A Nationwide Descriptive Analysis of Real-World Outcomes After Radical Prostatectomy in Japan Using the National Clinical Database

ABSTRACT: Real-World Outcomes After Radical Prostatectomy in Japan

Objectives

The objective of this study is to evaluate real-world biochemical recurrence-free survival (BCRFS) after radical prostatectomy (RP) for prostate cancer in Japan. We utilized nationwide data from the National Clinical Database (NCD) to achieve this goal.

Methods

This study included patients who underwent RP between April and December 2018. These patients were registered in the NCD from 647 participating institutions. We estimated BCRFS using the Kaplan–Meier method. Outcomes were evaluated based on surgical approach and clinicopathological factors. We did not adjust for baseline characteristics.

Results

A total of 14,992 patients with available 5-year postoperative follow-up data were included in the analysis. Robot-assisted RP was the most common procedure, accounting for 73.2% of cases. Open RP followed at 16.0%, while laparoscopic RP made up 10.8%. The overall 5-year BCRFS rate was 81%.

BCRFS was comparable across different age groups and surgical approaches. However, pathological factors had a significant impact on prognosis. The five-year BCRFS rate decreased with increasing pathological stage: pT2 had a rate of 86%, pT3 dropped to 65%, and pT4 fell to 41%. Additionally, patients with nodal metastasis showed lower rates (pN0 at 81% and pN1 at 59%).

The International Society of Urological Pathology (ISUP) Grade Group displayed a stepwise association with prognosis. The 5-year BCRFS rate declined from 92% in grade group 1 to 60% in grade group 5. Among the different surgical approaches, the extended lymph node dissection group had the lowest 5-year BCRFS at 73%. This was followed by the obturator lymph node dissection group at 80% and the no-dissection group at 87%.

Conclusions

Current nationwide data delineate the real-world oncological outcomes following RP in Japan. Pathological tumor characteristics, rather than patient age or surgical approach, were the predominant determinants of postoperative prognosis. These findings may provide essential benchmarks to guide clinical decision-making.

Understanding Biochemical Recurrence-Free Survival (BCRFS)

Biochemical recurrence-free survival (BCRFS) is a crucial metric in evaluating the effectiveness of prostate cancer treatments. It refers to the period during which a patient remains free from detectable prostate-specific antigen (PSA) levels after treatment. In the context of radical prostatectomy, understanding BCRFS helps gauge the success of the surgical intervention.

Importance of Surgical Approach

The choice of surgical approach can significantly influence outcomes. In our study, robot-assisted RP was the most prevalent method. This technique offers several advantages, including reduced blood loss and quicker recovery times. However, the data indicate that the surgical approach alone does not determine long-term success. Instead, the pathological characteristics of the tumor play a more critical role.

Pathological Factors and Their Impact

Pathological factors are essential in predicting the prognosis of prostate cancer patients. The study revealed that as the pathological stage increased, the BCRFS rates decreased. This highlights the importance of early detection and intervention. For instance, patients diagnosed at an earlier stage (pT2) had a much better chance of remaining recurrence-free compared to those diagnosed at a later stage (pT4).

The Role of ISUP Grade Group

The ISUP Grade Group classification is another vital tool in assessing prostate cancer prognosis. Our findings showed a clear correlation between the ISUP grade and BCRFS. This means that higher-grade tumors are associated with poorer outcomes. Understanding this relationship can aid in treatment planning and patient counseling.

Final Thoughts

In summary, the data from this study provide valuable insights into the real-world outcomes of radical prostatectomy in Japan. It emphasizes the importance of pathological characteristics over surgical approach or patient age. These findings can help healthcare professionals make informed decisions regarding treatment options and patient management.

S. Sakamoto, K. Yamamoto, H. Yamamoto, et al., “A Nationwide Descriptive Analysis of Real-World Outcomes After Radical Prostatectomy in Japan Using the National Clinical Database,” International Journal of Urology 33, no. 7 (2026): e70567, https://doi.org/10.1111/iju.70567.