Contemporaneous comparison of open vs minimally‐invasive radical prostatectomy for high‐risk prostate cancer. (28th January 2013)

• Record Type: Journal Article
• Authors: Pierorazio, Phillip M.; Mullins, Jeffrey K.; Eifler, John B.; Voth, Kipp; Hyams, Elias S.; Han, Misop; Pavlovich, Christian P.; Bivalacqua, Trinity J.; Partin, Alan W.; Allaf, Mohamad E.; Schaeffer, Edward M.
• Is Part Of: BJU international. Volume 112:Number 6(2013:Sep.)
• Page Start: 751
• Page End: 757
• Publication Date: 2013-01-28
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11757.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11757-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11757-list-0001" list-type="bullet"> <list-item> <p>The ideal treatment for men with high‐risk prostate cancer is controversial, although most physicians agree that a multimodal approach, including radiation and hormone therapy with or without surgery, offers the best chance of cancer control. Minimally‐invasive radical prostatectomy has emerged as a treatment option for clinically localized cancer; however, critics argue that the open approach may afford advantages of tactile feedback and a better lymph node dissection.</p> </list-item> <list-item> <p>The present study demonstrates that open and minimally‐invasive radical prostatectomy offer equivalent short‐term outcomes for men with high‐risk prostate cancer at a highly experienced centre.</p> </list-item> </list> </p> </sec> <sec id="bju11757-sec-0002" sec-type="section"> <title>Objectives</title> <p> <list id="bju11757-list-0002" list-type="bullet"> <list-item> <p>To analyze pathological and short‐term oncological outcomes in men undergoing open and minimally‐invasive radical prostatectomy (MIRP) for high‐risk prostate cancer (HRPC; prostate‐specific antigen level [PSA] >20 ng/mL, ≥ cT2c, Gleason score 8–10) in a contemporaneous series.</p> </list-item> </list> </p> </sec> <sec id="bju11757-sec-0003" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11757-list-0003" list-type="bullet"> <list-item> <p>In total, 913 patients with HRPC were identified in the Johns Hopkins Radical Prostatectomy Database subsequent to the inception of MIRP at this institution (2002–2011)</p> </list-item> <list-item> <p>Of these, 743 (81.4%) underwent open radical retropubic prostatectomy (ORRP), 105 (11.5%) underwent robot‐assisted laparoscopic radical prostatectomy (RALRP) and 65 (7.1%) underwent laparoscopic radical prostatectomy (LRP) for HRPC.</p> </list-item> <list-item> <p>Appropriate comparative tests were used to evaluate patient and prostate cancer characteristics.</p> </list-item> <list-item> <p>Proportional hazards regression models were used to predict biochemical recurrence.</p> </list-item> </list> </p> </sec> <sec id="bju11757-sec-0004" sec-type="section"> <title>Results</title> <p> <list id="bju11757-list-0004" list-type="bullet"> <list-item> <p>Age, race, body mass index, preoperative PSA level, clinical stage, number of positive cores and Gleason score at final pathology were similar between ORRP and MIRP.</p> </list-item> <list-item> <p>On average, men undergoing MIRP had smaller prostates and more organ‐confined (pT2) disease (<italic>P</italic> = 0.02).</p> </list-item> <list-item> <p>The number of surgeons and surgeon experience were greatest for the ORRP cohort.</p> </list-item> <list-item> <p>Overall surgical margin rate was 29.4%, 34.3% and 27.7% (<italic>P</italic> = 0.52) and 1.9%, 2.9% and 6.2% (<italic>P</italic> = 0.39) for pT2 disease in men undergoing ORRP, RALRP and LRP, respectively.</p> </list-item> <list-item> <p>Biochemical recurrence‐free survival among ORRP, RALRP and LRP was 56.3%, 67.8% and 41.1%, respectively, at 3 years (<italic>P</italic> = 0.6) and the approach employed did not predict biochemical recurrence in regression models.</p> </list-item> </list> </p> </sec> <sec id="bju11757-sec-0005" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11757-list-0005" list-type="bullet"> <list-item> <p>At an experienced centre, MIRP is comparable to open radical prostatectomy for HRPC with respect to surgical margin status and biochemical recurrence.</p> </list-item> </list> </p> </sec> </abstract>