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Abbreviations & AcronymsObjectives: To compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer. Methods: Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancerspecific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline Charlson Comorbidity Index and age. Results: For patients treated with radical prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson Comorbidity Index of Ն2. Rates were 2.1 versus 5.0% in patients aged 65-69 years, 2.8 versus 5.5% in patients aged 70-74 years, and 2.9 versus 7.6% in patients aged 75-80 years (all P < 0.001). At multivariable analyses, radiotherapy was associated with less favorable cancer-specific mortality in all categories (all P < 0.001). Conclusions: Patients treated with radical prostatectomy fare substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories.

What ' s known on the subject? and What does the study add?In a previous randomized controlled trial, barbed polyglyconate suture for vesicourethral anastomosis was associated with more frequent cystogram leaks, longer mean catheterization times and greater suture costs per case.In the current randomized controlled trial, we show that barbed polyglyconate suture is associated with decreased anastomosis time, decreased need to readjust suture tension, cost reduction, and equal continence and early/late urinary complication rates. OBJECTIVE• To examine the effectiveness of barbed polyglyconate suture (V-Loc 180; Covidien, Mansfi eld, MA, USA) compared with standard monofi lament for posterior reconstruction (PR) and vesico-urethral anastomosis (VUA) during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS• A prospective randomized controlled trial was conducted in 70 consecutive RARP cases by a single surgeon (K.C.Z.).• Standard VUA was performed using three 4-0 poliglecaprone 25 (Monocryl; Ethicon Endosurgery, Cincinnati, OH, USA) sutures secured with absorbable suture clips (LapraTy, Ethicon; one single 6-inch [ 15.2 cm ] for PR and two attached 6-inch [ 15.2 cm ] for VUA).• Barbed suture VUA was performed using two 3-0 6-inch (15.2 cm) barbed polyglyconate sutures.• Time to complete the suture set-up by the nursing team, anastomosis time and need to adjust suture tension were recorded. Suture-related complications, validated-questionnaire continence and cost were also examined. RESULTS• Compared with a conventional reconstruction technique, there was a signifi cant reduction in mean nurse set-up time (31 vs. 294 s; P < 0.01) and reconstruction time (13.1 vs. 20.8 min; P < 0.01) for the barbed suture technique.• Need to readjust suture tension or to place additional suture clips for watertight closure was greater in the standard monofi lament group than in the barbed suture group (6% vs. 24%; P = 0.03).• A cost reduction was recorded at our institution (48.05 vs. 70.25 $CAN) with the barbed suture technique.• With a mean follow-up of 6.2 months, no delayed anastomotic leak or bladder neck contracture was observed in either group.• Pad-free continence outcomes for the monofi lament suture vs the barbed suture groups at 1 (64 vs. 69%, P = 0.6), 3 (76 vs. 81%, P = 0.5) and 6 months (88 vs. 92%, P = 0.7) were similar. CONCLUSIONS• Compared with standard monofi lament suture, the unidirectional barbed polyglyconate suture appears to provide safe, effi cient and cost-effective PR and VUA during RARP.• Use of the interlocked barbed polyglyconate suture technique prevents slippage, precluding the need for assistance, knot-tying and constant reassessment of anastomosis integrity.

These authors contributed equally to the manuscript• When patients were stratified based on their clinical findings according to the D'Amico risk groups for disease progression, the proportion of low-risk patients dropped from 66% in 2004 to 35% ( P = 0.016) in the final year of the study period.• Similarly, histopathological evaluation of RP specimens showed a decrease of favourable disease (organ confinement and Gleason 3 + 3 grade) from 53 to 17% ( P = 0.008).• This trend was accompanied by an increase in the number of patients with nonorgan-confined prostate cancer (PCa) from 19% in 2003 to 33% in 2009 ( P = 0.008).• The restriction of the analyses in the present study to a single tertiary-care centre could limit the generalizeability of the results. CONCLUSIONS• During the last decade, we observed an inverse stage migration trend in those European patients with PCa who were treated with RP.• The recorded increase in patients with non-organ-confined disease after RP could be related to changes in patient selection and the growing adoption of RP in multimodal treatment settings for locally advanced tumours as well as the availability of new treatment alternatives for low-risk disease.

4 7What ' s known on the subject? and What does the study add? In patients treated with radical cystectomy, pelvic lymph node dissection may have a benefi cial effect on cancer control outcomes.We examined the effect of pelvic lymph node dissection on stage-specifi c cancer control outcomes. OBJECTIVE• To examine the effect of stage-specifi c pelvic lymph node dissection (PLND) on cancer-specifi c (CSM) and overall mortality (OM) rates at radical cystectomy (RC) for bladder cancer. METHODS• Overall, 11 183 patients were treated with RC within the Surveillance, Epidemiology, and End Results database.• Univariable and multivariable Cox regression analyses tested the effect of PLND on CSM and OM rates, after stratifying according to pathological tumour stage. RESULTS• Overall, PLND was omitted in 25% of patients, and in 50, 35, 27, 16 and 23% of patients with respectively pTa/is, pT1, pT2, pT3 and pT4 disease ( P < 0.001).• For the same stages, the 10-year CSM-free rates for patients undergoing PLND compared with those with no PLND were, respectively, 80 vs 71.9% ( P = 0.02), 81.7 vs 70.0% ( P < 0.001), 71.5 vs 56.1% ( P = 0.001), 43.7 vs 38.8% ( P = 0.006), and 35.1 vs 32.0% ( P = 0.1).• In multivariable analyses, PLND omission was associated with a higher CSM in patients with pTa/is, pT1 and pT2 disease (all P ≤ 0.01), but failed to achieve independent predictor status in patients with pT3 and pT4 disease (both P ≥ 0.05).• Omitting PLND predisposed to a higher OM across all tumour stages (all P ≤ 0.03). CONCLUSIONS• Our results indicate that PLND was more frequently omitted in patients with organ-confi ned disease.• The benefi cial effect of PLND on cancer control outcomes was more evident in these patients than in those with pT3 or pT4 disease.• PLND at RC should always be considered, regardless of tumour stage. KEYWORDSlymphatic metastasis , lymph node excision , neoplasm staging , SEER program , survival analysis , urinary bladder neoplasms Study Type -Therapy (cohort) Level of Evidence 2b