Biochemical recurrence in 3,671 patients following robot-assisted radical prostatectomy.

Abstract

e15048 Background: Long-term oncologic outcomes for patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) are limited. We evaluated oncologic outcomes in patients undergoing RARP at a high-volume tertiary center, with a focus on long-term biochemical recurrence free survival (BCRFS). Methods: A total of 4,047 consecutive patients underwent RARP from September 2001 to December 2008; 3,671 patients comprised the study cohort (excluding for: loss to follow-up, incomplete data, positive lymph nodes, neo-adjuvant and adjuvant treatment). Biochemical recurrence (BCR) was defined as a serum prostate-specific antigen ≥ 0.2 ng/ml with a confirmatory value. BCRFS, metastasis free survival (MFS) and cancer specific survival (CSS) were estimated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to determine variables predictive of BCR. Event time distributions for the time to failure were compared using the log rank test. Results: Mean preoperative PSA was 6.1 ng/ml. Biopsy Gleason score was ≥ 7 in 44.4% of patients, pathologic Gleason grade was ≥ 7 in 64.5% of patients, and pathologic stage was ≥ pT3 in 30.3% of patients. BCR was noted in 324 (8.8%) patients; mean follow up was 33.8 months (median follow up – 27.3 months). Nine patients died of PCa (0.3%) and 18 patients developed metastatic disease (0.5%). Actuarial 3 and 5-year BCRFS was 91.3% and 87.0%. Actuarial 3 and 5-year CSS was 99.8% and 99.6%. Conclusions: In a large contemporary cohort of patients treated in the PSA era, robot-assisted radical prostatectomy appears to confer effective intermediate and long-term biochemical control. To our knowledge, this is the largest report of oncologic outcomes in a RARP series to date. Despite a cohort in which a majority of patients possessed Gleason 7 or greater disease, and 30% had extraprostatic extension or seminal vesicle invasion, 8.8% experienced a BCR, with a 5-year actuarial BCRFS of 87%, 0.5% experienced metastasis and 0.3% experienced a cancer specific death.