Ten-year experience of robot-assisted radical prostatectomy: the road from cherry-picking to standard procedure

Patients treated with robot-assisted radical prostatectomy (RARP) are frequently selected according to more favorable characteristics. Such patient selection might decrease according to increasing experience.

We relied on the Martini Clinic Prostate Cancer Center database and focused on patients treated with RARP between 2004 and 2013. Differences in clinical, pathological and surgical characteristics at RARP over time (2004-2010, 2011-2012 and 2013) were assessed.

Overall, 1783 RARP patients were identified. Of those, 407 (22.8%), 764 (42.8%) and 612 (34.3%) were treated between 2004 and 2010, in 2011-2012 and in 2013, respectively. Unfavorable characteristics rate, such as biopsy Gleason Score ≥4+4 (8 vs. 9 vs. 15%, P<0.001), D'Amico high-risk (12 vs. 14 vs. 19%, P=0.001) and pathological Gleason score ≥4+4 (3 vs. 4 vs. 6%, P<0.001) increased over time. Pelvic lymph node dissection (PLND) was more frequently performed over time (62 vs. 83 vs. 84%, P<0.001), especially in D'Amico intermediate or high-risk patients (82 vs. 94 vs. 96%, P<0.001). Lymph node yield increased over time in overall (7 vs. 9 vs. 13, P<0.001), D'Amico intermediate (6 vs. 9 vs. 12, P<0.001) and D'Amico high-risk patients (9 vs. 12 vs. 18, P<0.001). No differences in surgical margin (P=0.7) and nerve sparing rates (P=0.09) were found.

A clear trend towards more unfavorable tumor characteristics over time was recorded. Additionally, the rates and extent of PLND increased with increasing experience. RAR P does not represent a barrier to PLND at our institution.