Introduction

To estimate the conditional probability of biochemical recurrence (BCR) free survival and cancer-specific mortality (CSM) for men with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP)._x000D_

Methods

The study population consisted of 3576 consecutive patients who underwent laparoscopic radical prostatectomy (LARP) and 2619 men treated with robotic radical prostatectomy (RARP) in the last 15 years at our institution. BCR was defined as PSA≥0.2 ng/dl. PCa death was defined as patients who died with metastasis in an androgen independent setting. Kaplan Meier and Cox regression methods was used to estimate BCR and CSM conditional probabilities. _x000D_

Results

Median follow-up was 8.49 years (IQR 4.01-12.97). Positive surgical margins (PSM) were identified in 1202 patients (19.4%); of these, 664 (55.24%) had organ confined disease and 523 (43.51%) had extraprostatic extension (EPE). BCR-free survival rate was significantly higher with RARP (83% vs 77% for laparoscopic surgery at 10 years; p<0.001). Patients with PSA<10 ng/dl BCR-free survival at 10 years was 80% vs 64% for PSA 10-20 ng/dl, and 59% for PSA >20ng/dl; p>0.001.Negative margins, Gleason≤6 and no extracapsular extension in the specimen were found to have higher BCR-free survival (all p< 0.001)._x000D_ Conditional probability of BCR after surgery 1st year is 6.7%. Those who reach the 2nd year without recurrence have a relapse probability of 4%, (cumulative probability 9.8%) That probability falls to 3.5% after the 3rd year (cumulative probability 13%), 2% after the 4th year (cumulative probability 15%) and is 2.1% after the 5th year (cumulative probability 17%). After 10 years of follow-up without recurrence, the subsequent probability of relapse is 0.8%, (cumulative probability 21%)._x000D_ A total of 92 (1.48%) patients died of disease. Among patients with BCR, those who recur within the first three years of follow-up had higher CSM (9% vs 4% for BCR after 3 years; p=0.04). The table shows the variables associated with CSM in multivariable analysis._x000D_

Conclusions

We found a 50% decrease in BCR probability in patients who had not recurred with the first 3 years. Similar drop was identified for CSM. This is not only useful for patients counseling but also to optimize postoperative follow-up strategies._x000D_

Funding

none