PSA recurrence following radical prostatectomy is comparable for all age groups in the UK

Khan, Fakhar Z.; Kaisary, Amir; Boustead, G.; Gillatt, David; Winkler, Mathias

doi:10.1038/sj.pcan.4500786

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…A necessary priority, especially for training cases, is to ensure that no patient has an excessively long procedure, which risks limb neuropraxia and increases the risk of DVT. The present results, together with no conversions to open surgery in the last 990 cases, no rectal injuries in the last 400 and one patient transfused in the last 970, compare favourably with those published to date in the UK on RP (Table 3) [11–16].…”

Section: Discussionsupporting

confidence: 86%

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The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple ‘learning curves’

Eden¹,

Neill²,

Louie-Johnsun³

2009

BJU International

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OBJECTIVE To report the initial experience of one surgeon, with contemporary experience of both open radical prostatectomy (ORP) and reconstructive laparoscopy, in laparoscopic radical prostatectomy (LRP) in 1000 patients, and to investigate the rate of change of various outcome variables for this procedure with time. PATIENTS AND METHODS Between March 2000 and December 2007, 1000 consecutive patients with clinical stage T ≤ 3aN0M0 prostate cancer underwent LRP, either supervised (17%) or performed (83%), by one surgeon. The median prostate‐specific antigen (PSA) level was 7.0 (1–50) ng/mL and median Gleason sum 6 (4–10); the clinical stage was T1 in 46.9%, T2 in 49.8% and T3 in 3.3%. RESULTS The median (range) operative duration was 177 (78–600) min. There was one conversion (patient 8) to open surgery. The median blood loss was 200 (10–1300) mL and four patients were transfused (0.4%). The median postoperative hospital stay was 3.0 (3–28) nights. The median catheterization time was 10.0 (0.8–120) days. There were 48 complications (4.8%) requiring surgical intervention in 33 (3.3%) patients, 58% of these as a day‐case admission. The positive margin rates according to d’Amico risk groups were: low, 9.1%; intermediate, 20.3%; and high, 36.8%. The overall positive margin rate was 13.3%. The PSA level was ≤0.1 mg/L at 3 months in 99.1% of patients. At a mean follow‐up of 27.7 (3–72) months, 96.1% of patients were free of biochemical recurrence. In patients with a follow‐up of ≥24 months potency rates peaked in the series at 86% for all men and 94% for men aged ≤65 years, and continence rates at 98% before declining thereafter in men with a shorter follow‐up. CONCLUSION The learning curve for operating time and blood loss was overcome within the first 100–150 cases, but complication and continence rates took 150–200 cases to reach a plateau. The longest learning curve was for potency, which did not stabilize until 700 cases. These learning curves are likely to be considerably shorter when surgeons are taught in departments with a high throughput of cases but both surgeons and patients should be aware of them. In view of these findings, the authors recommend that LRP should not be self‐taught and should be learned within an immersion teaching programme. Even then, a large surgical volume is likely to be needed to maintain clinical outcomes at the highest level.

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Section: Discussionsupporting

confidence: 86%

“…[21] in 2001, held as the ‘high standard for those advocating LRP’, in which the PSM rate was 20%. Statistics are not necessary to show that the present rate is also significantly lower than that previously reported in the UK, either for historical [16] or more contemporary [11–15] series (Table 3).…”

Section: Discussionmentioning

confidence: 83%

The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple ‘learning curves’

Eden¹,

Neill²,

Louie-Johnsun³

2009

BJU International

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“…The paucity of outcome data from LRP in the UK and Ireland is very apparent. There are published outcome studies for ORP but UK oncological outcome data are limited to short‐term follow‐up . One UK centre has published a number of papers since 2002 on outcomes in their series over the last 9 years , but these papers did not provide a rigorous analysis of oncological outcomes and did not provide important preoperative risk outcome data.…”

