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Trends in clinical and oncological outcomes of robot-assisted radical prostatectomy before and after the 2012 US Preventive Services Task Force recommendation against PSA screening: a decade of experience
- Source :
- BJU International. 125:884-892
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Objective To assess the influence of the 2012 US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA)-based screening on oncological and functional outcomes following robot-assisted laparoscopic prostatectomy (RALP). Materials and methods We retrospectively analysed patients who underwent RALP between 2008 and 2018 with a minimum of 12-month follow-up from a prospectively collected institutional review board-approved database. The impact of the USPSTF recommendation against PSA screening on our surgical outcomes was assessed using a logistic regression model using two groups comprising patients treated before/after the USPSTF statement and indicating time trends for each successive year. Results The mean preoperative PSA increased from 6.0 to 7.4 ng/mL after the USPSTF recommendation. We detected statistically significant time-trend changes after 2012, including an increase in the positive slope of Gleason ≥3 + 4 or ≥pT3 disease. We detected a fall in bilateral full nerve-sparing and an increase in partial nerve-sparing. The total positive surgical margin (PSM) rate increased after the USPSTF recommendation; however, PSM rates pertinent to each pathological stage did not change significantly after 2012. There was a significant negative trend change in the postoperative 12-month continence and potency rates, indicating a breakpoint in functional outcomes after 2012. We detected a 1.7-fold increase in 12-month biochemical recurrence (BCR) rates. The 12-month BCR, potency and continence rates were maintained in young ( 22 and low-volume disease. Conclusion Since the USPSTF's recommendation in 2012, we have seen a significant increase in the incidence of high-risk disease that has forced us to modify our approach to the procedure and the grade of nerve-sparing used, leading to a wider resection, in order to reduce PSMs. This has led to a decrease in postoperative functional recovery. Patients with favourable characteristics had good outcomes before and after the USPSTF's recommendation, implying that the quality of surgery did not change over time.
- Subjects :
- Biochemical recurrence
medicine.medical_specialty
business.industry
Prostatectomy
Urology
medicine.medical_treatment
Incidence (epidemiology)
030232 urology & nephrology
Disease
Logistic regression
03 medical and health sciences
0302 clinical medicine
030220 oncology & carcinogenesis
Internal medicine
medicine
Laparoscopic Prostatectomy
Positive Surgical Margin
Stage (cooking)
business
Subjects
Details
- ISSN :
- 14644096
- Volume :
- 125
- Database :
- OpenAIRE
- Journal :
- BJU International
- Accession number :
- edsair.doi...........e6d3502c40094046a4db1810a3e75d40