WCE 2017: Midterm Outcomes of Four-Port Extraperitoneal Laparoscopic Radical Prostatectomy for High-Risk Prostate Cancer within Asian Population

Vancouver, Canada (UroToday.com) At time of diagnosis of prostate cancer in Taiwan, men tend to present with higher grade disease then that of the other races. This can be contributed to the fact that there is no PSA screening for men until they present other symptoms of prostate cancer, typically the presence of nodules during a digital rectal exam. Dr. Wu, during his presentation, mentioned that currently his hospital in Taiwan does not currently possess a robot and is therefore assessing the effectiveness of a laparoscopic approach for high grade prostate cancer as first line treatment in a multimodality treatment strategy.

Dr. Wu and colleagues retrospectively analyzed 202 patients who underwent laparoscopic radical prostatectomy from January 2006 to January 2016. Following the D’Amico classification system, the authors identified 122 (60%) patients that were classified as high risk. Patients under went lymphadenectomy and neurovascular bundle preservation depending on their risk stratification.

The authors looked at very standard perioperative variables, such as, blood loss, hospital stay, operative time, specimen weight, positive margins, etc.. During Dr. Wu’s presentation he specifically called attention to the relatively low rate of positive surgical margins obtained across the cohort. The overall incident rate of positive margins for pT2, pT3, and pT4 was 28.7%. The authors also report a recurrence-free survival of 83% and 69% at 3 and 5 years respectively. Their overall survival was 96% and 92.2% at 3 and 5 years respectively. Dr. Wu also wanted to clarify that since his center is only 10 years old, only 5 year survival data was available.

There are a few limitations that the authors mentioned regarding this study. The first being that the overall cohort was a relatively small sample size for the amount of categorization and subset analysis performed. They also pointed out that there is no control group and that the analyses were completed mid-term. In conclusion this study showed that even for advanced/high risk disease, laparoscopic radical prostatectomy is a viable option for primary treatment.

Presenter: Richard Wu, MD

Authors: Richard Wu and Victor Lin
Affiliation: E-Da hospital Kaohiung, Kaohsiung, Taiwan

Written by: Anthony Warner (AS), research intern from the University of California, Irvine, CA, USA at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.