Section: Discussionmentioning

confidence: 99%

Five‐year oncological outcomes of endoscopic extraperitoneal radical prostatectomy (EERPE) for prostate cancer: results from a medium‐volume UK centre

et al. 2013

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Objective• To determine the 5-year oncological outcomes of endoscopic extraperitoneal radical prostatectomy (EERPE) from a medium-volume centre, thereby providing much needed data on outcomes from the UK. Patients and Methods• From January 2006 to January 2012, 575 patients underwent EERPE for localized prostate cancer, performed by a single surgeon who had completed a modular training programme.• Follow-up was as per local hospital policy and data were collected in our prospective database.• A retrospective review of patient demographics, prostate-specific antigen (PSA) levels, pathological T stages, Gleason scores, surgical margin status and biochemical recurrence (BCR) data was performed. BCR was defined as PSA >0.2 μg/L. Results• The mean (range) patient age was 62 (40.3-76.5) years and the mean (range) follow-up was 30 (12-72) months. The median (interquartile range [IQR]) operating time was 135 (120-170) min and the median (IQR) blood loss was 200 (100-250) mL.• Of the 575 patients, 135 (23.5%) had positive surgical margins (PSMs). The PSM rate for pT2 disease was 66/406 patients (16.3%) and for pT3 disease it was 68/168 patients (40.5%). Overall BCR-free survival at 5-years was 81.5%.• Multivariate Cox analysis showed that PSMs, Gleason score, D'Amico risk category and pT stage were independent predictors of BCR-free survival. Conclusions• This assessment of the oncological results of EERPE, which included the surgical learning curve, shows that the adoption of EERPE after mentored fellowship training translates into mid-term oncological outcomes in line with those of retropubic/transperitoneal laparoscopic approaches and with large-volume centres worldwide which have pioneered laparoscopic radical prostatectomy.• The study shows that EERPE in a medium-volume second generation laparoscopic centre (that introduced EERPE after adequate training in pioneering centres) produces results with good 5-year oncological outcomes, similar to those of other major series, for patients in the UK.

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“…As a result of men's and healthcare professionals' preference for aggressive cancer treatment, the advent of PSA testing has dramatically altered the age profile of men who undergo prostatectomies and the median age for men treated for the disease has dropped substantially over the last 20 years (Khan et al 2005). Moreover, since the beginning of the 'PSA era', there has been a huge increase in treatment for localised and early-stage disease, with radical prostatectomy rates increasing 2-4-fold for men in their 50s and 60s between the late 1980s and the turn of the twenty-first century (Moul 2000).…”

Section: Introductionmentioning

confidence: 99%

PSA testing: Molecular technologies and men's experience of prostate cancer survivorship

Bell

Kazanjian

2011

Health, Risk & Society

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Although the value of the PSA (prostate-specific antigen) test as a cancerscreening instrument remains hotly contested, over the past two decades its usage has become commonplace. While most men diagnosed with prostate cancer will die with rather than of the disease, widespread PSA screening has led to an attendant increase in cancer diagnoses and the usage of aggressive treatments to 'combat' it. Despite the central (if controversial) role that PSA now plays in the diagnosis of prostate cancer and monitoring for recurrence, few studies have set out to explore its role in men's experiences of the disease. Drawing on ethnographic fieldwork at a prostate cancer support group in western Canada, we seek to delineate the meanings the PSA test holds for prostate cancer survivors. For many men in the study, their PSA levels were seen to provide an objective indicator of the presence or absence of cancer, with important implications for their subjective experience of cancer diagnosis and survivorship.

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PSA recurrence following radical prostatectomy is comparable for all age groups in the UK

Cited by 6 publications

References 20 publications

The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple ‘learning curves’

The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple ‘learning curves’

Five‐year oncological outcomes of endoscopic extraperitoneal radical prostatectomy (EERPE) for prostate cancer: results from a medium‐volume UK centre

PSA testing: Molecular technologies and men's experience of prostate cancer survivorship

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