Clinical Edge

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Robot-Assisted Radical Prostatectomy

Key clinical point: Radiological recurrence-free survival (rRFS) outcomes of robot-assisted radical prostatectomy (RARP) and volumetric modulated arc therapy (VMAT) after a medium-term follow-up period were similar.

Major finding: Regarding rRFS, RARP patients had significantly better outcomes than VMAT patients, however, multivariate analysis together with D'Amico's risk classification, age-adjusted Charlson's comorbidity index, and concomitant androgen-deprivation therapy, demonstrated no significant difference between RARP and VMAT.

Study details: 860 patients with cT1-4N0M0 prostate cancer who underwent RARP (n = 500) or VMAT (n = 360) between 2011 and 2016 were retrospectively analyzed.

Citation:

Taguchi S, et al. Radiother Oncol. 2019 Jun 5;140:62-67. doi: 10.1016/j.radonc.2019.05.015.

Commentary:

Appropriate selection of radiation or surgery for curative intent continues to be a challenge in the treatment of prostate cancer. Taguchi et al. present findings from a retrospective study designed to compare robot-assisted surgery versus radiation. Radiologic relapse-free survival appeared to be similar between both modalities while biochemical recurrence was lower or higher depending on use of the standard Phoenix criteria or a unified definition. Thus, the challenges of comparing biochemical relapse was evident due to the use of differing definitions for each modality. While the findings reflect those from other similar studies, the need to reconcile outcome definitions is highlighted. —Mark A. Klein, MD