Re: Williams et al.: Radical Retropubic Prostatectomy and Robotic-assisted Laparoscopic Prostatectomy: Likelihood of Positive Surgical Margin(s) (Urology 2010;76:1097-1101)

Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy.Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed.Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer.Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

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165: Robotic Assisted Laparoscopic Prostatectomy Versus Radical Retropubic Prostatectomy: Assessment of Perioperative Pain

The Journal of Urology ◽

10.1016/s0022-5347(18)37427-5 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 44-44 ◽

Cited By ~ 2

Author(s):

Todd M. Webster ◽

S. Duke Herrell ◽

Roxelyn G. Baumgartner ◽

Laura Anderson ◽

Joseph A. Smith

Keyword(s):

Radical Retropubic Prostatectomy ◽

Robotic Assisted ◽

Laparoscopic Prostatectomy ◽

Retropubic Prostatectomy ◽

Perioperative Pain

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Obesity and metabolic syndrome correlate with a higher risk of biochemical recurrence in high risk and intermediate risk prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.5580 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 5580-5580

Author(s):

Shifeng Mao ◽

Ralph Miller ◽

John Lyne ◽

Jeffrey Cohen ◽

Arash Samiei

Keyword(s):

Prostate Cancer ◽

Metabolic Syndrome ◽

Biochemical Recurrence ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Obese Patients ◽

Robotic Assisted ◽

Laparoscopic Prostatectomy ◽

Increased Risk ◽

Significant Difference

5580 Background: Obesity and metabolic syndrome (MS) is prevalent in our society, and have been linked to a higher incidence of prostate cancer (PCa). The relationship of obesity or MS and cancer control has yielded mixed results in previous studies. We examined the correlation between the incidence of biochemical recurrence (BCR) with MS and BMI in a cohort of patients with PCa who underwent robotic-assisted laparoscopic prostatectomy (RALP). Methods: A retrospective study of patients who underwent RALP at a single center from 2007 to 2015 was conducted. Parameters including preoperative BMI, fasting glucose, lipid profile, blood pressure, PSA, Gleason score, pathologic stage, time to BCR, and surgical margin status were analyzed. Patients were categorized in high (HR), intermediate (IR), and low-risk (LR) groups based on the National Comprehensive Cancer Network (NCCN) guidelines. WHO classification was used for MS criteria, and BCR was defined as two consecutive postoperative PSA volume of ≥ 0.2 ng/mL. Obesity is defined as BMI ≥30 kg/m2. Results: A total of 726 patients with 189 in HR, 471 in IR and 66 patients in LR groups were included in this study with the median age of 59 (interquartile range [IQR] 55-64) years old. The median follow-up from surgery was 38 (IQR 22-46) months. More obese patients were found in the HR group compared to IR/LR group (46.5% vs. 33.1%, p<0.01). There were also more patients with MS in the HR group compared to IR/LR group (36.5% vs. 12.0%, p<0.01). Obese patients had a higher rate of BCR across risk groups in comparison to non-obese patients 32.1% vs. 15.4% (P<0.001), specifically 68% vs. 40%(p<0.01) in HR group and 21.3% vs. 12.7% (p=0.035) in the IR group. Similarly, patients with MS had a higher rate of BCR in HR and IR groups in comparison to the patients without MS, 39.1% vs. 18.7% (P<0.01); specifically, 67.7% vs. 42.2% (p<0.01) in HR and 29% vs. 11.6% (p<0.01) in the IR group. No correlation between MS or obesity and BCR was observed in LR group. There was no statistically significant difference in the positive surgical margin rate between obese and non-obese cohorts in each risk group. Conclusions: Among HR and IR-PCa patietns who underwent RALP, both obesity and MS correlate with increased risk of BCR. There were significantly more obesity and MS in HR-PCa patients, suggesting a potential pathophysiologic interplay between obesity or MS and cancer progression.

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