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Title: Robotic radical prostatectomy as the initial step in multimodal therapy for men with high risk localised prostate cancer: intial experince of 160 men.
Epworth Authors: Kerger, Michael
Murphy, Declan
Costello, Anthony
Crowe, Helen
Peters, Justin
Other Authors: Connolly, Stephen
Cathcart, Paul
Gilmore, P.
Keywords: Prostatectomy
Prostate Cancer
Robotic Radical Prostatectomy
Multimodal Therapy
Prostatic Neoplasms
Retospective Studies
Androgen Deprivation Therapy
National Comprehensive Control Network
Prostate-Specific Antigen
Issue Date: Mar-2012
Publisher: Wiley
Citation: BJU Int. 2012 Mar;109(5):752-9
Abstract: OBJECTIVES: To report the outcome of robotic-assisted laparoscopic radical prostatectomy (RALP) for men with localised high-risk prostate cancer at diagnosis. Although commonly managed by radiotherapy (RT) with prolonged androgen-deprivation therapy (ADT), we hypothesize that initiation of multimodal therapy with RALP is oncologically efficacious and may allow many men to avoid ADT. PATIENTS AND METHODS: Between December 2003 and September 2010, 1480 men underwent RALP of whom 160 fulfilled the National Comprehensive Control Network criteria for high-risk disease (prostate-specific antigen (PSA) > 20 ng/mL and/or clinical stage, cT ≥ 3 and/or biopsy Gleason score ≥ 8). Biochemical recurrence (postoperative PSA ≥ 0.2) was used to assess outcome after RALP monotherapy. Treatment failure was defined as either a rising PSA level after salvage RT or the initiation of ADT. RESULTS: The mean age ± standard deviation was 63.1 ± 6.3 years. Median PSA level was 9.95 ng/mL (interquartile range 6.0-21.4). Analysis of prostatectomy specimen showed Gleason 8-10 cancers in 65 (41%), and extracapsular disease, pT ≥ 3, in 96 (60%) of which seminal vesicle invasion was evident in 36 (23%). Downgrading by prostatectomy occurred in 64 (40% of total group) and five (3%) were downstaged to pT2 disease. By contrast, any upgrading occurred in 29 (18% of total group) and upstaging occurred in 68 (43%). The overall positive surgical margin rate was 38%, correlating with stage pT2 (15%) or pT3 (53%). With median follow-up of 26.2 months (interquartile range 5.5-37.3), two non-cancer-related deaths have occurred (overall survival 98.8%; cancer-specific survival 100%), and biochemical recurrence has occurred in 53 men (33%). RALP surgery has served as monotherapy (n= 117, 73%), or has been followed by salvage RT (n= 24, 15%) and/or ADT (n= 43, 27%). Overall 2-year and 3-year treatment failure was 31 and 41%, respectively. Serum PSA level was the only independent predictor of overall treatment failure (hazard ratio [HR] 1.02, P= 0.001) although a strong trend was observed for both clinical stage (HR 1.22, P= 0.058) and the number of positive biopsy cores on transrectal biopsy (HR 1.06, P= 0.057). CONCLUSIONS: RALP incorporating the use of postoperative RT is a good multimodal management strategy for men with this aggressive variant of prostate cancer. At median follow-up in excess of 2 years, we found low rates of treatment failure enabling a high proportion of men to remain free of ADT.
DOI: 10.1111/j.1464-410X.2011.10548.x
PubMed URL:
ISSN: 1464-410X
Journal Title: British Journal Of Urology International
Type: Journal Article
Affiliated Organisations: Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Cancer Services
UroRenal, Vascular
Epworth Prostate Centre

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