Session: MP67: Prostate Cancer: Localized: Surgical Therapy III
MP67-05: Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the Taskforce recommendations against PSA screening
Introduction: For experienced surgeons, prostate cancer outcomes are ultimately affected by the pathology of the disease they treat. Over the last decade, we have experienced a dramatic alteration in the pathology we are addressing. During this time, the most significant shift in prostate cancer management was the 2012 USPSTF (United States Preventive Service Task Force) decision to recommend against PSA screening. This has affected the types of prostate cancers we are treating and potentially influenced treatment outcomes. We aimed to analyze the functional and oncologic trends in prostate cancer outcomes in the largest single surgeon series. Methods: We retrospectively reviewed our prospective IRB-approved prostate cancer registry for 11396 patients that underwent RALP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups before and 6 months after the USPSTF recommendation. Group 1: 1/2008- 12/2012, Group 2: 1/ 2013-12-2021. Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. We assessed the functional and oncologic outcomes of the two groups. Results: We detected time-trend changes after 2012. There was a migration to younger ages, less than 60, and an increase in the median preoperative PSA (5 to 6 ng/ml). There was 18% increase in the higher grade and stage of the disease, Gleason =3+4 (19% increase), and = pT3 (18% increase). This translated into a 6% increase in positive surgical margins with an initial rapid increase that was tempered with a surgical adjustment in the amount of (NS) nerve sparing. There was a 24% reduction in full nerve sparing in response to the worsening pathology. Outcomes were also affected by the modification in NS. Comparing groups 1 and 2, there was a significant decline in post-operative outcomes: 12-month continence reduction by 9%, reduction in potency by 27%, and trifecta by 22%. Conclusions: We have witnessed a significant change in the types of patients we are seeing and the outcomes we are able to deliver. We are seeing younger patients with higher-grade diseases, and 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. The USPSTF recommendation has affected the oncology and outcomes of prostate cancer in an increasingly younger patient population. SOURCE OF Funding: none
