Oncological outcome after laparoscopic radical prostatectomy: 10-year experience

Abstract

16017 Purpose: We analyzed the oncological outcome after laparoscopic radical prostatectomy (LRP) in a consecutive series of patients with prostate cancer. Materials and Methods: From 1998 to 2007, 1564 consecutive patients (median age 61 years, IQ range 56, 66) with clinically localized prostate cancer (cT1c-cT3a) were treated with LRP at IMM (Paris, France) or MSKCC (New York, USA). Progression of disease was defined as a PSA of 0.1 ng/ml or greater, or initiation of secondary therapy and was available for 1422 patients. Patients were stratified as low, intermediate or high risk based on the pretreatment prostate cancer nomogram progression free probability of ≥90%, 89% to 71% and ≥ 70% respectively. Results: The overall 5-year probability of freedom from progression was 79% (95% CI 74%-82%). For low, intermediate and high risk cancer, the 5-year progression free probability was 92% (95% CI 85%-95%) 77% (95% CI 71%-82%) and 53% (95% CI 40%-65%) respectively. Surgical margins were positive in 12.5% of cases. The 5-year progression free probability was 49% (95% CI 35%-61%) when the surgical margins were positive vs. 83% (95% CI 79%-86%) in negative surgical margins cases. Nodal metastases were detected in 3% of the patients after limited pelvic lymph node dissection and in 10% after a standard pelvic lymph node dissection (p<0.0001). The 3 year probability of freedom from progression for node positive patients was 46%. There were 22 overall deaths and 2 deaths from prostate cancer. Conclusion: Laparoscopic radical prostatectomy provided 5-year cancer control in 79% of patients with clinically localized prostate cancer and 53% of those with high risk cancers. A pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases. No significant financial relationships to disclose.