1213 CONTEMPORARY ANALYSIS OF POST-PROSTATECTOMY SPECIMENS IN A LARGE VOLUME ROBOTIC PROSTATECTOMY PROGRAM: A PARADOXICAL STAGE MIGRATION TOWARD MORE AGGRESSIVE DISEASE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20131213 CONTEMPORARY ANALYSIS OF POST-PROSTATECTOMY SPECIMENS IN A LARGE VOLUME ROBOTIC PROSTATECTOMY PROGRAM: A PARADOXICAL STAGE MIGRATION TOWARD MORE AGGRESSIVE DISEASE Michael Maddox, Gyan Pareek, Simone Thavaseelan, Anthony Mega, and Joseph Renzulli Michael MaddoxMichael Maddox Providence, RI More articles by this author , Gyan PareekGyan Pareek Providence, RI More articles by this author , Simone ThavaseelanSimone Thavaseelan Providence, RI More articles by this author , Anthony MegaAnthony Mega Providence, RI More articles by this author , and Joseph RenzulliJoseph Renzulli Providence, RI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2567AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As a result PSA screening, there is concern for over diagnosis and treatment of low risk prostate cancer. With the widespread use of robot-assisted radical prostatectomy (RARP), a stage migration to less aggressive prostate cancer may be expected in pathological specimens. As our robotic experience has matured, we sought to analyze if the institution of robotics leads to more surgical treatment of indolent cancers. METHODS A total of 262 patients who underwent open prostatectomy (OP) from 2004 to 2006 and 757 patients who underwent RARP from 2007 to 2011 were identified from an IRB approved prospective database accrued by an independent third party committee. Demographic data, pathology, positive margin rates along with standard prostate cancer reporting data were recorded. The two groups were compared with regards to percentage of cases performed stratified by Gleason grade and pathologic stage. RESULTS The number of prostate cancer cases managed at our institution increased considerably after the introduction of robotics in 2007. The distributions of pathologic gleason grade and stage for OP versus RARP are shown in table 1. Overall, there was a significant decrease in the patients with Gleason 6 prostate cancer undergoing RARP as compared to open prostatectomy (p<0.0001). Additionally, RARP was performed on a significantly greater percentage of Gleason 7 disease (p<0.0001). Comparing pathological stage between the two groups, there was a significant increase in the incidence of pT3 disease following robotic prostatectomy (p<0.0001). CONCLUSIONS Recent studies suggest there is an increase in treatment of indolent prostate cancer. In our experience the introduction of minimally invasive radical prostatectomy did not result in an increased application of surgery for the treatment of low risk prostate cancer. Conversely, our data suggests that RARP has led to an increase in surgery for higher risk cancers. Open Prostatectomy(%) Robotic Prostatectomy(%) Statistical Significance Gleason 6 52.3 32.6 p < 0.0001 Gleason 7 61.2 40.9 p < 0.0001 Gleason 8 4.6 2.5 p=0.138 pT2 86.8 75.6 p=0.0001 pT3 10.7 24.4 p < 0.0001 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e497 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Maddox Providence, RI More articles by this author Gyan Pareek Providence, RI More articles by this author Simone Thavaseelan Providence, RI More articles by this author Anthony Mega Providence, RI More articles by this author Joseph Renzulli Providence, RI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...