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15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer

Prostate Cancer and Prostatic Diseases volume 26, pages 778–786 (2023)Cite this article

Subjects

Abstract

Background

An informed decision regarding a treatment option requires data on its long-term efficacy and side-effect profile. While the side-effects of robotic radical prostatectomy have been well-quantified, the data on its long-term efficacy are lacking. We here provide 15-year oncological outcomes of clinically-localized prostate cancer (CLPCa) patients treated with robot-assisted laparoscopic prostatectomy (RALP).

Methods

We treated 1,807 men with CLPCa with RALP between 2001 and 2005 and prospectively collected follow-up data through 2020. We examined the rates of biochemical failure (BCF), metastatic progression, secondary therapy use, PCa-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and competing-risk cumulative incidence methods as appropriate.

Results

The median follow-up was 14.1 years. Six hundred eight and 312 men had D’Amico intermediate- and high-risk disease, respectively. Overall, the 15-year rates of BCF, metastasis, secondary therapy use, PCSM, and OS were 28.1%, 4.0%, 16.3%, 2.5%, and 82.1%, respectively. The rates of oncologic failure increased with increasing D’Amico (preoperative) and Diaz (postoperative) risk scores — BCF, metastasis, and PCSM rates in D’Amico low-, intermediate-, and high-risk groups at 15-years were 15.2%, 38.3%, and 44.1% [BCF], 1.1%, 4.1%, and 13.0% [metastasis], and 0.5%, 3.4%, and 6.6% [PCSM], respectively, and in Diaz risk groups 1, 2, 3, 4, and 5 were 5.5%, 20.6%, 41.8%, 66.9%, and 89.2% [BCF], 0%, 0.5%, 3.2%, 20.5%, and 60.0% [metastasis], and 0%, 0.8%, 0.6%, 13.5%, and 37.5% [PCSM], respectively. The OS rates in D’Amico low-to-high and Diaz 1-to-5 risk groups at 15-years were 85.9%, 78.6%, and 75.2%, and 89.4%, 83.2%, 80.6%, 67.2%, and 23.4%, respectively.

Conclusions

Men diagnosed with clinically-localized prostate cancer in the contemporaneous PSA-screening era and treated with RALP achieve durable long-term oncological control. The data reported here (in a risk-stratified manner) represent the longest follow-up after robotic radical prostatectomy, and as such, should be of value when counseling patients regarding expected oncologic outcomes from RALP.

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Fig. 1: Outcomes in overall cohort.
Fig. 2: Outcome stratified by preoperative D’Amico risk class.
Fig. 3: Outcomes stratified by postoperative Diaz risk class.

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Data availability

Data are available to interested parties on request from the corresponding author.

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Author information

Authors and Affiliations

  1. VCORE – Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA

    Akshay Sood, Mireya Diaz-Insua, Firas Abdollah & Mani Menon

  2. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

    Akshay Sood, James O. Peabody, Wooju Jeong, Firas Abdollah, Mahendra Bhandari & Mani Menon

  3. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Akshay Sood, Jan K. Rudzinski & Jack R. Andrews

  4. Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Akshay Sood

  5. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Ralph Grauer, Ashutosh K. Tewari, Michael A. Gorin & Mani Menon

  6. Department of Urology, Wake Forest University, Winston-Salem, NC, USA

    Ashok K. Hemal

  7. Department of Urology, Cleveland Clinic, Weston, FL, USA

    Alok Shrivastava

  8. Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Michael A. Gorin

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Contributions

Conception and design: AS. Acquisition of data, statistical analysis: MDI. Analysis and interpretation of data: AS, MDI, MM. Drafting of manuscript: AS, RG, AKT, AKH, ASH, JOP, WJ, FA, JKR, JRA, MAG, MB, MM. Critical revision of the manuscript for important intellectual content: AS, MM. Funding, administrative, technical, or material support: MM.

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Correspondence to Akshay Sood.

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Sood, A., Grauer, R., Diaz-Insua, M. et al. 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer. Prostate Cancer Prostatic Dis 26, 778–786 (2023). https://doi.org/10.1038/s41391-023-00674-2

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