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Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period

Prostate Cancer and Prostatic Diseases volume 7, pages 258–262 (2004)Cite this article

Abstract

Objective: To show the impact of learning curve and patient selection on complication rate and biochemical recurrence-free survival of a UK radical prostatectomy series for localised prostate cancer and to model the influence of common preoperative variables on biochemical recurrence after controlling for learning curve.

Patients and Methods: From 1989 to 1999, 280 of 350 patients who underwent anatomical radical retropubic prostatectomy (RRP) at our institution had complete records and follow-up of at least 1 y. After exclusions of preoperative staging, factors reflecting the learning curve, early complications and prostate-specific antigen (PSA) outcome were recorded on 217 patients. Procedures before 1995 were compared with procedures after 1995.

Results: Comparison of the two groups showed a significant decrease in operating time (mean 152 vs 130 min), blood loss (mean 1500 vs 1000 ml), transfusion rate (83 vs 42%) and hospital stay (mean 7 vs 6 days). Median preoperative PSA changed significantly from 13.2 to 11.5 ng/ml. Only 17% were diagnosed by rectal examination compared to 27% in the early years. The number of clinical T1 tumours increased from 33 to 47%. This did lead to an increase of organ-confined tumours on pathological staging by 25%. Biochemical recurrence-free survival improved significantly after 1995. After controlling for the learning curve PSA and clinical stage were significant predictors of PSA recurrence.

Conclusion: Time trends of case selection, stage migration and a steep learning curve are shown over a 10-y period. Factors associated with the learning curve as well as case selection have a significant impact on outcome. There may be other as yet not specified factors over time, which have a significant impact on PSA recurrence-free survival. Patients with a PSA of 20 ng/ml and above have a poor outcome and do not appear to be suitable candidates for RRP.

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Acknowledgements

We are grateful to Miss Kate Parry, Statistician at the Research and Development Support Unit, Southmead Hospital for her indispensable assistance with the statistical analysis.

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  1. Bristol Urological Institute, Southmead Hospital, Bristol, UK

    M H Winkler & D A Gillatt

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  1. M H Winkler
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Correspondence to M H Winkler.

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Winkler, M., Gillatt, D. Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period. Prostate Cancer Prostatic Dis 7, 258–262 (2004). https://doi.org/10.1038/sj.pcan.4500734

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