Dados do Trabalho

Título

IMPACTS ON FUNCTIONAL AND ONCOLOGICAL OUTCOMES OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY 10 YEARS AFTER THE US PREVENTIVE SERVICE TASKFORCE RECOMMENDATIONS AGAINST PSA SCREENING.

Introdução e Objetivo

For experienced surgeons, prostate cancer outcomes are ultimately affected by the pathology of the disease they treat. Over the last decade and a half, we have experienced a dramatic alteration in the pathology that we are addressing. During this time, the most significant shift in prostate cancer management was observed following the May 2012 decision by the United States Preventive Service Task Force (USPSTF) that recommended against PSA screening for all men. This has affected the types of prostate cancers we are treating and can potentially influence treatment outcomes. We aimed to analyze the functional and oncologic trends in prostate cancer outcomes in the largest single surgeon, single practice series. 

Método

We retrospectively reviewed 11396 patients who underwent robotic-assisted radical prostatectomy (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 detected by two statistical methods (Bayesian regression with multiple change points and regression with unknown breakpoints). Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. We assessed and compared the functional and oncologic outcomes of both groups.

Resultados

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%. Limitation regards the retrospective design of the study.

Conclusão

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.