Is there a clinical benefit from prostate cancer center certification? An evaluation of functional and oncologic outcomes from 22,649 radical prostatectomy patients.

PURPOSE

To explore whether patients undergoing radical prostatectomy at a German Cancer Society (DKG: Deutsche Krebsgesellschaft) certified center (CC) have superior functional and surgical outcomes compared to patients undergoing radical prostatectomy at a non-certified hospital (nCC).

METHODS

A retrospective cohort of 22,649 patients treated between 2008 and 2017 and subsequently recovered at two rehabilitation clinics within 35 days of surgery were analyzed. Urine loss (24 h-pad-test), margin status, and nerve-sparing status at rehab admission were compared between CC and nCC patients, adjusting for age, histopathology (pT, pN, Gleason score), metastases (cM), Karnofsky performance status, time from surgery to rehabilitation, and insurance provider (statutory vs. private).

RESULTS

Thirty-four percent of patients underwent surgery at a CC. Complete continence is more pronounced in patients treated in CC (16.6% vs. 24.4%, p < 0.001). In the adjusted models, incontinent patients from CC had less urine loss compared to patients from nCC (- 27.41% difference; 95% CI - 31.71% to - 22.84%, p < 0.001). CC patients were less likely to have positive resection margins (adjusted OR 0.71; 95% CI 0.66 to 0.76, p < 0.001) and more likely to have had a nerve-sparing procedure (adjusted OR 1.29; 95% CI 1.21 to 1.38, p < 0.001).

CONCLUSION

Patients treated at certified centers presented to rehab with better urinary continence, higher nerve-sparing rates, and lower positive-margin rates. These results imply superior care at DKG certified centers.