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

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Abstract
Objectives: To evaluate real‐world biochemical recurrence‐free survival (BCRFS) after radical prostatectomy (RP) for prostate cancer in Japan using nationwide data from the National Clinical Database (NCD). Methods: This study included patients who underwent RP between April and December 2018 and were registered in the NCD from 647 participating institutions. BCRFS was estimated using the Kaplan–Meier method. Outcomes were evaluated according to surgical approach and clinicopathological factors without adjustment 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 accounted for the majority of procedures (73.2%), followed by open RP (16.0%) and laparoscopic RP (10.8%). The overall 5‐year BCRFS rate was 81%. BCRFS was comparable across age groups and surgical approaches. In contrast, pathological factors strongly influenced prognosis. Five‐year BCRFS decreased with increasing pathological stage (pT2, 86%; pT3, 65%; pT4, 41%) and was lower in patients with nodal metastasis (pN0, 81%; pN1, 59%). The International Society of Urological Pathology (ISUP) Grade Group demonstrated a stepwise association with prognosis, with 5‐year BCRFS declining from 92% in grade group 1 to 60% in grade group 5. Five‐year BCRFS was lowest in the extended lymph node dissection group (73%), followed by the obturator lymph node dissection group (80%) and the no‐dissection group (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.

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