victoria each year, with the others being done by surgeons who may only do a very small number of ORPs each year in cities (like Mildura) that can be hundreds of miles from Melbourne (or pretty much anywhere else) and have populations of just 30,000 or less. Even Bendigo, in Victoria, which is the fourth largest inland city in the whole of Australia, has a population of only about 110,000.

3 Responses

  1. Mike, you have many Australian readers. Tasmania with an area of about 26,000 square miles is the smallest state of Australia.

  2. Ooops. You are of course correct. Us foreigners tend to forget about Tasmania!

  3. I have not forgotten Tasmania since I learned about the Tasmanian wombat, at age 16.

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