The Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease

Jospeh F. Renzulli II; Michael M. Maddox; Omar Nadeem; Simone Thavaseelan; Gyan Pareek; Anthony E. Mega

doi:10.4236/ojim.2014.44017

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Open Journal of Internal Medicine > Vol.4 No.4, December 2014

The Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease ()

Jospeh F. Renzulli II^*, Michael M. Maddox, Omar Nadeem, Simone Thavaseelan, Gyan Pareek, Anthony E. Mega

Warren Alpert Medical School, Brown University, Providence, USA.

DOI: 10.4236/ojim.2014.44017 PDF HTML XML 2,009 Downloads 2,399 Views

Abstract

Introduction: With the widespread use of robot-assisted radical prostatectomy (RARP), a stage migration to less aggressive prostate cancer (CaP) may be expected in pathological specimens due to over-treatment of low risk disease. It is unclear whether implementation of a multidisciplinary clinic (MDC) model would offset this phenomenon. We sought to analyze our database for possible stage migration in prostatectomy specimens in the setting of MDC. Methods: A total of 262 patients who underwent open prostatectomy (OP) from 2004 to 2006 and 757 patients who underwent RARP from 2007 to 2011 were identified from our prospective database. The implementation of MDC occurred concurrently at the time of RARP initiation. Demographic data, pathology, positive margin rates along with standard CaP reporting data were recorded. The two groups were compared with regards to percentage of cases stratified by Gleason grade. Results: The number of CaP cases managed at our institution increased considerably after the introduction of robotics and MDC. There was a significant decrease in the patients with Gleason 6 CaP undergoing RARP as compared with OP (p = 0.001). Additionally, RARP was performed on a significantly greater percentage of Gleason 7 disease (p < 0.001). When comparing pathological stage, there was a significant increase in the incidence of pT3 disease following RARP (p < 0.0001). Conclusions: The introduction of a MDC and minimally invasive radical prostatectomy did not result in an increased application of surgery for the treatment of low risk prostate cancer. This highlights the importance of MDC in a large volume RARP program.

Keywords

Prostate Cancer, Robotics, Multidisciplinary Care

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Renzulli II, J. , Maddox, M. , Nadeem, O. , Thavaseelan, S. , Pareek, G. and Mega, A. (2014) The Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease. Open Journal of Internal Medicine, 4, 108-114. doi: 10.4236/ojim.2014.44017.

Conflicts of Interest

The authors declare no conflicts of interest.

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