Introduction: To present oncological results of laparoscopic radical prostatectomy (LRP) monotherapy for men with high-risk, localized prostate cancer, and to find factors associated with a good prognosis via surgery alone.
Methods: Between 2002 and 2009, 241 men underwent LRP at an Asian tertiary referral center. Among them, we retrospectively identified 85 men (35.3%) who met D'Amico's high-risk criteria: prostate-specific antigen level > 20 ng/mL, Gleason score of 8-10, or clinical stage ≥ T2c. Perioperative parameters were analyzed against biochemical recurrence (BCR)-free survival.
Results: At a median follow-up of 54 months, 28 (34.1%) developed BCR, with an actuarial BCR-free survival rate of 63.3% at 5 years. Pathologically, 37.6% of the men had organ-confined (OC) disease. Positive surgical margins (PSM) were identified in 49.4% of the patients. A favorable pathological outcome, defined as OC(+)PSM(-), was observed in 24 patients and associated with a 5-year BCR-free survival rate of 87.0%, compared with 100%, 54.0% and 46.4% in men with OC(+)PSM(+), OC(-)PSM(-) and OC(-)PSM(+) disease (log-rank, p=0.008). The overall positive lymph node rate was 14.1%. Men (65.9%) with only one D'Amico risk factor had a 5-year BCR-free survival rate of 76.9%, compared with 34.6% in men (34.1%) with ≥ 2 risk factors (log-rank, p< 0.001).
Conclusions: Radical prostatectomy monotherapy performed laparoscopically or robotically appears to be an option for high-risk prostate cancer, especially in men with a single D'Amico risk factor. Men with ≥ 2 risk factors are more prone to develop BCR following surgery, and may need second-line therapy.
Written by:
Tai HC, Lai MK, Huang CY, Wang SM, Huang KH, Chen CH, Chung SD, Chueh SC, Yu HJ, Pu YS. Are you the author?
National Taiwan University Hospital, Urology, Chung-Shan S. Rd, Taipei, Taiwan, 100, Taiwan.
Reference: J Endourol. 2013 Aug 30. Epub ahead of print.
doi: 10.1089/end.2013.0118
PubMed Abstract
PMID: 23987245
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