The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy

Vickers, Andrew J.; Bianco, Fernando J.; Serio, Angel M.; Eastham, James A.; Schrag, Deborah; Klein, Eric A.; Reuther, Alwyn M.; Kattan, Michael W.; Pontes, J. Edson; Scardino, Peter T.

doi:10.1093/jnci/djm060

Cited by 366 publications

(251 citation statements)

References 19 publications

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“…Previous publications have demonstrated that surgical experience and surgical technique affect biochemical recurrence, continence, and potency after RP. [5][6][7] Therefore, these results and the nomogram developed based on these results may not be applicable to other surgeons and await validation using other datasets. In addition, all of the procedures were performed using an open technique and thus these outcomes may not be applicable to patients treated with perineal, laparoscopic, or roboticassisted laparoscopic RP.…”

Section: Discussionmentioning

confidence: 99%

Predicting an Optimal Outcome After Radical Prostatectomy: The Trifecta Nomogram

2008

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Purpose-The optimal outcome after radical prostatectomy (RP) for clinically localized prostate cancer is freedom from biochemical recurrence (BCR) along with recovery of continence and erectile function, a so-called trifecta. We evaluated our series of open radical prostatectomy patients to determine the likelihood of this outcome and to develop a nomogram predicting the trifecta. Material and Methods-We reviewed records of patients undergoing open RP for clinical stageT1c-T3a prostate cancer at our center during 2000-2006. Men were excluded if they received preoperative hormonal therapy, chemotherapy, or radiation therapy; if their pre-treatment PSA was >50 ng/ml; or if they were impotent or incontinent before RP; 1577 men were included in the study. Freedom from BCR was defined as post-RP PSA <0.2 ng/ml. Continence was defined as not having to wear any protective pads. Potency was defined as erections adequate for intercourse on the majority of attempts, with or without a phosphodiesterase-5 inhibitor.Results-Mean patient age was 58 years and mean pretreatment PSA was 6.4 ng/ml. A trifecta outcome (cancer-free status with recovery of continence and potency) was achieved in 62% of patients. In a nomogram developed to predict the likelihood of the trifecta, baseline PSA was the major predictive factor. The area under the receiver operating characteristic curve for the nomogram was 0.773, and calibration appeared excellent.Conclusions-A trifecta (optimal) outcome can be achieved in the majority of men undergoing RP. The nomogram will permit patients to estimate preoperatively their likelihood of an optimal outcome after RP.

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Section: Discussionmentioning

confidence: 99%

Predicting an Optimal Outcome After Radical Prostatectomy: The Trifecta Nomogram

2008

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“…Only the series of Vickers et al 20 clearly identifies that the learning curve to decrease prostate cancer recurrence after open radical prostatectomy was significant and did not start to plateau until a surgeon had completed approximately 250 operations.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Extraperitoneal Radical Prostatectomy: Impact of the Learning Curve on Perioperative Outcomes and Margin Status

Rodríguez

Kapoor

Pow‐Sang³

2010

JSLS

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“…Our patient population underwent RP at a tertiary care center and all surgeons had extensive experience in performing RP. As surgeon experience has been shown to be an important factor influencing BCR-free survival, 29 our nomogram may predict an overly optimistic chance of recurrencefree survival for patients who are operated on by less experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

Schroeck

Sun

Freedland

et al. 2008

Prostate Cancer Prostatic Dis

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We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml À1 or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3 þ 4, 4 þ 3, 47, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant ) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (Pp0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.

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The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy

Abstract: As a surgeon's experience increases, cancer control after radical prostatectomy improves, presumably because of improved surgical technique. Further research is needed to examine the specific techniques used by experienced surgeons that are associated with improved outcomes.

Cited by 366 publications

References 19 publications

Predicting an Optimal Outcome After Radical Prostatectomy: The Trifecta Nomogram

Predicting an Optimal Outcome After Radical Prostatectomy: The Trifecta Nomogram

Laparoscopic Extraperitoneal Radical Prostatectomy: Impact of the Learning Curve on Perioperative Outcomes and Margin Status

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

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