PD43-04 COMPARING THE 8-YEAR ONCOLOGIC OUTCOMES OF OPEN AND ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR HIGH RISK PROSTATE CANCER

Abstract

INTRODUCTION AND OBJECTIVES: We compared oncologic outcomes between retropubic radical prostatectomy (RRP) and robotassisted radical prostatectomy (RARP) in patient with high-risk PCa, and investigated predictive factors for favorable disease to aid patient selection in high-risk prostate cancer (PCa). METHODS: Comparative analysis of high-risk patients who underwent radical prostatectomy was conducted. High-risk PCa was defined as cT3a, Gleason score (GS) 8-10, or PSA >20 ng/ml. Favorable disease was defined as pT2, pGS 7, and pN0. After controlling preoperative variables such as age, prostate volume, preoperative PSA, clinical stage, biopsy GS, percentage of positive cores on biopsy, and surgeon experience, the 5-year survival outcomes according to the surgical approach were evaluated. We pursued to find the predictor of favorable disease after radical prostatectomy in high-risk disease. RESULTS: Among the total of 356 high-risk patients, 106 (29.8%) underwent RRP and 250 (70.2%) underwent RARP. The unadjusted 5-year biochemical recurrence-free survival (BCRFS) rates were better in RARP compared to RRP (RRP vs. RARP; 54.9% vs. 66.4%, p1⁄40.015). After adjustment, 5-year BCRFS rates were slightly better in RARP than those in RRP (51.6% vs. 59.3%, p1⁄40.066). Favorable disease was observed in 26.7% of high-risk patients. They showed better 5-year BCRFS rates than other patients (87.8% vs. 51.7%, p<0.001). Preoperative PSA, clinical stage, and percentage of GS 8-10 core were predictors of favorable disease. CONCLUSIONS: Oncologic outcomes of RARP were equivalent to RRP in high-risk PCa. We constructed scoring system for predicting favorable disease with predictors including PSA, clinical stage, and percentage of GS 8-10 core. Using this scoring system, we can predict favorable disease with 78.1% of predictive accuracy.