scholarly journals Salvage robot-assisted radical prostatectomy (sRARP) for radiation resistant prostate cancer in a group of initially high risk patients

2017 ◽  
Vol 1 (1) ◽  
pp. 21-27
Author(s):  
Nirmal Lamichhane ◽  
Adam S. Dowrick ◽  
Ulrika Axcrona ◽  
Bjørn Brennhovd ◽  
Sophie D. Fosså ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
High Frequency ◽  
Salvage Treatment ◽  
Rectal Injury ◽  
Robot Assisted ◽  
Radiation Resistant ◽  
Risk Patients

Introduction: Salvage robot-assisted radical prostatectomy (sRARP) is seen as an attractive option for salvage treatment of radiation therapy -recurrent prostate cancer (PC), thanks in part to the good visualisation that is possible using this modality. However, the results of fewer than 200 salvage sRARPs have been published in the literature. We report the outcomes in a cohort of initially high risk patients of robot-assisted radical prostatectomy as salvage local therapy for radiation-resistant PC in a Scandinavian healthcare setting. Materials and methods: A retrospective review of the charts of all patients who underwent sRARP for biochemical failure (BCF) after primary radiation treatment for localised PC at a single institution was performed. Results: Twenty-two patients, median age 67 years (range 57 to 72), had sRARP performed between June 2008 to July 2013. A median follow-up of 26 months (range 2 to 63) was observed. Perioperative complications occurred in 4 patients (18%), with one patient sustaining a rectal injury. Histo-pathological diagnosis was pT2 in three, pT3a in five, pT3b in twelve and pTx in one patient. Ten patients (45%) had a positive surgical margin (PSM). At follow-up, 54 % of patients were free of biochemical progression and 41% were continent. Conclusions: We showed that salvage RARP is technically feasible in a cohourt of patients with predominantly high risk disease. This study adds to the limited data already in the literature, demonstrating the high frequency of locally advanced (pT3b) PC, a patient group that is usually not included in salvage treatments, as e.g. high frequency ultrasound or salvage brachytherapy. Further, given that the historical barriers to salvage RP with higher rates of rectal injury and poor urinary control no longer seem to be applicable in the modern era, we think that more patients should be considered candidates for this potentially curative salvage treatment of radiation-resistant PC. However, long-term follow-up is needed to confirm if the additional burden on these patients confers to oncological control following the procedure.

scholarly journals Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joanne Nyaboe Nyarangi-Dix ◽  
Magdalena Görtz ◽  
Georgi Gradinarov ◽  
Luisa Hofer ◽  
Viktoria Schütz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Postoperative Radiotherapy ◽  
Locally Advanced ◽  
Laparoscopic Radical Prostatectomy ◽  
Oncologic Outcomes ◽  
Robot Assisted

Abstract Background Retzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort. Methods Prospectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery. Results 3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out. Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP. 84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%. 34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT. Conclusions RsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.

scholarly journals Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wen Deng ◽  
Ru Chen ◽  
Ke Zhu ◽  
Xiaofeng Cheng ◽  
Yunqiang Xiong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Lower Risk ◽  
Cancer Control ◽  
Robot Assisted ◽  
Grade Ii ◽  
Functional Preservation

Aim. To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods. 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results. Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group ( p  < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group ( p  = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group ( p  = 0.192 and p  = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up ( p  = 0.013 and p  = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups ( p  = 0.228). Conclusions. For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.

scholarly journals Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

2021 ◽  
Author(s):  
Deng Wen ◽  
Zhang Cheng ◽  
Jiang Hao ◽  
Li Yulei ◽  
Liu Xiaoqiang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Lower Risk ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Robot Assisted ◽  
Grade Ii

Abstract Background To evaluate the functional and oncological efficacy of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for immediate- and high-risk localized prostate cancer (PCa). Methods 232 patients bearing immediate- and high-risk localized PCa between January 2016 and October 2019 were enrolled according to the inclusion criteria. The perioperative, functional and oncological outcomes were compared between the RARP and LRP groups after applying the propensity-score matching (PM) (1:1) method, which were employed to attenuate the impact of the potential baseline confounders. Results In all, except for 10 patients without a suitable pair, the remaining patients in the LRP group were successfully matched to 85 patients in the RARP arm. All differences in preoperative variables turned to be insignificant after PM. Within the matched cohort, no open conversion was required in both groups. The RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to that in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the mean estimated blood loss, rates of pT3 disease and positive surgical margin, median specimen Gleason score and hospital stay length existed between the two groups. RARP vs. LRP tended to a significantly higher percentage of urinary continence at the removal of catheter (p = 0.031), postoperative 6 months (p = 0.043), and last follow-up (p = 0.046). Significant differences were also found between the RARP and LRP arms in erectile function at postoperative 6 months and last follow-up (p = 0.013 and p = 0.009, respectively). The statistical comparability between the two groups was observed in biochemical recurrence-free survival (p = 0.228). Conclusions For surgically managing immediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised when comparing with LRP.

scholarly journals Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes and complications

2019 ◽  
Author(s):  
Young Suk Suk Kwon ◽  
Wei Wang ◽  
Arnav Srivast ◽  
Thomas L Jang ◽  
Singer A Eric ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Study Cohort ◽  
High Risk Prostate Cancer ◽  
Pathologic Features ◽  
Risk Prostate Cancer

Abstract Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk PCa after RP, 12.7% (n=959), 13.2% (n=1710), and 74.1% (n=4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p=0.004). Multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Radiation related toxicities, including urinary incontinence, erectile dysfunction, and urethral stricture, were higher in the eRT group when compared to the lRT group. Conclusions: Our results suggest that a blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.

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