Login to Access Video or Poster Abstract: MP97-19
Sources of Funding: None

Introduction

Principles of high quality oncologic surgery suggest that complete excision be achieved with negative surgical margins and adequate staging. Obtaining quality outcomes in Radical prostatectomy (RP) for high risk prostate cancer can be difficult given the increased risk of extra-prostatic extension and inability to directly visualize the disease intra-operatively. Little is known about the clinical predictors of a quality surgical outcome in patients with high risk prostate cancer. We hypothesize that higher volume providers have improved surgical outcomes.

Methods

Patients diagnosed with prostate cancer were selected from the National Cancer Database between 2010-2013. Patients with biopsy Gleason sum ≥ 8 or PSA > 20 and no clinical evidence of metastasis were included for analysis. A Surgical Outcomes for Advanced Prostate cancer (SOAP) score was generated for each patient. Patients received 2 points each for negative surgical margins and sampling of ≥ 5 pelvic lymph nodes and 1 point each for no readmission with in 30 days, no mortality within 30 days, and hospital length of stay ≤ 2 days. Patients were considered to have a good surgical outcome with a SOAP score ≥ 6. Provider volume was calculated by number of RPs reported from the treatment facility with high volume centers considered to be ones in the top third of reported RPs. Multivariable logistic regression was conducted to determine factors independently associated with quality surgical outcomes using the SOAP score.

Results

We identified 72,864 patients with high risk disease, of whom 42.5% (n=31,008) were treated with RP. Overall, 34.1% of patients had a quality surgical outcome with a SOAP score ≥ 6. On multivariable logistical regression, factors associated with a quality surgical outcome included surgery at a high volume center (OR 1.8: CI 1.6-1.9; p= <0.01), surgery at an academic hospital (OR 1.8: CI 1.7-1.9: p= <0.01), cN1 stage (OR 1.6: CI 1.2-2.0; p= <0.01), and omission of neoadjuvent hormonal therapy (OR 1.4: CI 1.3-1.5; p= <0.01). Factors associated with a poor surgical outcome include robotic approach (OR 0.81: CI 0.76-0.87; p= <0.01), PSA > 30 (OR 0.59: CI 0.55-0.64; p= <0.01), and African American ethnicity (OR 0.89: CI 0.82-0.96; p= <0.01).

Conclusions

For patients with high risk prostate cancer, treatment at high volume centers and at academic centers appear to be associated with a high quality surgical outcomes. Given the increased use of this management strategy, optimizing surgical quality is needed in order to achieve the best outcomes for this aggressive malignancy.

Funding

None