All the truth about local treatment options T1-2: surgery Vincenzo Ficarra Department of Oncological and Surgical Sciences...
Radical Prostatectomy History 1904   1983  1992  2000 Non-anatomic Radical Prostatectomy (Young, 1904) Anatomic Retropubic...
Use of Minimally Invasive vs Open RP SEER registries: 2003-2007 Hu JC. et al. JAMA 2009; 302: 1557-1564
130 citations (2009-2011)
MEDLINE [4,000 records] EMBASE [2,265 records] Web Science [4,219 records] 37 comparative studies non comparative studies ...
Evidence from systematic review <ul><li>LRP and RALP are followed by significantly  </li></ul><ul><li>lower blood loss and...
EAU Guidelines on Prostate Cancer www.uroweb.org  Guidelines on Prostate Cancer – 2011  <ul><li>LRP and RALP were followed...
Update of the systematic review Novara G, Ficarra V, Montorsi F. et al. (Unpublished data)
Update of the systematic review 37 comparative studies RRP Vs LRP  (n = 23) RRP Vs RALP (n = 10) LRP Vs RALP (n = 4) RRP V...
Outcomes evaluated <ul><li>Perioperative </li></ul><ul><li>- blood loss, transfusion rate, overall complication  </li></ul...
Perioperative data: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
Blood loss: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Most of the comparative studies reporte...
Transfusion rate: RRP Vs RALP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
Overall complications: RRP Vs RALP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
Overall complication rate: RRP Vs RALP Carlsson S. et al. Urology 2010; 75: 1092-1099
Outcomes evaluated <ul><li>Perioperative </li></ul><ul><li>- blood loss, transfusion rate, overall complication  </li></ul...
Urinary continence recovery Myers R. J Urol 1987; 138 (3): 543-50
Urinary continence recovery: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
Urinary continence: RALP Vs RRP Tewari et al BJU Inter 2003; 92: 205-210. RALP RRP
Urinary continence: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) 6-mo continence rate
Urinary continence: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) 12-mo continence rate
Nerve-sparing techniques and  Potency recovery Stolzenburg JU et al, Eur Urol 2007;51(3):629-39 Interfascial Intrafascial
Potency recovery: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
Potency recovery: RALP Vs RRP Tewari et al BJU Inter 2003; 92: 205-210. RALP RRP
Potency recovery: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
Outcomes evaluated <ul><li>Perioperative </li></ul><ul><li>- blood loss, transfusion rate, overall complication  </li></ul...
Positive Surgical Margin rates after RALP  Ficarra V. et al. AUA Update series – Lesson 30; 2010
Positive surgical margins:  RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
Positive surgical margins:  RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Sensitivity analysis in...
Positive surgical margins:  RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Sensitivity analysis in...
Oncological Results: 5-year bDFS Menon M et al  Eur Urol 2010; 58: 838-846 95% 91% 86% 81%
Oncological Results: 5-year bDFS Mottrie A et al  (submitted to BJU Inter) 81%
Oncological Results: 3-year bDFS Schroeck FR et al BJU Inter 2008; 102: 28-32
Oncological Results: 3-year bDFS Barocas DA et al J Urol 2010; 183: 990-996
Oncological Results: 5-year bDFS Drouin SJ et al World J Urol 2009; 27: 599-605
Potential disadvantages of minimally invasive radical prostatectomy: Costs Bolenz C. et al. Eur Urol 2010; 57: 453-458
Conclusions <ul><li>RALP is the main alternative to RRP in the  </li></ul><ul><li>surgical treatment of localized prostate...
Conclusions <ul><li>Early and intermediate oncological outcomes  </li></ul><ul><li>seems to be equivalent  </li></ul><ul><...
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ECCLU 2011 - V. Ficarra - Prostate cancer: All the truth about local treatment options T1-T2 - Surgery

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  • La robotica nel cronologia delle altre tecniche di prostatectomia radicale
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Ma il dato più significativo nel contenimento dei costi è legato al volume operatorio settimanale. Il numero ideale sarebbe superiore a 6-7!!
  • ECCLU 2011 - V. Ficarra - Prostate cancer: All the truth about local treatment options T1-T2 - Surgery

