Can robot-assisted laparoscopic radical prostatectomy (RALP) be performed very soon after biopsy?

Abstract

To identify the perioperative and oncological impact of different intervals between biopsy and robot-assisted laparoscopic radical prostatectomy (RALP) for localized prostate cancer. All consecutive patients with localized prostate cancer who underwent RALP with primary curative intent in January 2008-July 2014 in a large tertiary hospital were enrolled in this retrospective cohort study. The patients were divided into groups according to whether the biopsy-RALP interval was ≤2, ≤4, ≤6, or >6weeks. Estimated blood loss and operating room time were surrogates for surgical difficulty. Surgical margin status and continence at the 1year were surrogates for surgical efficacy. Biochemical recurrence (BCR) was defined as two consecutive postoperative prostate serum antigen values of ≥0.2ng/ml. Of the 1446 enrolled patients, the biopsy-RALP interval was ≤2, ≤4, ≤6, and >6weeks in 145 (10%), 728 (50.3%), 1124 (77.7%), and 322 (22.3%) patients, respectively. The >6week group had a significantly longer mean operation time than the ≤2, ≤4, and ≤6week groups. The groups did not differ significantly in terms of estimated blood loss or surgical margin status. Kaplan-Meier analysis showed that interval did not significantly affect postoperative BCR-free survival. Multivariable Cox proportional hazards model analysis showed that interval duration was not an independent predictor of BCR (≤2 vs. >2weeks, HR=0.859, p=0.474; ≤4 vs. >4weeks, HR=1.029, p=0.842; ≤6 vs. >6weeks, HR=0.84, p=0.368). Performing RALP within 2, 4, or 6weeks of biopsy does not appear to adversely influence surgical difficulty or efficacy or oncological outcomes.