A decade of declining prostatectomy margin positivity within a prostate cancer clinical quality registry

Papa, Nathan; Perera, Marlon; Bensley, Jonathan G.; Evans, Melanie; Millar, Jeremy; Frydenberg, Mark; Murphy, Declan; Bolton, Damien

doi:10.1016/j.urolonc.2022.08.012

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…The PMR was 83.3%, which was very high compared with other series [29,30]. This high percentage is probably attributable to the high number of patients with extracapsular disease at definitive diagnosis and the fact that the number of cases was limited.…”

Section: Discussionmentioning

confidence: 62%

Versius robotic surgical system: case series of 18 robot‐assisted radical prostatectomies

De Maria,

Meneghetti,

Mosillo

et al. 2023

BJU International

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ObjectiveTo present the results of the first series of patients treated with robot‐assisted radical prostatectomy (RARP) with the use of the Versius® Surgical System (CMR Surgical Ltd., Cambridge, UK). RARP has demonstrated better perioperative outcomes compared to open RP. However, RARP remains limited by platform availability and cost‐effectiveness issues. The increasing competition from new robotic surgical platforms may further drive utilisation of the robotic approach.Patients and MethodsData were collected prospectively for our first 18 consecutive patients with localised prostate cancer who underwent RARP at our centre over a 3‐month period. We recorded parameters, including patient demographics and perioperative outcomes. We also report our optimised set‐up with regard to trocar placement, bedside unit placement, and overall composition of the operating room for this procedure. Describing the incremental modifications carried out to achieve reductions in set‐up and operating times to optimise utilisation of the Versius system.ResultsThe median (interquartile range [IQR]) set‐up time was 8.5 (7–10) min. The median (IQR) console time was 201 (170–242) min. The median (IQR) operative time was 213 (186–266) min. The median (IQR) total surgery time was 226 (201–277) min. Bilateral pelvic lymphadenectomy median (IQR) time was 19 (17–20) min. There were no complications and/or limitations related to the use of the Versius system including need for conversion. There were no relevant intra‐ or postoperative complications at the 1‐month follow‐up related to the use of the Versius system. Patients were discharged after a median (IQR) of 4 (3.75–5) days, and the transurethral catheter was removed after a mean (range) of 8 (7–14) days. Continence at 2 months was achieved in 72.2% of the patients.ConclusionsPerforming RARP using the Versius system is feasible, safe, and easily reproducible. Our set‐up enables a rapid docking approach and efficient completion of the surgery.

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Section: Discussionmentioning

confidence: 62%

Versius robotic surgical system: case series of 18 robot‐assisted radical prostatectomies

De Maria,

Meneghetti,

Mosillo

et al. 2023

BJU International

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“…Varios estudios han tratado de identificar los factores predictores de RBQ, ya que se ha visto una significativa relación de esta con las metástasis y la sobrevida específica de cáncer [10][11][12] . Con características poblacionales estadísticamente similares, y pese a asociarse a enfermedades de mayor riesgo, tanto por ISUP como por TNM, los MQP no fueron estadísticamente significativos en relación con la RBQ, la sobrevida libre de metástasis, la sobrevida específica de cáncer y la sobrevida global en ambos grupos de pacientes.…”

Section: Discussionunclassified

Influencia de márgenes positivos tras prostatectomía en resultados oncológicos intermedios subrogantes para sobrevida

