OBJECTIVE: To investigate the results of performing laparoscopic radical prostatectomy (LRP) in patients with high-risk prostate cancer (HRPC): PSA ≥20 ng/ml +/- biopsy Gleason ≥8 +/- cT ≥2c.
PATIENTS AND METHODS: Of a total of 1,975 patients having LRP during a 159 month period from 2000-2013, 446 (22.6%) had HRPC; all patients were staged by pre-operative MRI or CT and isotope bone scanning. Median patient age (with range) = 64.0 (36-79) years; BMI = 27.0 (18-43) kg/m2; PSA = 8.1 (0.1-93) ng/ml and biopsy Gleason = 8 (6-10). All patients had a pelvic lymphadenectomy, which was done using an extended template after April 2008 (53.3%). Neurovascular bundle (NVB) preservation was done in 41.5% (bilateral = 26.3%; unilateral = 15.2%) of patients; an incremental or partial nerve-sparing technique was used in 99 of the 302 (32.8%) NVBs preserved.
RESULTS: Median gland weight = 58.5 (20-161) g; operating time = 180 (92-330) minutes; blood loss = 200 (10-1400) ml; post-op. hospital stay = 3.0 (2-7) nights; catheterization time = 14 (2-35) days; complication rate = 7.6%; node count = 16 (2-51); lymph node positivity = 16.2%; node involvement = 2 (1-8); margin positivity = 26.0%; up-grading = 2.5%; down-grading = 4.3%; up-staging from T1/2 to T3 = 24.7%; down-staging from T3 to T1/2 = 6.1%. No cases were converted to open surgery and 3 patients were transfused (0.7%) after surgery. At a mean follow-up of 24.9 (3-120) months 79.2% of patients were free of biochemical recurrence, 91.8% were continent and 64.4% of previously-potent non-diabetic men < 70 years were potent after bilateral nerve preservation.
CONCLUSION: The low morbidity, 55.4% specimen-confined rate, 26.0% positive surgical margin rate, 79.2% biochemical disease free survival, 91.8% continence rate and 64.4% potency rate at 35.2 months seen in this study serve as evidence firstly that surgery is an effective treatment for patients with HRPC, curing many and representing the first step of multi-modal treatment for others, and that LRP for HRPC appears to be as effective as open RP in this context.
Written by:
Di Benedetto A, Soares R, Dovey Z, Bott S, McGregor RG, Eden CG. Are you the author?
Department of Urology, The Royal Surrey County Hospital, Guildford, UK.
Reference: BJU Int. 2014 May 6. Epub ahead of print.
doi: 10.1111/bju.12797
PubMed Abstract
PMID: 24802619
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