1058 RADICAL RETROPUBIC PROSTATECTOMY VERSUS ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: AN ASSESSMENT OF BIOCHEMICAL RECURRENCE RATES BY D'AMICO RISK GROUP AND SURGEON VOLUME

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

Oncologic efficacy for retropubic radical prostatectomy (RRP) compared to robotic-assisted radical prostatectomy (RARP) is poorly understood. Our study evaluates early biochemical recurrence (BCR) among patients undergoing RRP versus RARP based upon D'Amico risk group and surgeon volume.

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METHODS 

Between 2002 and 2008, 6638 patients underwent RRP or RARP at our institution by multiple surgeons. We excluded 730 patients with limited followup and those refusing research leaving 5908 patients [RRP, n=4824; RARP, n=1084] for clinical, surgical, and pathological comparison. All patients were assigned into a low, intermediate, or high risk group as described by D'Amico et al. BCR was defined as a PSA >0.4 ng/mL. Kaplan-Meier analysis was performed comparing BCR between RRP and RARP. A Cox proportional hazard model was generated to control for D'Amico risk group, clinical stage, PSA and adjuvant therapy on the rate of BCR. Impact of highest surgeon volumes for either RRP or RARP was also evaluated in a subset analysis.

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RESULTS 

The median followup was 3.0 years. Overall, BCR was 12% for RRP and 5% for RARP (p<0.0001). For all low D'Amico risk patients BCR risk was higher for RRP (p=0.02), but not significant between RRP and RARP when controlling for highest surgeon volumes(p=0.14). Among D'Amico high risk patients, BCR differences between RRP and RARP were not significant (overall, p=0.46; high volume, p=0.46). On multivariate analysis for all patients, RARP significantly decreased the risk of BCR (hazard ratio= 0.639, p=0.004), while significantly increased risk of BCR was associated with intermediate D'Amico risk group (hazard ratio=3.05, p<0.0001), high D'Amico risk group (hazard ratio=4.78, p<0.0001), margin positivity (hazard ratio=2.26, p<0.0001), and seminal vesicle involvement (hazard ratio=2.31, p<0.0001). In a similar multivariate analysis limited to highest surgeon volumes, impact of surgical approach was not significant regardless of D'Amico risk group (p>0.10).

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CONCLUSIONS 

Overall RARP patients in the D'Amico low risk group had significantly lower rates of BCR, however differences in BCR between RRP and RARP were not significant when the analysis was limited to highest surgeon volumes. Among patients in the D'Amico high risk groups, rates of BCR between RARP and RRP were not significant overall or when limited to surgeons with highest volumes. Especially in lower D'Amico risk groups, surgeon volume appears to limit risk of BCR for RRP and RARP.