Bravo-Izurieta,

Pozo-Lechenbauer,

Lizana-Gálvez

et al. 2024

RECHURO

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Antecedentes: El cáncer de próstata (CaP) es el segundo cáncer más común en los países occidentales. La prostatectomía radical (PR) es el tratamiento estándar para el CaP localizado. Los márgenes quirúrgicos positivos (MQP) se asocian con un aumento de la recidiva bioquímica (RBQ), aunque el impacto a largo plazo sigue siendo controversial. La larga evolución natural del CaP presenta un desafío en los ensayos diseñados para mejorar sobrevida. Objetivo: Determinar la influencia de los MQP en los resultados intermedios subrogantes para sobrevida. Método: Estudio de cohorte retrospectivo. La información se extrajo de la base institucional de pacientes operados de PR entre enero de 2015 y junio de 2022. Se compararon los pacientes con bordes positivos vs. negativos, los meses hasta la RBQ, la muerte específica de cáncer, la sobrevida global y la sobrevida libre de metástasis. Resultados: Se realizaron 291 PR, incorporándose 272 al estudio, de las cuales 100 (27,5%) tuvieron MQP. No hubo diferencia estadística cuando se compararon la sobrevida libre de RBQ (p = 0,26), la sobrevida libre de metástasis (p = 0,31), la sobrevida específica de cáncer (p = 0,12) y la sobrevida global (p = 0,71) entre aquellos con bordes positivos y negativos tras la PR. Se evaluaron determinantes quirúrgicas y prequirúrgicas asociadas a MQP, existiendo relación significativa con compromiso extraprostático (p = 0,001) y CaP significativo (p = 0,001). Conclusiones: Los MQP no estarían asociados a un cambio en los resultados intermedios subrogantes para sobrevida en nuestro centro, no pudiendo establecer que estén involucrados en la sobrevida global de los pacientes con CaP.

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“…Two recent studies using the binational prostate cancer registry (PCOR‐ANZ) showed population‐level data demonstrated clinically equivalent PROMs from randomised controlled trials 41,42 . Another study using PCOR‐Vic revealed that positive margin rate has significantly reduced since the inception of the registry, where the authors commented that benchmarking against established aspirational real‐world post‐operative outcomes facilitates the detection of areas of improvement 43 . Further improvements in data quality will increase the relevance of studies derived from such registries.…”

Section: Discussionmentioning

confidence: 99%

“… 41 , 42 Another study using PCOR‐Vic revealed that positive margin rate has significantly reduced since the inception of the registry, where the authors commented that benchmarking against established aspirational real‐world post‐operative outcomes facilitates the detection of areas of improvement. 43 Further improvements in data quality will increase the relevance of studies derived from such registries. SA‐PCCOC as a main contributor to the PCOR‐ANZ, evidence on risk‐adjusted posttreatment outcomes would leverage other registries and provide benchmarks to encourage quality improvement efforts to produce improved outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical and functional outcomes for risk‐appropriate treatments for prostate cancer

Tiruye,

O'Callaghan,

Ettridge

et al. 2023

BJUI Compass

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ObjectivesTo describe real‐world clinical and functional outcomes in an Australian cohort of men with localised prostate cancer according to treatment type and risk category.Subjects and methodsMen diagnosed from 2008 to 2018 who were enrolled in South Australian Prostate Cancer Clinical Outcomes Collaborative registry—a multi‐institutional prospective clinical registry—were studied. The main outcome measures were overall survival, cancer‐specific survival, decline in functional outcomes, biochemical recurrence and transition to active treatment following active surveillance. Multivariable adjusted models were applied to estimate outcomes.ResultsOf the 8513 eligible men, majority of men (46%) underwent radical prostatectomy (RP) followed by external beam radiation therapy with or without androgen deprivation therapy (EBRT +/− ADT) in 22% of the cohort. Five‐year overall survival was above 91%, and 5‐year prostate cancer‐specific survival was above 97% in the low‐ and intermediate‐risk categories across all treatments. Five‐year prostate cancer‐specific survival in the active surveillance group was 100%. About 37% of men with high‐risk disease treated with RP and 17% of men treated with EBRT +/− ADT experienced biochemical recurrence within 5 years of treatment. Of men on active surveillance, 15% of those with low risk and 20% with intermediate risk converted to active treatment within 2 years. The decline in urinary continence and sexual function 12 months after treatment was greatest among men who underwent RP while the decline in bowel function was greatest for men who received EBRT +/− ADT.ConclusionThis contemporary real‐world evidence on risk‐appropriate treatment outcomes helps inform treatment decision‐making for clinicians and patients.

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A decade of declining prostatectomy margin positivity within a prostate cancer clinical quality registry

Cited by 4 publications

References 21 publications

Versius robotic surgical system: case series of 18 robot‐assisted radical prostatectomies

Versius robotic surgical system: case series of 18 robot‐assisted radical prostatectomies

Influencia de márgenes positivos tras prostatectomía en resultados oncológicos intermedios subrogantes para sobrevida

Clinical and functional outcomes for risk‐appropriate treatments for prostate cancer

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