Background:
Comparative outcomes for the treatment of localized prostate cancer in community-based medical centers remain sparse. Our institution's prostate cancer database allows direct comparisons between open radical prostatectomy (ORP), laparoscopic robot-assisted radical prostatectomy (LRAP), and prostate brachytherapy (PB).
Methods:
Non-randomized, prospective, single-institution comparison of patients treated by ORP, LRAP, and PB. All patients treated by ORP from January 2000 - January 2005, LRAP from November 2003 - January 2005, and PB from August 1998 - January 2005 were evaluated. Demographic, treatment related, quality of life, and cancer specific outcomes were evaluated. Patients were evaluated pretreatment, 3 months, 6 months, 12 months following treatment, and annually thereafter.
Results:
218 ORP, 70 LRAP, and 313 PB patients were evaluated. For ORP, LRAP, and PB mean age and follow up were 61 yrs, 60 yrs, 67 yrs; 32 mos, 8 mos, 33 mos. Presenting PSA, clinical stage, grade and risk level were similar. For ORP, LRAP,and PB neoadjuvant hormonal therapy was used in 4.6%, 7.1%, 44%. For ORP, LRAP, and PB mean estimated blood loss, % transfusion and length of stay were 1018 ml, 216 ml, 0 ml; 40 %, 0%, 0%; 3.5 days, 2.6 days, 1 day. For ORP and LRAP pathologic stage, grade, and maximal tumor diameter were similar, while positive surgical margin rate was 24.4% vs 14.5%. For ORP and LRAP bladder neck contractures occurred in 11% vs 0%. For ORP, LRAP, and PB post catheter removal urinary retention occurred in 0%, 4.2%, 11.2%. For ORP and LRAP % zero pads @ 3,6,12 mos were 60 % vs 52 %, 73% vs 73%, 86% vs 90%. For PB mean AUA symptom score @ 3,6,12 mos were 17, 11, 9. For PB 1% required a TURP, 14.4% Grade 2 urinary urgency, 12.8% Grade 3 urinary urgency, 5.4% Grade 1 radiation proctitis, and 1.6% Grade 2 radiation proctitis. For ORP, LRAP, and PB erections adequate for intercourse @ 3, 6, 12 mos were 27%, 13%, 31%; 40%, 36%, 36%; 61%, 40%, 43%. For ORP, LRAP, and PB biochemical disease free survival was 94.4%, 97.1%, 96.2%.
Conclusions:
It is unusual to find comparative outcomes between ORP, LRAP, and PB for the treatment of localized prostate cancer from a community-based medical center. Technological advances are allowing for decreased treatment related toxicities, and shortened hospital stays, while maintaining similar treatment outcomes. This prostate cancer database demonstrates our ongoing efforts to comparatively evaluate ORP,LRAP, and PB.

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