Does robot-assisted radical prostatectomy benefit prostate cancer patients with bone oligometastases?

To investigate perioperative and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in oligometastatic prostate cancer (PCa).

We retrospectively reviewed the records of 79 oligometastatic PCa patients treated with RARP or ADT between 2005 and 2015 at our institution. Of these 79 patients, 38 were treated with RARP and 41 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated perioperative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analyzed data using Kaplan-Meier methods with log-rank tests and multivariate Cox regression models.

RARP-treated patients showed comparable postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than those of ADT-treated patients. PFS and CSS were improved in RARP-treated, compared with ADT-treated, patients (median PFS: 75 vs. 28 months, p = 0.008; median CSS: not reached vs. 40 months, p = 0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio [HR] = 0.388, p = 0.003; CSS: HR = 0.264, p = 0.004).

We demonstrated that RARP in the setting of oligometastatic PCa is a safe and feasible procedure and that it improves oncologic outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. However, our study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa. Therefore, to confirm our findings, large, prospective, multicenter studies are required. This article is protected by copyright. All rights reserved.

BJU international. 2017 Aug 21 [Epub ahead of print]

Won Sik Jang, Myung Soo Kim, Won Sik Jeong, Ki Don Chang, Kang Su Cho, Won Sik Ham, Koon Ho Rha, Sung Joon Hong, Young Deuk Choi

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.