title: Intermediate-term cancer control outcomes in prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy: a multi-institutional analysis.
abstract: OBJECTIVE
  Cancer control outcomes following robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) remain inadequately addressed over intermediate-term (≥5-year) follow-up. We examined biochemical recurrence-free survival (BCRFS), clinical recurrence-free survival (CRFS), and cancer-specific survival (CSS) in a multi-institutional cohort of men undergoing RARP for localized PCa.
  
  
  METHODS
  A total of 5670 PCa patients undergoing RARP ± pelvic lymph node dissection as primary treatment modality at three tertiary care centers between 2001 and 2010 were analyzed. BCRFS, CRFS, and CSS were estimated using the Kaplan-Meier method. Cox proportional hazards model tested their association with available preoperative and postoperative parameters.
  
  
  RESULTS
  43.6 and 15.1 % of patients had D'Amico intermediate- and high-risk disease, respectively. Over a mean (median) follow-up of 56 (50.4) months, 797 men had a BCR, 78 men had CR, and 32 men died of PCa. Actuarial BCRFS, CRFS, and CSS, respectively, were 83.3, 98.6, and 99.5 % at 5-year; 76.5, 97.5, and 98.7 % at 8-year; and 73.3, 96.7, and 98.4 % at 10-year follow-ups. Only 1.7 % of patients received any adjuvant treatment. Preoperative prostate-specific antigen (PSA) and biopsy Gleason score (GS) were independent clinical predictors of BCRFS, CRFS, and CSS, while postoperatively positive surgical margin, pathological GS, pathological stage, and lymph node invasion were significantly associated with BCR and CR (all p < 0.05).
  
  
  CONCLUSIONS
  Cancer control outcomes of RARP appear comparable to those reported for open and laparoscopic RP in previous literature, despite low overall rate of adjuvant treatment. Disease severity and preoperative PSA may aid in risk prognostication and defining postoperative follow-up protocols.
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA. firas.abdollah@gmail.com.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Beyer
authors.affiliation: Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Mireya
authors.initials: M
authors.lastname: Diaz-Insua
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.affiliation: Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.affiliation: Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Biochemical recurrence; Clinical recurrence; Intermediate-term follow-up; Prostate cancer; Robot-assisted radical prostatectomy