PD43-05 PROSPECTIVE COMPARISON OF OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER: ANALYSIS OF 1806 CONSECUTIVE MEN TREATED IN A UNIVERSAL HEALTHCARE SYSTEM

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-05 PROSPECTIVE COMPARISON OF OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER: ANALYSIS OF 1806 CONSECUTIVE MEN TREATED IN A UNIVERSAL HEALTHCARE SYSTEM Adrian Fairey, Sunita Ghosh, Niels Jacobsen, Lucas Dean, Derek Bochinski, Michael Chetner, Howard Evans, Michael Hobart, David Mador, Blair St. Martin, Keith Rourke, and Eric Estey Adrian FaireyAdrian Fairey More articles by this author , Sunita GhoshSunita Ghosh More articles by this author , Niels JacobsenNiels Jacobsen More articles by this author , Lucas DeanLucas Dean More articles by this author , Derek BochinskiDerek Bochinski More articles by this author , Michael ChetnerMichael Chetner More articles by this author , Howard EvansHoward Evans More articles by this author , Michael HobartMichael Hobart More articles by this author , David MadorDavid Mador More articles by this author , Blair St. MartinBlair St. Martin More articles by this author , Keith RourkeKeith Rourke More articles by this author , and Eric EsteyEric Estey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1783AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are limited prospective data comparing outcomes of Open Radical Prostatectomy (ORP) and Robot-Assisted Radical Prostatectomy (RARP) for clinically localized prostate cancer (CLPC). Our primary objective was to compare ORP and RARP with respect to cancer control outcomes in men treated within a universal healthcare system. METHODS A prospective analysis of data from the University of Alberta Radical Prostatectomy Database was performed. Between September 2007 and January 2013, 1,806 consecutive men underwent radical prostatectomy for CLPC. The surgeon selected the surgical approach. The primary end point was biochemical recurrence (BCR). BCR was defined as a PSA≥0.2 µg/L followed by a subsequent confirmatory value or initiation of salvage therapy. Secondary endpoints included positive surgical margin (R1) rate, 1-year urinary and erectile function preservation rate, 90-day complication rate, and 90-day return to emergency room or readmission to hospital rate. The Kaplan-Meier method and multivariable Cox regression analyses were used to analyze BCR. Statistical tests were two-sided (p<0.05). RESULTS Complete data were evaluable for 1,769 out of 1,806 patients. 333 patients underwent ORP and 1,436 patients underwent RARP. The median follow-up duration was 48 months. Baseline age (62 years vs. 61 years, p=0.07), BMI (29 kg/m2 vs. 29 kg/m2, p=0.29), and D'Amico risk stratification score (low risk: 50% vs. 45%; intermediate risk: 42% vs. 46%; high risk: 8% vs. 9%, p=0.15) were similar between the ORP and RARP groups. The 5-year freedom from BCR rate differed between the ORP and RARP groups (79% vs. 86%, log rank p=0.006). In multivariable Cox regression analysis that adjusted for surgical margin status, pathologic Gleason score, pathologic T stage, and preoperative PSA, ORP was independently associated with an increased risk of BCR (HR 1.62, 95% CI 1.21 to 2.18, p=0.001). The 1-year urinary function preservation rate (60% vs. 72%, p=0.004), 1-year erectile function preservation rate (10% vs. 17%, p=0.007), and blood transfusion rate (4% vs. 1%, p<0.001) differed between the ORP and RARP groups. There were no significant differences between groups for R1 rate (24% vs. 26%, p=0.57) 90-day complication rate (27% vs. 27%, p=0.27), return to emergency room rate (21% vs. 20%, p=0.54), or readmission to hospital rate (3% vs. 4%, p=0.15). CONCLUSIONS In men treated at a Canadian academic center within a universal healthcare system, RARP provided superior cancer control, functional preservation, and blood product transfusions rates compared to ORP. Further analyses designed to examine mechanisms of differences in cancer control and functional preservation is needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e994 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Adrian Fairey More articles by this author Sunita Ghosh More articles by this author Niels Jacobsen More articles by this author Lucas Dean More articles by this author Derek Bochinski More articles by this author Michael Chetner More articles by this author Howard Evans More articles by this author Michael Hobart More articles by this author David Mador More articles by this author Blair St. Martin More articles by this author Keith Rourke More articles by this author Eric Estey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...