10-year follow-up of robotic radical prostatectomy

The authors aimed to evaluate long-term cancer outcomes associated with robot-assisted prostatectomy.

Robot-assisted radical prostatectomy is a relatively new procedure used to surgically remove the prostate gland. This involves keyhole (or minimal access) surgery using robotic assistance to remove the prostate, seminal vesicles (tube-like glands which make semen) and occasionally lymph nodes. It is performed under general anesthetic and uses a number of small incisions (ports) to access the diseased organ.

As this is a relatively new procedure, long-term reports on the cancer-related outcomes for this treatment method are relatively rare. This study reported on the 10-year outcomes following robot-assisted radical prostatectomy from a single-center, as well as the predictors of these outcomes.

483 men with localized prostate cancer (cancer that is only present within the prostate gland) who underwent robot-assisted radical prostatectomy were followed. During the average follow-up of 10 years, 22.4% of the patients experienced biochemical recurrence (a rise in the levels of prostate specific antigen after treatment). 2.3% of patients experienced metastases (spread of the cancer) while 1.4% of patients died from prostate cancer. 7.9% of patients died due to causes not related to prostate cancer.

The biochemical recurrence-free survival (survival without return of the disease) rate was 73.1% at 10 years, while the metastasis-free survival (survival without spread of the cancer) rate was 97.5% for the same interval. Cancer-specific survival (those who did not die directly from the cancer) rates were 98.8%.

D’Amico groups are a method of stratifying patients into risk groups. Low-risk patients have a prostate specific antigen (PSA) level of less than 10 ng/ml, a Gleason score (a grading system based on analysis of tissue samples) of less than 6 and the percentage of involved cores (the percentage of tissue samples testing positive for cancer) less than 50%. Intermediate-risk patients have a PSA level of 10-20 ng/ml or a Gleason score of 7 or low-risk with the percentage of involved cores greater than 50%. High-risk patients have a Gleason score of greater than 8 or a PSA level of greater than 20 ng/ml and more than 1 positive cores. When stratified into these groups, biochemical recurrence-free survival rates after robot-assisted prostatectomy were 85.7% for low-risk, 62.4% for intermediate-risk and 43.2% for high-risk patients.

The authors concluded that in patients with localized prostate cancer, robot-assisted prostatectomy led to effective 10-year cancer control.