May Outcomes of Robotic Radical Prostatectomy Performed After an Initial Surveillance Strategy Differ from Those from Immediate Surgery? A Propensity Score-Matched Analysis on 362 Patients Undergoing Surgery at a Referral Center

Rocco, Bernardo; Sighinolfi, Maria Chiara; Moschovas, Marcio Covas; Sandri, Marco; Assumma, Simone; Bozzini, Giorgio; Micali, Salvatore; Seetharam, Bath; Patel, Vipul

doi:10.1089/end.2021.0812

Cited by 1 publication

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“…Another factor we believe that may influence the increasing rates of high-grade tumors in the last years is the increasing use of active surveillance (AS) performed in the community with non-standard protocols and follow-up. We recently described our experience comparing patients who underwent RARP at the time of the diagnosis with patients referred to operate in our center after undergoing active surveillance in the community ( 25 ). Comparing two groups of 181 patients, matched with a propensity score analysis, we found 16% higher positive surgical margins rates (38% vs. 22%, p=0.001) and a significant increase in biochemical recurrence after surveillance and delayed RARP (HR 4.0; 95%CI 1.4-12; p=0.013).…”

Section: Discussionmentioning

confidence: 99%

Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the US Preventive Service Taskforce recommendations against PSA screening

Moschovas,

Jaber,

Saikali

et al. 2024

Int. braz j urol.

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Objective: In the following years after the United States Preventive Service Task Force (USPSTF) recommendation against prostate cancer screening with PSA in 2012, several authors worldwide described an increase in higher grades and aggressive prostate tumors. In this scenario, we aim to evaluate the potential impacts of USPSTF recommendations on the functional and oncological outcomes in patients undergoing robotic-assisted radical prostatectomy (RARP) in a referral center. Material and Methods: We included 11396 patients who underwent RARP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups based on an inflection point in the outcomes at the end of 2012 and the beginning of 2013. The inflection point period was detected by Bayesian regression with multiple change points and regression with unknown breakpoints. We reported continuous variables as median and interquartile range (IQR) and categorical variables as absolute and relative percent frequencies. Results: Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. In the final pathology, Group 2 had 9.5% increase in tumor volume, 24% increase on Gleason ≥ 4+3 (ISUP 3), and 18% increase on ≥ pT3. This translated to a 6% increase in positive surgical margins and 24% reduction in full nerve sparing in response to the worsening pathology. There was a significant decline in post-operative outcomes in Group 2, including a 12-month continence reduction of 9%, reduction in potency by 27%, and reduction of trifecta by 22%. Conclusions: The increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. Among some historical changes in prostate cancer diagnosis and management in the period of our study, the USPSTF recommendation coincided with worse outcomes of prostate cancer treatment in a population who could benefit from PSA screening at the appropriate time.

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Section: Discussionmentioning

confidence: 99%