title: Evolution and oncological outcomes of a contemporary radical prostatectomy practice in a UK regional tertiary referral centre.
abstract: OBJECTIVE
  To investigate the clinical and pathological trends, over a 10-year period, in robot-assisted laparoscopic prostatectomy (RALP) in a UK regional tertiary referral centre.
  
  
  METHODS
  In all, 1 500 consecutive patients underwent RALP between October 2005 and January 2015. Prospective data were collected on clinicopathological details at presentation as well as surgical outcomes and compared over time.
  
  
  RESULTS
  The median (range) age of patients throughout the period was 62 (35-78) years. The proportion of preoperative high-grade cases (Gleason score 8-10) rose from 4.6% in 2005-2008 to 18.2% in 2013-2015 (P < 0.001). In the same periods the proportion of clinical stage T3 cases operated on rose from 2.4% to 11.4% (P < 0.001). The median prostate-specific antigen (PSA) level at diagnosis did not alter significantly. Overall, 11.6% of men in 2005-2008 were classified preoperatively as high-risk by National Institute for Health and Care Excellence criteria, compared with 33.6% in 2013-2015 (P < 0.001). The corresponding proportions for low-risk cases were 48.6% and 17.3%, respectively. Final surgical pathology showed an increase in tumour stage, Gleason grade, and nodal status over time. The proportion of pT3 cases rose from 43.2% in 2005-2008 to 55.5% in 2013-2015 (P < 0.001), Gleason score 9-10 tumours increased from 1.8% to 9.1% (P < 0.001) and positive nodal status increased from 1.6% to 12.9% (P < 0.001) between the same periods. Despite this, positive surgical margin rates showed a downward trend in all pT groups across the different eras (P = 0.72).
  
  
  CONCLUSIONS
  This study suggests that the patient profile for RALP in our unit is changing, with increasing proportions of higher stage and more advanced disease being referred and operated on. However, surgical margin outcomes have remained good.
authors.affiliation: Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK. vjg29@cam.ac.uk.|Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. vjg29@cam.ac.uk.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Gnanapragasam
authors.affiliation: Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Thurtle
authors.affiliation: Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Anandagopal
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Volanis
authors.affiliation: Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: George
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Artitaya
authors.initials: A
authors.lastname: Lophatananon
authors.affiliation: Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Stearn
authors.affiliation: Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Warren
authors.affiliation: Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.|Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Lamb
authors.affiliation: Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Greg
authors.initials: G
authors.lastname: Shaw
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Ben C
authors.initials: BC
authors.lastname: Thomas
authors.affiliation: Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Maxine G
authors.initials: MG
authors.lastname: Tran
authors.affiliation: Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.affiliation: Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Nimish.Shah@addenbrookes.nhs.uk.
authors.forename: Nimish C
authors.initials: NC
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: high risk; prostate cancer; radical prostatectomy; robot-assisted laparoscopic prostatectomy