Declining use of radical prostatectomy and pelvic lymphadenectomy despite more robotics: National population data over 15 years

Matthew J. Roberts, Nathan Papa, Marlon Perera, Andre Joshi, Susan Scott, Damien Bolton, Nathan Lawrentschuk, John Yaxley

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)


Aim: To describe national surgical patterns of prostate cancer (PCa) care considering radical prostatectomy with or without pelvic lymphadenectomy and consideration of robotic-assisted techniques. Methods: Retrospective analysis of publicly accessible Medicare claims data was performed for the period 2001–2016 and included patients undergoing radical prostatectomy with or without pelvic lymphadenectomy relative to total and PCa-specific populations among men aged 45–84 years. Proportion of cases performed robotically was considered. Results: Total procedures performed increased from 2001, peaked in 2009 and subsequently decreased until 2016. Since 2009, the age-specific rate of surgery in men aged 75–84 increased by 2.3-fold, whereas the rates for men aged 55–64 and 45–54 reduced by 44% and 55%, respectively. Rates of concurrent pelvic lymphadenectomy fell until 2009 with subsequent stabilization (ratio 1.05–1.14) through to 2016. Significant regional practice patterns were observed, as was an increasing trend toward a robotic-assisted laparoscopic approach, comprising more than 80% of radical prostatectomies in 2016. Conclusion: Since the peak in 2009, radical prostatectomy is performed less in men <65 years and more in men ≥65 years. An increasing proportion of cases omit concurrent pelvic lymphadenectomy and are performed robotically.

Original languageEnglish
Pages (from-to)e118-e124
Number of pages7
JournalAsia-Pacific Journal of Clinical Oncology
Issue number2
Publication statusPublished - Apr 2020
Externally publishedYes


  • pelvic lymphadenectomy
  • prostate cancer
  • radical prostatectomy
  • treatments
  • trends

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