AUA 2018: Clinical and Oncological Outcomes of Robot-Assisted Radical Prostatectomy with Nerve Sparing for High-Risk Prostate Cancer Patients
Particularly in younger men with high-risk disease, functional outcomes are relevant and affect quality of life. As such, Dr. Takahara and colleagues from Toyoake, Japan presented their clinical and oncological outcomes among men with high risk disease treated with robotic prostatectomy at AUA 2018 localized prostate cancer session. For this study, the authors identified 767 patients at their institution from August 2009 to December 2016 who underwent robotic radical prostatectomy. Among these patients, 230 (30.0%) had high-risk disease and had at least 6 months of follow-up post-surgery. Clinical and oncological outcomes of robotic radical prostatectomy, comparing nerve-sparing vs no nerve-sparing among these high-risk patients were assessed. The authors used descriptive statistics to compare outcomes between these two groups.
The mean preoperative serum PSA was 12 ng/ml and mean age of the patients was 65.7 years among men included in the study. The majority of patients had unilateral nerve-sparing (n=125, 54%) and no nerve-sparing (n=97, 42%), whereas only 4% (n=8) had bilateral nerve-sparing. The median follow-up for the cohort was 25 months. Using the Clavien–Dindo classification, 10% of cases had Grade IIIa or greater complications. The nerve-sparing group had a 18% positive surgical margin rate, whereas the non-nerve sparing group had a surgical margin rate of 29% (p>0.05). Over the course of follow-up, the 1-year biochemical recurrence-free survival rates in nerve-sparing group was 84% vs 86% in the non-nerve sparing group (p=0.66); the 3-year biochemical recurrence-free survival rates in the nerve-sparing group was 73% vs 75% in the non-nerve sparing group (p=0.08). The median number of pads used at 3 months was 1.1 for patients undergoing nerve-sparing vs 1.5 for the non-nerve sparing group (p=0.045); the median number of pads used at 6 months was 0.6 for patients undergoing nerve-sparing vs 1.0 for the non-nerve sparing group (p=0.009).
Although the authors demonstrate that robotic radical prostatectomy is feasible among men with D’Amico high risk prostate cancer, the 10% Grade IIIa or greater complication rate is concerning. Limitations include the inherent selection bias associated with a retrospective study, particularly when an intervention is decided at the time of operation with no information included with regards to pre-operative erectile function (ie. IIEF score) or lower urinary tract symptoms (ie. IPSS score). The authors concluded that in their study, a nerve-sparing technique at the time of robotic prostatectomy for men with high risk disease was associated with equivalent oncological outcomes and superior continence outcomes compared to men not undergoing nerve-sparing, albeit with relatively short follow-up.
Presented By: Kiyoshi Takahara, Fujita Health University School of Medicine, Toyoake, Japan
Co-Authors: Masaru Hikichi, Kosuke Fukaya, Manabu Ichino, Naohiko Fukami, Hitomi Sasaki, Mamoru Kusaka, Ryoichi Shiroki, Toyoake, Japan
References:
1. Jemal A, Fedewa SA, Ma J, et al. Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA 2015;315(19):2054-2061.
2. Loeb S, Folkvaljon Y, Curnyn C, et al. Uptake of active surveillance for very-low-risk prostate cancer in Sweden. JAMA Oncol 2017;3(10):1393-1398.
3. Richard PO, Alibhai SM, Panzarella T, et al. The uptake of active surveillance for the management of prostate cancer: A population-based analysis. Can Urol Assoc J 2016;10(9-10):333-338.
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA