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Has RALRP lead to increased treatment of low risk disease?
Simone Thavaseelan, MD1, Michelle Gaudreau, RN, BSN, CCRP2, George Haleblian, MD1, Gyan Pareek, MD1, Renzulli Joseph, Jr., MD1.
1Brown University, Providence, RI, USA, 2The Miriam Hospital, Providence, RI, USA.

Background:
Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP) has surpassed open prostatectomy (OP) as the most commonly performed surgical procedure for localized prostate cancer. Nationally, concern has been raised to whether there is over treatment of low risk localized prostate cancer. RALRP as a new modality for treatment of localized prostate cancer may result in more low risk disease being treated especially early in the learning curve. The objective of this study is to compare the Gleason Score of prostate cancers treated with RALRP at our institution and compared to our most recent cohort of OP at Brown University.
Methods:
A total of 262 consecutive patients who underwent OP were evaluated from 2004 to 2006 from an IRB approved retrospective database accrued by an independent third party committee. Similarly, a total of 446 consecutive patients who underwent RALRP were evaluated from 2006 to 2009 from an IRB approved prospective database accrued by an independent third party committee. These two groups were compared with regards to percentage of cases performed stratified by Gleason Grade.
Results:
As displayed in Figures 1&2, the average percentage of OP performed from 2004 to 2006 stratified by Gleason Grade 3+3, 3+4, 4+3 and 4+4 respectively was 52.3%, 32.9%, 8% and 2.5% respectively.
The average percentage of RALRP performed from 2006 to 2009 stratified by Gleason Grade 3+3, 3+4, 4+3 and 4+4 respectively was 42.4%, 46.7%, 7.9% and 1.5%.
Statistical analysis using the Chi square test revealed a significant difference (p= 0.0267) between OP (52.3%) and RALRP (42.4%) for Gleason Score 3+3 cases in favor of OP.
Statistical analysis using the Chi square test revealed a significant difference (p= 0.0267) between OP (32.9%) and RALRP (46.7%) for Gleason Score 3+4 cases in favor of RALRP.
Conclusions:
RALRP is a newer treatment modality for localized prostate cancer and concerns have been raised regarding the possibility of increased surgical treatment of indolent prostate cancers. However, our comparison of the percentage of cases performed by RALRP versus OP, stratified by preoperative Gleason Score, demonstrates a decrease in low risk disease (3+3) and increase in intermediate risk disease (3+4) cases performed with RALRP.
Figure 1: Percentage of OP stratified by Gleason Grade

3+33+44+34+4
200440.432.312.15
200556.5383.31.1
20066028.68.61.4
Average52.332.982.5

Figure 2: Percentage of RALRP stratified by Gleason Grade
3+33+44+34+4
200637.562.500
200749.335.811.51.4
200840.342.812.62.5
200942.745.87.62.3
Average42.446.77.91.5

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