Our aim was to evaluate the predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy.
The study cohort consisted of 359 consecutive non-metastatic prostate cancer patients who underwent Retzius-sparing robot-assisted radical prostatectomy between November 2012 and January 2016. According to the National Comprehensive Cancer Network prostate cancer risk classification, 164 patients (45.7%) had high- or very high-risk prostate cancer. No patient received adjuvant therapy until documented biochemical recurrence. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of biochemical recurrence.
The median follow-up period was 26 months (interquartile range 19-38 months). The overall biochemical recurrence rate was 14.8%, and the median time to biochemical recurrence was 11 months (interquartile range 6-22 months). The 3-year biochemical recurrence-free survival probability was 71.2%, 72.1%, 88.7%, 82.3% and 95.7% in very high-, high-, intermediate-, low- and very low-risk prostate cancer, respectively (log-rank, P < 0.001). On multivariable analysis, preoperative prostate-specific antigen (hazard ratio 1.03, 95% confidence interval 1.02-1.04; P < 0.0001), percentage of maximum core involvement on biopsy (hazard ratio 1.02, 95% confidence interval 1.01-1.03; P = 0.029) and clinical stage ≥T3a (hazard ratio 2.12, 95% confidence interval 1.02-4.39; P = 0.043) were predictors of biochemical recurrence, whereas pathological Gleason score ≥8 (hazard ratio 5.63, 95% confidence interval 1.62-19.61; P = 0.007) and pathological tumor volume (hazard ratio 1.08, 95% confidence interval 1.04-1.20; P < 0.001) were the main pathological predictors of biochemical recurrence.
Retzius-sparing robot-assisted radical prostatectomy confers effective biochemical recurrence control at the mid-term follow-up period. Preoperative prostate-specific antigen, advanced clinical stage and higher Gleason score were important predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy. Long-term oncological safety still needs to be established.
International journal of urology : official journal of the Japanese Urological Association. 2018 Oct 01 [Epub ahead of print]
Ali Abdel Raheem, Ki Don Chang, Mohammed Jayed Alenzi, Won Sik Ham, Woong Kyu Han, Young Deuk Choi, Koon Ho Rha
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.