Propensity score comparison of the various radical surgical techniques for high-risk prostate cancer - Abstract

INTRODUCTION: The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP).

We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence.

PATIENTS AND METHODS: A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models.

RESULTS: Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7% for RARP, in 8.2, 36.4, 55.5% for LRP and in 0, 60.9 and 39.1% for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0% for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1% (p< 0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100% respectively (statistically not significant).

CONCLUSION: RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.

Written by:
Busch J, Gonzalgo M, Leva N, Ferrari M, Friedersdorff F, Hinz S, Kempkensteffen C, Miller K, Magheli A.   Are you the author?
Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin; Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.

Reference: Aktuelle Urol. 2015 Jan;46(1):45-51.
doi: 10.1055/s-0034-1395562

PubMed Abstract
PMID: 25526221

Article in German. Prostate Cancer Section