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Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients

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Abstract

Purpose

Comparative data related to the use of open and minimally invasive surgical approaches for the treatment of high-risk prostate cancer (PCa) remain limited. We determined outcomes of open radical prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in matched cohorts of patients with high-risk prostate cancer.

Materials and methods

A total of 805 patients with high-risk PCa [prostate-specific antigen (PSA) >20 ng/mL, Gleason score ≥8, or clinical stage ≥cT2c] were identified. A total of 407 RRP cases were propensity score (PS) matched 1:1 to 398 LRP or RARP cases to yield 3 cohorts (RARP, LRP, and RRP) of 110 patients each for analysis. PS matching variables included the following: age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon experience, and nerve-sparing technique. Overall survival (OS) and recurrence-free survival (RFS) were compared with log-rank test. RFS predictor analysis was calculated within Cox regression models.

Results

Pathological Gleason scores <7, =7, and >7 were found in 3.3, 50.9, and 45.8 % of patients. There were no statistically significant differences for pathological stage and positive surgical margins between surgical techniques. Mean 3-year RFS was 41.4, 77.9, and 54.1 %, for RARP, LRP, and RRP, respectively (p < 0.0001 for RARP vs. LRP). There were no significant differences for mean estimated 3-year OS for patients treated with RARP, LRP, or RRP (95.4, 98.1, and 100 %).

Conclusions

RARP demonstrated similar oncologic outcomes compared to RRP and LRP in a PS-matched cohort of patients with high-risk prostate cancer.

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Abbreviations

RP:

Radical prostatectomy

RARP:

Robot-assisted laparoscopic RP

MIRP:

Minimally invasive RP

RRP:

Retropubic RP

PS:

Propensity score

BMI:

Body mass index

PSA:

Prostate-specific antigen

OS:

Overall survival

RFS:

Recurrence-free survival

EBRT:

External beam radiation therapy

ADT:

Androgen deprivation therapy

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Acknowledgments

We acknowledge the excellent work of Markus Loos on the Charité prostate cancer database. This study was funded by a Charles Huggins-Grant of the German Society of Urology.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

Author information

Authors and Affiliations

  1. Department of Urology, Charité University Medicine Berlin, Berlin, Germany

    Jonas Busch, Ahmed Magheli, Stefan Hinz, Frank Friedersdorff, Tom Florian Fuller & Kurt Miller

  2. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA

    Natalia Leva & Michelle Ferrari

  3. Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Avenue, M-814, Miami, FL, 33136, USA

    Mark L. Gonzalgo

Authors
  1. Jonas Busch
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  2. Ahmed Magheli
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  3. Natalia Leva
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  4. Stefan Hinz
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  5. Michelle Ferrari
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  6. Frank Friedersdorff
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  7. Tom Florian Fuller
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  8. Kurt Miller
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  9. Mark L. Gonzalgo
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Corresponding author

Correspondence to Jonas Busch.

Additional information

Jonas Busch and Ahmed Magheli have equally contributed to this work.

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Busch, J., Magheli, A., Leva, N. et al. Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients. World J Urol 32, 1411–1416 (2014). https://doi.org/10.1007/s00345-014-1270-0

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  • DOI: https://doi.org/10.1007/s00345-014-1270-0

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