Dados do Trabalho

Título

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

Resumo

During the last decade, the most significant shift in prostate cancer management was the 2012 USPSTF (United States Preventive Service Task Force) decision against PSA screening for all men. This has affected the types of prostate cancers we are treating and potentially can influence treatment outcomes. We aimed to analyze the functional and oncologic trends in prostate cancer outcomes in the largest single surgeon, single practice series. METHODS: We retrospectively reviewed our 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: Group 1, before; and Group 2, six months after changes to USPSTF recommendations. 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 an 18% increase in the higher grade and stage of the disease, Gleason ≥3+4 (19% increase), and ≥ pT3 (18% increase). This translated to a 6% increase in positive surgical margins with an initial rapid increase that was tempered with a surgical adjustment in the amount of nerve sparing (NS). There was a 24% reduction in full nerve sparing in response to the worsening pathology. Outcomes were also affected by the modification in NS. There was a significant decline in post-operative outcomes in Group 2, including: a 12-month continence reduction by 9%, reduction in potency by 27%, and reduction trifecta by 22%. The breakpoint in functional outcomes appears to be mid-2012. CONCLUSION: In our practice, 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 functional and oncological outcomes of prostate cancer in an increasingly younger patient population.