Effect of neoadjuvant systemic therapy prior to radical prostatectomy in high-risk prostate cancer on surgical morbidity: Contemporary results utilizing the Clavien System.

Abstract

66 Background: There is limited evidence definingthe morbidity of radical prostatectomy (RP) with curative intent for patients with high risk prostate cancer. Multimodality treatment for men with high risk prostate cancer using neoadjuvant systemic therapy followed by surgery is being increasingly explored. Methods: We analyzed 215 consecutive patients with high risk and very high risk prostate cancer who underwent robotic or open RP with extended pelvic lymph node dissection previously untreated or received neoadjuvant systemic therapy between 2006 and 2010 at a single tertiary care academic center. Univariable and multivariable logistic regression analyses were used to identify predictors of complications. Results: Baseline characteristics were similar between patients who underwent neoadjuvant systemic therapy followed by RP versus RP alone except for PSA (PSA< or equal to 4 ng/ml: 75.4% vs. 15.5%, p<0.001) and preoperative hemoglobin (13.8 g/dl vs. 14.4 g/dl, p=0.003), respectively. Twenty nine percent of patients (63 of 215 patients) experienced a complication of any grade ≤90 d after surgery 6% experienced Grade ≥3, with no significant difference between either cohort (p=0.50). On multivariate analysis, estimated blood loss [Odds Ratio (OR) 1.10; 95% CI, 1.0 to 1.2, p=0.03), length of stay (OR 1.75; 95% CI, 1.3 to 2.4, p=0.001) and preoperative hemoglobin (OR 0.71; 95% CI, 0.53 to 0.94, p=0.02) were independent predictors of the occurrence of any grade complication. Considering grade 3 or 4 complications, procedure time (OR 2.20; 95% CI 1.0 to 4.8, p=0.05) and estimated blood loss (OR 1.39; 95% CI, 0.98 to 1.96, p=0.06) were significant predictors of major complications. Conclusions: Postoperative morbidity in patients with high risk prostate cancer following RP with or without the use of neoadjuvant systemic therapy is comparable to contemporary RP series of low to intermediate risk disease reporting outcomes in a similar fashion. Use of neoadjuvant systemic therapy prior to RP was safe and did not appear to increase the risk of having a perioperative complication.