508 A COMPARISON OF BIOCHEMICAL RECURRENCE RATES OF OPEN AND ROBOTIC PROSTATECTOMY AT A LARGE TERTIARY CARE CENTER (2012)

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2012508 A COMPARISON OF BIOCHEMICAL RECURRENCE RATES OF OPEN AND ROBOTIC PROSTATECTOMY AT A LARGE TERTIARY CARE CENTER Jonathan Silberstein, Daniel Su, Leonard Glickman, Gal Keren-Paz, Matthew Kent, Andrew Vickers, Jonathan Coleman, James Eastham, Peter Scardino, and Vincent Laudone Jonathan SilbersteinJonathan Silberstein New York City, NY More articles by this author , Daniel SuDaniel Su New Brunswick, NJ More articles by this author , Leonard GlickmanLeonard Glickman New York City, NY More articles by this author , Gal Keren-PazGal Keren-Paz New York City, NY More articles by this author , Matthew KentMatthew Kent New York City, NY More articles by this author , Andrew VickersAndrew Vickers New York City, NY More articles by this author , Jonathan ColemanJonathan Coleman New York City, NY More articles by this author , James EasthamJames Eastham New York City, NY More articles by this author , Peter ScardinoPeter Scardino New York City, NY More articles by this author , and Vincent LaudoneVincent Laudone New York City, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.579AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the biochemical recurrence (BCR) rates of robot assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) performed by high volume surgeons in a contemporaneous cohort patients at a tertiary care center. METHODS We conducted a retrospective review of patients who underwent RP for localized prostate cancer, by the highest volume surgeons performing ORP (JAE, PTS) or RALP (JAC, VPL), respectively, at a single center from 2007-2010. Patients were excluded from analysis if they were receiving salvage surgery, had evidence of metastatic disease, or if surgical approach was not the surgeon's majority practice pattern. BCR was defined as PSA >0.1 ng/ml or any detectable PSA with receipt of additional therapy. A multivariable Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (“nomogram”) for BCR based on preoperative stage, grade and PSA. To determine whether differences between groups depended on baseline risk, an interaction term between nomogram risk and procedure type was included in a second model. To explore whether the results were sensitive to the choice of covariates, analyses were repeated using AUA defined risk groups in place of nomogram probability. RESULTS Of the 1,454 patients who met inclusion criteria, 961 (66%) received ORP and 493(34%) received RALP. There were no important differences in tumor characteristics by group, 32% of the cohort was low-risk, 49% intermediate and 19% high-risk. Preoperatively most patients had clinical Gleason 7 tumors (50%, n=733), 37% (n=509) had palpable disease. Postoperatively, 35% (n=506) had pT3 disease, 10% (n= 139) had Gleason >8 disease, and 15% (n=221) had positive surgical margins. In multivariate model adjusting for preoperative risk there was no significant difference in the rates of BCR for RALP compared to ORP (HR 0.84; 95% CI 0.47, 1.52; p=0.6). When added to the model, the interaction term between nomogram risk and procedure type was not statistically significant (p=0.7). Using AUA risk group as the covariate in a Cox model gave similar results to the nomogram based analysis (HR 0.85; 95% CI 0.47, 1.5; p=0.6). The interaction term between AUA risk group and procedure type was also non-significant (p=0.9). CONCLUSIONS In this cohort of patients undergoing RP by highly experienced oncologic surgeons we found no evidence that surgical approach impacted rates of BCR, regardless of patient risk. Individual surgeon skill and experience are likely more important to oncologic outcomes than surgical approach. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e208-e209 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Silberstein New York City, NY More articles by this author Daniel Su New Brunswick, NJ More articles by this author Leonard Glickman New York City, NY More articles by this author Gal Keren-Paz New York City, NY More articles by this author Matthew Kent New York City, NY More articles by this author Andrew Vickers New York City, NY More articles by this author Jonathan Coleman New York City, NY More articles by this author James Eastham New York City, NY More articles by this author Peter Scardino New York City, NY More articles by this author Vincent Laudone New York City, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...