966 ONCOLOGIC OUTCOMES FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC VS. OPEN RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced (III)1 Apr 2013966 ONCOLOGIC OUTCOMES FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC VS. OPEN RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER Chad Ritch, Daniel Barocas, Chaochen You, Alexandra May, S. Duke Herrell, Peter Clark, David Penson, Sam Chang, Michael Cookson, and Joseph Smith Chad RitchChad Ritch Nashville, TN More articles by this author , Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , Chaochen YouChaochen You Nashville, TN More articles by this author , Alexandra MayAlexandra May Nashville, TN More articles by this author , S. Duke HerrellS. Duke Herrell Nashville, TN More articles by this author , Peter ClarkPeter Clark Nashville, TN More articles by this author , David PensonDavid Penson Nashville, TN More articles by this author , Sam ChangSam Chang Nashville, TN More articles by this author , Michael CooksonMichael Cookson Nashville, TN More articles by this author , and Joseph SmithJoseph Smith Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.547AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies suggest that surgical intervention may confer a benefit over observation for intermediate-risk (IR) and high-risk (HR) prostate cancer patients. It is unclear if this benefit differs based on surgical approach. We compared biochemical recurrence (BCR) free survival as well as predictors of BCR in IR and HR patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs. open radical prostatectomy (ORP). METHODS A retrospective review was performed on 1286 men with IR or HR prostate cancer (cT2b or higher, or clinical Gleason Sum (GS) ≥7, or pre-op PSA >10) who underwent either RALP or ORP between 2003 -2009. We excluded any patient who had neoadjuvant therapy, <6 months of follow-up or insufficient clinicopathological data. We compared demographic, clinical and pathologic variables between the groups. Kaplan-Meier analysis was performed to compare the 5-year BCR-free survival between groups. Multivariate models were developed to determine predictors of BCR. RESULTS A total of 631 IR and HR patients (422 RALP, 209 ORP) met inclusion criteria. Median age was 62.2 years and was similar between groups, while median follow-up was shorter for RALP compared to ORP (3.7 vs. 4.5 yrs, p<0.001). Median PSA and clinical GS were 7.5 ng/ml and 7, respectively. ORP patients had a higher median PSA (8.6 vs. 6.9 ng/ml) than RALP patients (p<0.01). ORP patients had significantly more pathological GS 8-10 tumors (38% vs. 21%, p<0.001). There was a higher proportion of seminal vesicle involvement (SVI) in the ORP group (25% vs. 15%, p<0.01). The positive margin rate was similar between groups. Overall, 176 patients (28%) experienced BCR during follow-up (108 RALP, 68 ORP). There was no significant difference in 5-year BCR-free survival between groups. Extracapsular extension, pGS, and PSM were significant independent predictors of BCR in multivariate analysis. CONCLUSIONS Among IR and HR prostate cancer patients, the oncologic outcomes are similar between RALP and ORP. Not surprisingly, adverse pathologic features are a harbinger of BCR and identify those patients in need of multimodal therapy. Future research should focus on ways to reduce clinical recurrence among these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e396 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chad Ritch Nashville, TN More articles by this author Daniel Barocas Nashville, TN More articles by this author Chaochen You Nashville, TN More articles by this author Alexandra May Nashville, TN More articles by this author S. Duke Herrell Nashville, TN More articles by this author Peter Clark Nashville, TN More articles by this author David Penson Nashville, TN More articles by this author Sam Chang Nashville, TN More articles by this author Michael Cookson Nashville, TN More articles by this author Joseph Smith Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...