Improving the surgical care of prostate cancer patients through reflection on clinical data

Abstract

The aim of this thesis is to assess and improve the outcomes of robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) patients. The hypotheses and research questions on which the studies in this thesis were based originated from a quality assurance program. This quality assurance program and a general introduction are described in the introduction. Parts one and two describe the use of magnetic resonance imaging (MRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT), respectively, for preoperative planning of RARP. Part three describes the perioperative phase and part four describes the postoperative phase. Quality assurance programs (QAP) aim to improve patient outcomes through the continuous and cyclical process of data registration, evaluation, and process adaptation. A group of motivated clinicians identifies in which surgical step or outcome they have unsatisfactory results. After reviewing and discussing their own results and techniques, strategies are devised to overcome these shortcomings. Several studies have described a decrease in positive surgical margins (PSM) and an increase in urinary continence after RARP after implementation of a QAP. This thesis implemented a QAP for the surgical care of prostate cancer patients and evaluated clinical outcomes.