Predictive factors for short-term biochemical recurrence-free survival after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients

Aim: To evaluate the preoperative predictors of pathological lymph node (LN) metastasis and prognostic factors for postoperative biochemical recurrence (BCR) in robot-assisted radical prostatectomy with extended pelvic LN dissection in patients with D'Amico high-risk prostate cancer (PCa). Patients and Methods: Overall, 107 patients with D'Amico high-risk PCa underwent robot-assisted radical prostatectomy with extended pelvic LN dissection without neoadjuvant or adjuvant therapy. BCR was defined as a prostate-specific antigen (PSA) level ≥0.2 ng/ml. Moreover, BCR-free survival rates were determined using Kaplan-Meier analysis. Logistic regression analysis was used to evaluate preoperative predictors of pathological LN metastasis. Cox regression analysis was used to evaluate the effects of preoperative and pathologic variables on BCR. Results: The median follow-up was 21 months, and the 5-year BCR-free survival rate was 59.8%. The positive LN rate was 21.5%. In multivariate analysis, the percentage of positive cores was a significant preoperative predictor of positive LNs. Patients with >50% positive cores (p=0.004) and PSA density (PSAD) >0.5 ng/ml/cc (p=0.005) had a high risk of having ≥3 positive LNs. In multivariate analysis, PSAD >0.5% was a significant preoperative predictor of BCR. Among the postoperative predictors, the number of positive LNs was significantly associated with BCR. Patients with ≥3 positive LNs (n=7) had significantly lower BCR-free survival rates than patients with one or two positive LNs (n=16) (p<0.001). Patients with >50% positive cores and PSAD >0.5 ng/ml/cc had a risk for a high number of positive LNs (≥3) that was strongly associated with shorter BCR-free survival (p<0.001). Conclusion: The percentage of positive cores may be useful as a preoperative predictor of pathological LN metastasis in patients with high-risk PCa. Patients with >50% positive cores and PSAD >0.5 ng/ml/cc were found to have a high risk for ≥3 positive LNs and shorter BCR-free survival.

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Robot-Assisted Radical Prostatectomy in Patients With Clinically High-Risk Prostate Cancer: Surgical Feasibility and Long-Term Functional and Oncologic Outcomes

10.21203/rs.3.rs-425802/v1 ◽

2021 ◽

Author(s):

Yong Seong Lee ◽

Tae Young Shin

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Survival Rates ◽

Oncologic Outcomes ◽

Robot Assisted ◽

Free Survival ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

Abstract Background Robot-assisted radical prostatectomy (RARP) is an acceptable procedure for localized prostate cancer. However, RARP has not been offered to patients with high-risk prostate cancer. We report long-term functional and oncologic outcomes of patients who underwent RARP for clinically high-risk prostate cancer and to assess the role of RARP in patients with high-risk prostate cancer. Methods This study included 90 patients with high-risk prostate cancer according to the D'Amico criteria who underwent RARP between January 2014 and December 2019. High risk was based on the presence of a clinical stage of ≥ T2c, a pretreatment prostate-specific antigen level > 20 ng/mL, or a biopsy Gleason score ≥ 8. Functional outcomes including postoperative continence and potency were assessed at 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs), biochemical recurrence (BCR), BCR-free survival, and clinical recurrence (CR)-free survival rates at 1 and 3 years. Results The median operative time was 185 (interquartile range [IQR], 140–250) minutes. Based on postoperative pathology, the rates of PSMs in the entire cohort and in those with stage pT2 disease were 27.8% and 8.9%, respectively. The continence and potency rates at 12 months were 87.8% and 56.7%, respectively. The BCR rate was 23.3%, and the median time to BCR was 10.5 (IQR, 3.5–26.9) months. The 1- and 3-year BCR-free survival rates were 91.5% and 85.5%, respectively, and the 1- and 3-year CR-free survival rates were 97.5% and 90.8%, respectively. Conclusions Most patients with clinically high-risk prostate cancer treated with RARP remained BCR-free and CR-free during the long-term follow-up. The optimal functional and oncologic outcomes indicating RARP as a safe and feasible approach in the present study should be confirmed in future studies.

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