Korean J Urol.  2015 Aug;56(8):572-579. 10.4111/kju.2015.56.8.572.

Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer

• Lee D
• Choi SK
• Park J
• Shim M
• Kim A
• Lee S
• Song C
• Ahn H

• KMID: 2164408
• DOI: http://doi.org/10.4111/kju.2015.56.8.572

Abstract

PURPOSE
To evaluate the oncologic outcomes of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa), we compared the surgical margin status and biochemical recurrence-free survival (BCRFS) rates between retropubic radical prostatectomy (RRP) and RARP.
MATERIALS AND METHODS
A comparative analysis was conducted of high-risk PCa patients who underwent RRP or RARP by a single surgeon from 2007 to 2013. High-risk PCa was defined as clinical stage> or =T3a, biopsy Gleason score 8-10, or prostate-specific antigen>20 ng/mL. Propensity score matching was performed to minimize selection bias, and all possible preoperative and postoperative confounders were matched. A Kaplan-Meier analysis was performed to assess the 5-year BCRFS, and Cox regression models were used to evaluate the effect of the surgical approach on biochemical recurrence.
RESULTS
A total of 356 high-risk PCa patients (106 [29.8%] RRP and 250 [70.2%] RARP) were included in the final cohort analyzed. Before adjustment, the mean percentage of positive cores on biopsy and pathologic stage were poorer for RRP versus RARP (p=0.036 vs. p=0.054, respectively). The unadjusted 5-year BCRFS rates were better for RARP than for RRP (RRP vs. RARP: 48.1% vs. 64.4%, p=0.021). After adjustment for preoperative variables, the 5-year BCRFS rates were similar between RRP and RARP patients (48.5% vs. 59.6%, p=0.131). The surgical approach did not predict biochemical recurrence in multivariate analysis.
CONCLUSIONS
Five-year BCRFS rates of RARP are comparable to RRP in high-risk PCa. RARP is a feasible treatment option for high-risk PCa.

Keyword

Prostatic neoplasms; Prostatectomy; Treatment outcome

MeSH Terms

Aged
Databases, Factual
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Prostatectomy/*methods
Prostatic Neoplasms/pathology/*surgery
Robotic Surgical Procedures/*methods
Treatment Outcome

Figure

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  Fig. 1 Kaplan-Meier survival curves for unadjusted (A) and adjusted cohorts (B). BCR, biochemical recurrence; RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy.

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  Fig. 2 Kaplan-Meier survival curves for unadjusted (A) and adjusted pT3 cohorts (B). BCR, biochemical recurrence; RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy.

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