TY - JOUR
T1 - Urinary continence recovery and oncological outcomes after surgery for prostate cancer analysed by risk category
T2 - results from the LAParoscopic prostatectomy robot and open trial
AU - Hagman, Anna
AU - Lantz, Anna
AU - Carlsson, Stefan
AU - Höijer, Jonas
AU - Stranne, Johan
AU - Tyritzis, S. I.
AU - Haglind, Eva
AU - Bjartell, Anders
AU - Hugosson, Jonas
AU - Akre, Olof
AU - Steineck, Gunnar
AU - Wiklund, Peter
PY - 2021
Y1 - 2021
N2 - Purpose: To evaluate urinary continence (UC) recovery and oncological outcomes in different risk-groups after robot-assisted radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP). Patients and methods: We analysed 2650 men with prostate cancer from seven open (n = 805) and seven robotic (n = 1845) Swedish centres between 2008 and 2011 in a prospective non-randomised trial, LAPPRO. UC recovery was defined as change of pads less than once in 24 h. Information was collected through validated questionnaires. Rate of positive surgical margins (PSM) and biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) > 0.25 mg/ml, were recorded. We stratified patients into two risk groups (low-intermediate and high risk) based on the D’Amico risk classification system. Result: Among men with high-risk prostate cancer, we found significantly higher rates of UC recovery up to 24 months after RRP compared to RALP (66.1% vs 60.5%) RR 0.85 (CI 95% 0.73–0.99) while PSM was more frequent after RRP compared to RALP (46.8% vs 23.5%) RR 1.56 (CI 95% 1.10–2.21). In the same group no significant difference was seen in BCR. Overall, however, BCR was significantly more common after RRP compared to RALP at 24 months (9.8% vs 6.6%) RR 1.43 (Cl 95% 1.08–1.89). The limitations of this study are its non-randomized design and the relatively short time of follow-up. Conclusions: Our study indicates that men with high-risk tumour operated with open surgery had better urinary continence recovery but with a higher risk of PSM than after robotic-assisted laparoscopic surgery. No significant difference was seen in biochemical recurrence. Trial registration: ISRCTN06393679.
AB - Purpose: To evaluate urinary continence (UC) recovery and oncological outcomes in different risk-groups after robot-assisted radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP). Patients and methods: We analysed 2650 men with prostate cancer from seven open (n = 805) and seven robotic (n = 1845) Swedish centres between 2008 and 2011 in a prospective non-randomised trial, LAPPRO. UC recovery was defined as change of pads less than once in 24 h. Information was collected through validated questionnaires. Rate of positive surgical margins (PSM) and biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) > 0.25 mg/ml, were recorded. We stratified patients into two risk groups (low-intermediate and high risk) based on the D’Amico risk classification system. Result: Among men with high-risk prostate cancer, we found significantly higher rates of UC recovery up to 24 months after RRP compared to RALP (66.1% vs 60.5%) RR 0.85 (CI 95% 0.73–0.99) while PSM was more frequent after RRP compared to RALP (46.8% vs 23.5%) RR 1.56 (CI 95% 1.10–2.21). In the same group no significant difference was seen in BCR. Overall, however, BCR was significantly more common after RRP compared to RALP at 24 months (9.8% vs 6.6%) RR 1.43 (Cl 95% 1.08–1.89). The limitations of this study are its non-randomized design and the relatively short time of follow-up. Conclusions: Our study indicates that men with high-risk tumour operated with open surgery had better urinary continence recovery but with a higher risk of PSM than after robotic-assisted laparoscopic surgery. No significant difference was seen in biochemical recurrence. Trial registration: ISRCTN06393679.
KW - Prostate cancer
KW - Prostatectomy
KW - Recurrence
KW - Robot-assisted surgery
KW - Urinary incontinence
U2 - 10.1007/s00345-021-03662-0
DO - 10.1007/s00345-021-03662-0
M3 - Article
C2 - 33743059
AN - SCOPUS:85103223824
SN - 0724-4983
VL - 39
SP - 3239
EP - 3249
JO - World Journal of Urology
JF - World Journal of Urology
IS - 9
ER -