Robotic prostatectomy has a superior outcome in larger prostates and PSA density is a strong predictor of biochemical recurrence - Abstract

Objectives: The aims of this study were to compare the outcomes of robotic assisted laparoscopic prostatectomy (RALP) between patients who had larger (≥75 g) and smaller (< 75 g) prostates and to evaluate the performance of PSA density (PSAD) in determining the oncological outcome of surgery.

Methods and Materials: 344 patients who underwent RALP at a single institution were included in the study. Preoperative risk factors and postoperative, oncological outcomes, erectile function, and continence status were recorded prospectively.

Results: During a mean follow-up of 20 months, biochemical recurrence (PSA > 0.2) was observed in 15 patients (4.3%). Prostate size ≥75 g was associated with lower Gleason score on final pathology (P = 0.004) and lower pathological stage (P = 0.02) but an increased length of hospital stay (P = 0.05). PSAD on binary logistic regression independently predicted biochemical recurrence (BCR) when defined as postoperative PSA >0.1 (P = 0.001) and PSA >0.2 (P = 0.039). In both instances PSA was no longer a significant independent predictor.

Conclusions: RALP in large prostates (≥75 g, < 150 g) is as safe as RALP in smaller prostates and is associated with a lower pathological grade and stage. Higher PSAD is independently associated with BCR and is superior to PSA as a predictor of BCR after RALP.

Written by:
Bishara S, Vasdev N, Lane T, Boustead G, Adshead J.   Are you the author?
Department of Urology, Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK.

Reference: Prostate Cancer. 2014;2014:763863.
doi: 10.1155/2014/763863

PubMed Abstract
PMID: 25580298 Prostate Cancer Section