Role of laparoscopic radical prostatectomy in locally advanced and high-risk prostate cancer: Whether safe and effective approach?

Abstract

Introduction: Historically, patients with locally advanced and high-grade diseases have not been viewed as a good candidate for radical prostatectomy (RP). The role of RP for locally advanced and high-grade diseases is controversial and the focus of debate. The objective of this study is to evaluate the role of RP in the treatment of locally advanced and high-grade disease. Materials and Methods: In this retroprospective study, all the laparoscopic RPs done for prostate cancer between January 2014 and January 2016, in the Department of Urology, DRRMLIMS, Lucknow, were enrolled and followed for five years. A total of 116 patients were included in this study. They were divided into two groups: group 1 includes 78 patients with localized carcinoma prostate and group 2 includes 38 patients with locally advanced and high-grade prostate cancer. The following characteristics were noted in both groups: margin status, biochemical progression, local recurrence, distant metastasis, clinical progression, and overall and cancer-specific survival (CSS). The primary endpoints were CSS and overall survival. Postoperative survival was estimated using Kaplan–Meier method and compared using log-rank test. Univariate and multivariate analysis of features associated with outcomes were conducted using Cox proportional hazards regression models. Result: The resulting survival estimates at the last follow-up after RP were 83%, 81.58% and 76.92%, 76.31% in groups 1 and 2 for prostate CSS and overall survival, respectively. Overall, 3.85% in group 1 and 21.05% in group 2 patients received salvage radiotherapy for biochemical recurrence, whereas 7.69% in group 1 and 15.79% in group 2 patients were treated with salvage androgen deprivation therapy during clinical follow-up. Margin status was positive in 10.25% and 21.05% of cases in groups 1 and 2, respectively. Conclusion: RP forms an important part of the multimodality approach to locally advanced prostate cancer. It can provide a better outcome (combined with adjuvant and salvage treatment if needed) than radiotherapy (RT) or hormonal therapy (HT) alone or a combination of RT and HT.