Objective: To examine characteristics of robot-assisted (RARP) and open radical prostatectomy (ORP) patients. Patients and Methods: We relied on the Surveillance, Epidemiology, and End Results-Medicare-linked database and focused on prostate cancer patients between 2008 and 2009. In multivariable logistic regression analyses, we predicted RARP. Results: Of 5,915 patients, 3,476 (58.8%) underwent RARP and 2,439 (41.2%) ORP. Patients within intermediate (OR 1.4, p = 0.01) or highest (OR 1.5, p = 0.02) education strata and those treated by surgeons with a high volume (OR 2.2, p < 0.001) were more likely to undergo RARP. Conversely, those residing in rural areas (OR 0.7, p = 0.005) and those with clinical stage T2 or higher (OR 0.7, p = 0.006) were less likely to undergo RARP. Additionally, patients from the Southwest were less likely to undergo RARP (OR 0.4, p < 0.001), but those from the Northern Plains were more likely to undergo RARP (OR 1.4, p = 0.02) than their counterparts from the East. Finally, RARP patients were neither younger nor healthier than ORP patients. Conclusions: Several patient characteristics such as education, region of residence and population density affect the likelihood of RARP vs. ORP treatment. Similarly, clinical stage and surgeon characteristics also affect the assignment to one or other treatment modality.

1.
Mohler J, Bahnson RR, Boston B, et al: NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw 2010;8:162-200.
2.
Heidenreich A, Bastian PJ, Bellmunt J, et al: EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014;65:124-137.
3.
Lowrance WT, Eastham JA, Savage C, et al: Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J Urol 2012;187:2087-2092.
4.
Trinh QD, Sammon J, Sun M, et al: Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 2012;61:679-685.
5.
Tewari A, Sooriakumaran P, Bloch DA, et al: Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 2012;62:1-15.
6.
Sooriakumaran P, Srivastava A, Shariat SF, et al: A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol 2014;66:450-456.
7.
Bütow Z, Schunk S, Janssen M, et al: Quality of preoperative biopsy is a risk factor for positive surgical margins in organ-confined prostate cancer treated with nerve-sparing robot-assisted radical prostatectomy. Urol Int 2015;95:465-471.
8.
Schiffmann J, Haese A, Leyh-Bannurah SR, et al: Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: differences between open and robot-assisted radical prostatectomy. Eur J Surg Oncol 2015;41:1547-1553.
9.
Schiffmann J, Haese A, Lenz J, et al: Differences in patient characteristics among men choosing open or robot-assisted radical prostatectomy in contemporary practice at a European high-volume center. Urol Int 2016;97:8-15.
10.
Gandaglia G, Trinh QD, Hu JC, et al: The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the ‘post-dissemination' period. Eur J Surg Oncol 2014;40:1080-1086.
11.
Feifer AH, Elkin EB, Lowrance WT, et al: Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy. Cancer 2011;117:3933-3942.
12.
Yee DS, Katz DJ, Godoy G, et al: Extended pelvic lymph node dissection in robotic-assisted radical prostatectomy: surgical technique and initial experience. Urology 2010;75:1199-1204.
13.
Feicke A, Baumgartner M, Talimi S, et al: Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases. Eur Urol 2009;55:876-883.
14.
Ploussard G, Briganti A, de la Taille A, et al: Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 2014;65:7-16.
15.
Hu JC, Gu X, Lipsitz SR, et al: Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 2009;302:1557-1564.
16.
Fowler FJ Jr, Gerstein BS, Barry MJ: How patient centered are medical decisions?: results of a national survey. JAMA Intern Med 2013;173:1215-1221.
17.
Warren JL, Klabunde CN, Schrag D, et al: Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 2002;40(8 suppl):IV-3-IV-18.
18.
Klabunde CN, Potosky AL, Legler JM, et al: Development of a comorbidity index using physician claims data. J Clin Epidemiol 2000;53:1258-1267.
19.
Hu JC, Prasad SM, Gu X, et al: Determinants of performing radical prostatectomy pelvic lymph node dissection and the number of lymph nodes removed in elderly men. Urology 2011;77:402-406.
20.
Merseburger AS, Herrmann TR, Shariat SF, et al: EAU guidelines on robotic and single-site surgery in urology. Eur Urol 2013;64:277-291.
21.
Williams SB, Chen MH, D'Amico AV, et al: Radical retropubic prostatectomy and robotic-assisted laparoscopic prostatectomy: likelihood of positive surgical margin(s). Urology 2010;76:1097-1101.
22.
Briganti A, Bianchi M, Sun M, et al: Impact of the introduction of a robotic training programme on prostate cancer stage migration at a single tertiary referral centre. BJU Int 2013;111:1222-1230.
23.
Cooperberg MR, Kane CJ, Cowan JE, et al: Adequacy of lymphadenectomy among men undergoing robot-assisted laparoscopic radical prostatectomy. BJU Int 2010;105:88-92.
24.
Smith JA Jr, Chan RC, Chang SS, et al: A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 2007;178:2385-2389; discussion 2389-2390.
25.
Howlader NNA, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds): SEER Cancer Statistics Review, 1975-2010. National Cancer Institute. http://seer.cancer.gov/csr/1975_2010/, based on November 2012 SEER data submission, posted to the SEER web site, 2013.
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