J Korean Med Sci.  2015 Nov;30(11):1631-1637. 10.3346/jkms.2015.30.11.1631.

Is Radical Perineal Prostatectomy a Viable Therapeutic Option for Intermediate- and High-risk Prostate Cancer?

• Lee HW
• Jeon HG
• Jeong BC
• Seo SI
• Jeon SS
• Lee HM
• Choi HY

• KMID: 2351114
• DOI: http://doi.org/10.3346/jkms.2015.30.11.1631

Abstract

The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA >20 ng/mL, bGS > or =8, or > or =cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.

Keyword

Prostatic Neoplasms; Radical Prostatectomy; Risk Assessment; Minimally Invasive Surgical Procedures; Treatment Outcome

MeSH Terms

Adult
Aged
Aged, 80 and over
Disease-Free Survival
Humans
Laparoscopy/*utilization
Male
Middle Aged
Minimally Invasive Surgical Procedures/*utilization
Perineum/*surgery
Prevalence
Prostatectomy/*utilization
Prostatic Neoplasms/diagnosis/*epidemiology/*surgery
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Treatment Outcome

Figure

• 

  Fig. 1 Kaplan-Meier estimates of metastasis-free survival (MFS) by surgical technique in (A) overall cohort and in patients with (B) intermediate- and (C) high-risk prostate cancer. RPP, radical perineal prostatectomy; RRP, radical retropubic prostatectomy; MIRP, minimally invasive radical prostatectomy (laparoscopic radical prostatectomy + robot-assisted laparoscopic radical prostatectomy).

• 

  Fig. 2 Kaplan-Meier curves of cancer-specific survival (CSS) after radical perineal prostatectomy in (A) all patients, and according to (B) preoperative risk, (C) pathologic Gleason score (pGS) and (D) pathological T stage (pT).

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