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

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.