A Nationwide Descriptive Analysis of Real-World Outcomes After Radical Prostatectomy in Japan Using the National...

Area of Science:

• Urology
• Oncology
• Health Services Research

Background:

• Radical prostatectomy (RP) is a primary treatment for prostate cancer.
• Real-world data on long-term oncological outcomes following RP in Japan are limited.
• Understanding factors influencing biochemical recurrence-free survival (BCRFS) is crucial for patient management.

Purpose of the Study:

• To evaluate real-world BCRFS after RP in Japan using nationwide data.
• To identify key determinants of BCRFS, including surgical approach and clinicopathological factors.
• To establish benchmarks for postoperative prognosis in Japanese prostate cancer patients.

Main Methods:

• Analysis of nationwide data from the National Clinical Database (NCD) in Japan.
• Inclusion of 14,992 patients who underwent RP between April and December 2018 with 5-year follow-up.
• Estimation of BCRFS using the Kaplan-Meier method and evaluation of outcomes by surgical approach and pathological factors.

Main Results:

• The overall 5-year BCRFS rate was 81%.
• BCRFS was comparable across different age groups and surgical approaches (robot-assisted, open, laparoscopic RP).
• Pathological factors significantly impacted prognosis: BCRFS decreased with higher pathological stage, presence of nodal metastasis, and higher ISUP Grade Group. Extended lymph node dissection was associated with lower BCRFS compared to no dissection or obturator dissection.

Conclusions:

• Nationwide data confirm that pathological tumor characteristics are the main predictors of postoperative prognosis after RP in Japan.
• Patient age and surgical approach were not significant determinants of BCRFS in this cohort.
• These findings provide essential benchmarks for clinical decision-making in prostate cancer management.