Oncologic outcomes data on robotic RP take center stage

Research presented at the upcoming AUA annual meeting will include some intriguing new findings about the cause, diagnosis, and management of localized prostate cancer, said Richard D. Williams, MD.

"There will be a number of reports comparing robotic versus laparoscopic versus open radical prostatectomy, and it appears that, at least in the short-term, the oncologic results are similar with all of those techniques. It is notable that these favorable results are being reported by a number of different groups of urologists from across the world who are performing the robot-assisted technique and that they include larger numbers of patients than reports in the past," he stated.

Also high on the interest list are studies from investigators looking beyond PSA for new prostate cancer diagnosis and progression markers. One group is reporting reasonably high sensitivity and specificity for a prostate cancer diagnostic and staging technique (M-score) based on multigene methylation analysis (APC, GSTP1, and MDR1). In addition, independent researchers from several different centers will be reporting on the utility of the urine PCA3 assay following prostatic massage as a method for prostate cancer diagnosis.

While measurement of PSA velocity has come into increasing use as a method for identifying men who are candidates for prostate biopsy, results from another collaborative study are of interest because they suggest that the PSA velocity threshold for predicting prostate cancer should be lowered in younger men (<60 years old) from 0.75 to 0.50 ng/mL/yr.

Two studies investigating outcomes of active surveillance with selective delayed intervention will provide some early reassuring data regarding use of that approach in low-risk patients. Also watch for interesting results from a study of men undergoing salvage cryotherapy after radiation failure supporting that intervention in select patients who have a PSA <4.0 ng/mL prior to its initiation.

Obesity and prostate cancer

Potential interactions between obesity and prostate cancer continue to provide a topic for research studies, and at the AUA meeting, two groups of investigators will report that obesity does not predict worse prostate cancer outcomes when obese men are compared with non-obese, stage-matched controls.

"There has been significant controversy regarding the influence of obesity on prostate cancer. Previous data indicate prostate cancer risk is increased in obese men and that they are also at risk for higher stage disease. This new information indicates that when men are matched stage for stage, obesity does not influence outcomes," Dr. Williams said.