title: Has the advent of minimally invasive surgery altered the risk profile of patients undergoing prostatectomy?
abstract: OBJECTIVE
  To determine whether the decreased short-term morbidity associated with minimally invasive surgery (MIS) has resulted in an alteration in the disease-specific risk profile of prostatectomy patients. MIS in many fields has resulted in an expansion in the pool of patients willing to undergo surgery.
  
  
  METHODS
  The Columbia Urologic Oncology Database was queried, and 1751 patients undergoing radical prostatectomy between 2000 and 2007 were identified. The cohort was divided into 2 groups: patients who received surgery before or after the initiation of robotic-assisted laparoscopic radical prostatectomy (RALRP) at our institution (from 2003 onward). Age at surgery, Kattan Nomogram (KN) score, prostate-specific antigen (PSA), Gleason score sum, and tumor stage were compared using unpaired t tests with Welch correction and Mann-Whitney tests.
  
  
  RESULTS
  A total of 663 patients underwent prostatectomy from 2000 to 2002 ("pre-MIS era"), and 1088 patients had surgery in 2003 or later ("MIS era"), of which 519 and 569 underwent RALRP and open prostatectomy, respectively. There was no significant difference between the 2 eras regarding age, Kattan Nomogram score, or tumor stage. However, there was a significant difference in preoperative PSA (P = .01) and Gleason sum (P = .0002). In a comparison of the pre-MIS era with RALRP patients, only PSA differed significantly (P = .0002).
  
  
  CONCLUSIONS
  The advent of MIS for prostate cancer did not significantly alter the characteristics of patients undergoing prostatectomy at our institution. Although advancements in surgical techniques may improve clinical outcomes, this study does not suggest a consequential effect on the risk stratification of patients choosing surgery for prostate cancer.
authors: Department of Urology, Columbia University Medical Center, New York, New York 10032, USA. ljb2119@columbia.edu
authors: LaMont J
authors: LJ
authors: Barlow
authors: Mark J
authors: MJ
authors: Mann
authors: Ketan K
authors: KK
authors: Badani
authors: Mitchell C
authors: MC
authors: Benson
authors: James M
authors: JM
authors: McKiernan
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors