MP16-02 ONCOLOGICAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN ISUP GRADE 5 PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2018MP16-02 ONCOLOGICAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN ISUP GRADE 5 PROSTATE CANCER Alexander Govorov, Konstantin Kolontarev, Pavel Rasner, Vladimir Dyakov, and Dmitry Pushkar Alexander GovorovAlexander Govorov More articles by this author , Konstantin KolontarevKonstantin Kolontarev More articles by this author , Pavel RasnerPavel Rasner More articles by this author , Vladimir DyakovVladimir Dyakov More articles by this author , and Dmitry PushkarDmitry Pushkar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.536AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the study was to assess oncological outcomes of robot-assisted radical prostatectomy (RARP) in patients with International Society of Urological Pathology (ISUP) grade 5 prostate cancer (PCa). METHODS Prospectively collected institutional database was analyzed for different pre- and post-surgery parameters of 116 men with ISUP prostate biopsy grade 5 and clinical stage T1c-T3bN0/N1M0 PCa, who underwent RARP with bilateral pelvic lymph node dissection (PLND) from 2009 to 2016. RESULTS Median patients′ age was 62 years (IQR 55.4-67); 44.8% of men had clinically organ-confined disease, 55.2% had locally advanced PCa. After RARP 55.8% of cT2 and 46.9% of cT3 patients were upstaged to pT3-4, and 12.5% of cT3 were downstaged to pT2; 22.4% of cases were downgraded to ISUP grades 3/4. After the median follow-up of 50.2 months (IQR 28-62), 44% of patients had biochemical failure with 19.8% of PSA persistence and 24.2% biochemical recurrence (BCR). Adjuvant and salvage radiation therapy (RT) were administered to 51.7% (n=60) and 20.7% (n=24) of men respectively, from which 77.4% (n=65/84) had concomitant androgen deprivation therapy (ADT); 10.3% of men underwent only ADT and 6% - salvage PLND. Distant metastases were detected in 11.2% of patients. Death from PCa was registered in 3.4% and from other causes - in 5.2% of cases (in total 8.6%). The 5-year overall, PCa-specific, metastasis-free and disease-free survival rates were 91%, 96%, 89% and 49% respectively (with Kaplan-Meier estimate). On multivariate analysis predominant biopsy Gleason grade 5, percentage/number of positive cores with Gleason grade 5 on biopsy, pre-surgery total PSA, pathological T-stage and lymph node involvement correlated with BCR and systemic failure. Relatively short follow-up and diverse post-RARP treatment combinations are limitations of the study. CONCLUSIONS RARP in ISUP grade 5 PCa is an effective treatment option for potentially lethal form of the disease: with multimodal approach PCa-specific mortality was quite low and 49% of the patients remained disease-free. The prostate biopsy disease volume with several other parameters predicted biochemical and systemic failure, allowing identify candidates for aggressive adjuvant therapy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e197-e198 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alexander Govorov More articles by this author Konstantin Kolontarev More articles by this author Pavel Rasner More articles by this author Vladimir Dyakov More articles by this author Dmitry Pushkar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...