Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period
- 29 June 2004
- journal article
- Published by Springer Science and Business Media LLC in Prostate Cancer and Prostatic Diseases
- Vol. 7 (3), 258-262
- https://doi.org/10.1038/sj.pcan.4500734
Abstract
Objective: To show the impact of learning curve and patient selection on complication rate and biochemical recurrence-free survival of a UK radical prostatectomy series for localised prostate cancer and to model the influence of common preoperative variables on biochemical recurrence after controlling for learning curve. Patients and Methods: From 1989 to 1999, 280 of 350 patients who underwent anatomical radical retropubic prostatectomy (RRP) at our institution had complete records and follow-up of at least 1 y. After exclusions of preoperative staging, factors reflecting the learning curve, early complications and prostate-specific antigen (PSA) outcome were recorded on 217 patients. Procedures before 1995 were compared with procedures after 1995. Results: Comparison of the two groups showed a significant decrease in operating time (mean 152 vs 130 min), blood loss (mean 1500 vs 1000 ml), transfusion rate (83 vs 42%) and hospital stay (mean 7 vs 6 days). Median preoperative PSA changed significantly from 13.2 to 11.5 ng/ml. Only 17% were diagnosed by rectal examination compared to 27% in the early years. The number of clinical T1 tumours increased from 33 to 47%. This did lead to an increase of organ-confined tumours on pathological staging by 25%. Biochemical recurrence-free survival improved significantly after 1995. After controlling for the learning curve PSA and clinical stage were significant predictors of PSA recurrence. Conclusion: Time trends of case selection, stage migration and a steep learning curve are shown over a 10-y period. Factors associated with the learning curve as well as case selection have a significant impact on outcome. There may be other as yet not specified factors over time, which have a significant impact on PSA recurrence-free survival. Patients with a PSA of 20 ng/ml and above have a poor outcome and do not appear to be suitable candidates for RRP.Keywords
This publication has 24 references indexed in Scilit:
- Recent trends in the use of radical prostatectomy in England: the epidemiology of diffusionBJU International, 2003
- Biochemical (Prostate Specific Antigen) Recurrence Probability Following Radical Prostatectomy for Clinically Localized Prostate CancerJournal of Urology, 2003
- A Randomized Trial Comparing Radical Prostatectomy with Watchful Waiting in Early Prostate CancerNew England Journal of Medicine, 2002
- Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen eraCancer, 2002
- CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTSJournal of Urology, 2002
- CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTSJournal of Urology, 2002
- Survey of the rate of PSA testing in general practiceBritish Journal of Cancer, 2001
- Radical retropublc prostatectomy for localized carcinoma of the prostate in a large metropolitan hospital: Changing trends over a 10-year period (1984–1994)Urology, 1995
- Proportional hazards tests and diagnostics based on weighted residualsBiometrika, 1994
- Radical prostatectomy for adenocarcinoma of the prostate: The influence of preoperative and pathologic findings on biochemical disease-free outcomeUrology, 1994