European study on radical prostatectomy (ESRPE) - Part II: Functional results and changes 1993-2004

INTRODUCTION & OBJECTIVES: To evaluate Oncological results of radical retropubic prostatectomy in Western and Eastern Europe from 1993-2004. MATERIAL & METHODS: In these retrospective evaluations 10,553 men who underwent radical retropubic prostatectomy between 1993 and 2004 were evaluated and onco-pathological data and features collected. Besides Pathological features, margin status at various stages, PSA recurrence rates were evaluated. RESULTS: In patients with clinically localised disease and a PSA 2.5-15 ng/mL, 81% underwent radical prostatectomy and 17% opted for radiation therapy and 2% opted for watchful waiting. Overall, Positive margin rates decreased from 38% to 18%, from 1993-2004. The biggest fall in the margin rate was observed between 1996 and 1999. Margin rates for pT2 cancers were 7.4-21.9%. The positive margin rate signifi cantly correlated with the number of surgeons involved per service and the total number of cases performed. (p=0.004). PSA recurrence rates at 3 and 7 years were 3.7-7.9% and 28.4-35.8%, respectively. The lowest rates in positive margins and PSA recurrence were seen in those centres performing > 200 cases per year. A constant relative increase in Nerv-sparing (uni- and bilateral) procedures was observed with highest rates 1998-2000, and reaching a plateau thereafter (at 71,4% of all cases). Distribution of positive margins did not differ signifi cantly over time despite changes in stage: 44.8% of + margins were located at the apex, 39.7% at the posterolateral aspect and 15.5% at the bladder neck. Immediate and long term Surgical complications (7 ESOU defi ned complications) decreased signifi cantly over time from 28.6% (1993-1995) to 13.2% (1996- 2004) of all cases. Equally, medical complications (non-surgical) decreased from 9.4% (1993-1995) to 4.2% (1996-2004) Complication rates remained unchanged (plateau) from 1999 to 2004. OR time decreased from 281 min (125-640) to 188 min (64-355) in the periods 1993-1995 to 2001-2004, respectively. Transfusion rates, although highly variable due to different local practices, decreased form 21.6% (1993-1994) to 8.6% (2001-2004). CONCLUSIONS: Radical retropubic prostatectomy has signifi cantly evolved over the past 12 years. A favourable trend was observed in OR time, transfusion rate, surgical and medical complication rates, margin status and biochemical recurrence rates. This favourable trend reached a steady state (plateau) between 2000- 2004 and continues as such. Best outcomes were seen in those centres performing > 200 cases per year and in those with the lowest surgeon/case ratio.