    1. 1. All the truth about local treatment options T1-2: surgery Vincenzo Ficarra Department of Oncological and Surgical Sciences Urologic Unit, University of Padova, Italy
    2. 2. Radical Prostatectomy History 1904 1983 1992 2000 Non-anatomic Radical Prostatectomy (Young, 1904) Anatomic Retropubic Radical Prostatectomy (Walsh, 1983) Magnified Laparoscopic Radical Prostatectomy (Schuessler, 1992) Millimetric Robotic Radical Prostatectomy (Binder, 2000)
    3. 3. Use of Minimally Invasive vs Open RP SEER registries: 2003-2007 Hu JC. et al. JAMA 2009; 302: 1557-1564
    4. 4. 130 citations (2009-2011)
    5. 5. MEDLINE [4,000 records] EMBASE [2,265 records] Web Science [4,219 records] 37 comparative studies non comparative studies Abstracts and reports from meeting of comparative studies Evidence acquisition: 1999-2008 Three Authors separately reviewed the records Studies cited in the references list
    6. 6. Evidence from systematic review <ul><li>LRP and RALP are followed by significantly </li></ul><ul><li>lower blood loss and transfusion rates and have </li></ul><ul><li>all traditional advantages of a minimally invasive </li></ul><ul><li>procedure </li></ul><ul><li>Data from this systematic review did not allow </li></ul><ul><li>us to prove the superiority of any surgical </li></ul><ul><li>approach in terms of functional and oncological </li></ul><ul><li>outcomes </li></ul>
    7. 7. EAU Guidelines on Prostate Cancer www.uroweb.org Guidelines on Prostate Cancer – 2011 <ul><li>LRP and RALP were followed by a </li></ul><ul><li>significantly lower blood loss and </li></ul><ul><li>transfusion rate </li></ul><ul><li>It is still not clear which technique is superior in terms of oncological and functional results and cost-effectiveness </li></ul><ul><li>Prospective trials are urgently needed </li></ul>
    8. 8. Update of the systematic review Novara G, Ficarra V, Montorsi F. et al. (Unpublished data)
    9. 9. Update of the systematic review 37 comparative studies RRP Vs LRP (n = 23) RRP Vs RALP (n = 10) LRP Vs RALP (n = 4) RRP Vs LRP (n = 1) RRP Vs RALP (n = 16) LRP Vs RALP (n = 4) 21 comparative studies
    10. 10. Outcomes evaluated <ul><li>Perioperative </li></ul><ul><li>- blood loss, transfusion rate, overall complication </li></ul><ul><li>rates </li></ul><ul><li>Functional </li></ul><ul><li>- urinary continence and potency recovery </li></ul><ul><li>Oncological </li></ul><ul><li>- positive surgical margins, bDFS, OS and CSS </li></ul>
    11. 11. Perioperative data: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
    12. 12. Blood loss: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Most of the comparative studies reported data in a format not suitable for cumulative analysis (median values)
    13. 13. Transfusion rate: RRP Vs RALP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
    14. 14. Overall complications: RRP Vs RALP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
    15. 15. Overall complication rate: RRP Vs RALP Carlsson S. et al. Urology 2010; 75: 1092-1099
    16. 16. Outcomes evaluated <ul><li>Perioperative </li></ul><ul><li>- blood loss, transfusion rate, overall complication </li></ul><ul><li>rates </li></ul><ul><li>Functional </li></ul><ul><li>- urinary continence and potency recovery </li></ul><ul><li>Oncological </li></ul><ul><li>- positive surgical margins, bDFS, OS and CSS </li></ul>
    17. 17. Urinary continence recovery Myers R. J Urol 1987; 138 (3): 543-50
    18. 18. Urinary continence recovery: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
    19. 19. Urinary continence: RALP Vs RRP Tewari et al BJU Inter 2003; 92: 205-210. RALP RRP
    20. 20. Urinary continence: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) 6-mo continence rate
    21. 21. Urinary continence: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) 12-mo continence rate
    22. 22. Nerve-sparing techniques and Potency recovery Stolzenburg JU et al, Eur Urol 2007;51(3):629-39 Interfascial Intrafascial
    23. 23. Potency recovery: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
    24. 24. Potency recovery: RALP Vs RRP Tewari et al BJU Inter 2003; 92: 205-210. RALP RRP
    25. 25. Potency recovery: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
    26. 26. Outcomes evaluated <ul><li>Perioperative </li></ul><ul><li>- blood loss, transfusion rate, overall complication </li></ul><ul><li>rates </li></ul><ul><li>Functional </li></ul><ul><li>- urinary continence and potency recovery </li></ul><ul><li>Oncological </li></ul><ul><li>- positive surgical margins, bDFS, OS and CSS </li></ul>
    27. 27. Positive Surgical Margin rates after RALP Ficarra V. et al. AUA Update series – Lesson 30; 2010
    28. 28. Positive surgical margins: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
    29. 29. Positive surgical margins: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Sensitivity analysis in prospective studies
    30. 30. Positive surgical margins: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Sensitivity analysis in pT2 prostate cancers
    31. 31. Oncological Results: 5-year bDFS Menon M et al Eur Urol 2010; 58: 838-846 95% 91% 86% 81%
    32. 32. Oncological Results: 5-year bDFS Mottrie A et al (submitted to BJU Inter) 81%
    33. 33. Oncological Results: 3-year bDFS Schroeck FR et al BJU Inter 2008; 102: 28-32
    34. 34. Oncological Results: 3-year bDFS Barocas DA et al J Urol 2010; 183: 990-996
    35. 35. Oncological Results: 5-year bDFS Drouin SJ et al World J Urol 2009; 27: 599-605
    36. 36. Potential disadvantages of minimally invasive radical prostatectomy: Costs Bolenz C. et al. Eur Urol 2010; 57: 453-458
    37. 37. Conclusions <ul><li>RALP is the main alternative to RRP in the </li></ul><ul><li>surgical treatment of localized prostate cancer </li></ul><ul><li>RALP showed significant advantages in terms of </li></ul><ul><li>perioperative outcomes in comparison with RRP </li></ul><ul><li>Data from the update of systematic review of the </li></ul><ul><li>Literature highlighted a significant advantage in </li></ul><ul><li>favour of RALP in terms of functional outcomes. </li></ul>
    38. 38. Conclusions <ul><li>Early and intermediate oncological outcomes </li></ul><ul><li>seems to be equivalent </li></ul><ul><li>Costs are the main disadvantages of RALP </li></ul><ul><li>It is likely that the selection of surgeon remains </li></ul><ul><li>one of the most critical factor influencing the </li></ul><ul><li>results </li></ul>

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