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ENDOUROLOGY
& LAPAROSCOPY
3-year
actuarial biochemical recurrence-free survival following laparoscopic
radical prostatectomy: experience from a tertiary referral center in the
United States
Pavlovich CP, Trock BJ, Sulman A, Wagner AA, Mettee LZ, Su LM
The Brady Urological Institute, The Johns Hopkins Medical Institutions,
Baltimore, Maryland 21224, USA
J Urol. 2008; 179: 917-21; discussion 921-2
- Purpose:
We performed a prospective analysis of pathological and oncological
outcomes following laparoscopic radical prostatectomy at a medical center
in the United States.
-
Materials and Methods:
A total of 528 men underwent laparoscopic radical prostatectomy between
April 2001 and August 2005. We excluded 4 open surgical conversions
(0.8%) and 16 men (3.0%) without followup. The remaining 508 men had
a mean preoperative prostate specific antigen of 6.0 ng/mL (range 0.3
to 27) and Gleason score of 6.3 (range 6 to 10). Stage was cT1b in 1
case (0.2%), cT1c in 350 (68.9%), cT2a in 135 (26.6%), cT2b in 21 (4.1%)
and cT2c in 1 (0.2%). Of the patients 89% underwent cavernous nerve
preservation. Biochemical recurrence was defined and timed at the first
prostate specific antigen of 0.2 ng/mL or greater if at repeat testing
it remained 0.2 ng/mL or greater.
-
Results: Mean
followup was 13.2 months (median 12, range 2 to 52). Pathological stage
was pT0N0/Nx in 2 men (0.4%), pT2N0/Nx in 414 (81.5%), pT3aN0/Nx in
72 (14.2%), pT3bN0/Nx in 17 (3.3%) and pT2-3N1 in 3 (0.6%). Positive
margin rates increased with higher stage (8.2% in pT2 and 39.3% in pT3
cases, p < 0.0001). Three-year actuarial biochemical recurrence-free
survival was 98.2% for pT2N0/Nx and 78.7% for pT3N0/Nx/N1 disease (p
< 0.0001), and it was 94.5% overall. Multivariate analysis controlling
for age, preoperative prostate specific antigen, postoperative Gleason
score and stage, and margin status showed that only Gleason score (greater
than vs. less than 7) and stage (pT3 or any N1 vs. pT2) predicted biochemical
progression.
-
Conclusions:
Laparoscopic radical prostatectomy can provide excellent cancer control
outcomes for clinically localized prostate cancer with high actuarial
biochemical recurrence-free survival rates at 3 years.
- Editorial
Comment
Since the first laparoscopic radical prostatectomy (LRP) was described
by Schuessler et al. in 1997 and then by Guillonneau et al. in 1999
this surgical technique has evolved, as well, as the laparoscopic instruments
and better understanding of the “laparoscopic” anatomy allowed
several other investigators to demonstrate no difference of oncological
outcomes between the open and laparoscopic approach in their reports.
In a couple of years we will celebrate the 10th anniversary of LRP performed
by high volume tertiary care centers. I foresee that the oncological
outcomes will be similar as the open surgical technique. Furthermore,
we do need reports from trials that can compare different surgical approaches
for the treatment of Prostate Cancer. Moreover, the ideal prostate cancer
marker should be identified in the near future to prevent overtreatment
of the disease and also to decrease disease specific mortality.
Dr.
Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA
E-mail: fernando.kim@uchsc.edu |