Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival.

PURPOSE We compared biochemical recurrence-free survival of patients who underwent radical retropubic prostatectomy vs robot assisted laparoscopic prostatectomy in concurrent series at a single institution. MATERIALS AND METHODS A total of 2,132 patients were treated between June 2003 and January 2008. We excluded from study patients with prior treatment (115), missing data (83) and lymph node involvement (30). The remaining cohort (1,904) was compared based on clinical, surgical and pathological factors. Kaplan-Meier analysis was performed comparing biochemical recurrence after robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy. A Cox proportional hazards model was generated to determine whether surgical approach is an independent predictor of biochemical recurrence. RESULTS There were 491 radical retropubic prostatectomies (25.9%) and 1,413 robot assisted laparoscopic prostatectomies (74.1%) performed, and median followup was 10 months (IQR 2 to 23). On univariate analysis the robot assisted laparoscopic prostatectomy group was slightly lower risk with lower median prostate specific antigen (5.4 vs 5.8, p <0.01), a lower proportion of pathological grade 7-10 (48.5% vs 54.7%, p <0.01) and lower pathological stage (80.5% pT2 vs 69.6% pT2, p <0.01). The 3-year biochemical recurrence-free survival rate was similar between the robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy groups on the whole as well as when stratified by pathological stage, grade and margin status. On multivariate analysis extracapsular extension (p <0.01), pathological grade 7 or greater (p <0.01) and positive surgical margin (p <0.01) were independent predictors of biochemical recurrence while surgical approach was not. CONCLUSIONS The likelihood of biochemical recurrence was similar between groups when stratified by known risk factors of recurrence. Surgical approach was not a significant predictor of biochemical recurrence in the multivariate model. Our analysis is suggestive of comparable effectiveness for robot assisted laparoscopic prostatectomy, although longer term studies are needed.

[1]  Ketul Shah,et al.  Robotic radical prostatectomy: outcomes of 500 cases , 2007, BJU international.

[2]  S. Herrell,et al.  Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. , 2005, The Journal of urology.

[3]  J. Smith.  Robotically assisted laparoscopic prostatectomy: an assessment of its contemporary role in the surgical management of localized prostate cancer. , 2004, American journal of surgery.

[4]  J. Srigley.  Key issues in handling and reporting radical prostatectomy specimens. , 2009, Archives of pathology & laboratory medicine.

[5]  James O Peabody,et al.  Vattikuti Institute prostatectomy: contemporary technique and analysis of results. , 2007, European urology.

[6]  Hiroshi Nishiyama,et al.  Points to consider on switching between superiority and non-inferiority. , 2006, British journal of clinical pharmacology.

[7]  R. Link,et al.  Laparoscopic radical prostatectomy , 2000, World Journal of Urology.

[8]  Ashutosh Tewari,et al.  Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. , 2002, The Journal of urology.

[9]  J. Stanford,et al.  Factors associated with initial therapy for clinically localized prostate cancer: prostate cancer outcomes study. , 2001, Journal of the National Cancer Institute.

[10]  Hans Garmo,et al.  Radical prostatectomy versus watchful waiting in early prostate cancer. , 2005, The New England journal of medicine.

[11]  A. Wein,et al.  Campbell-Walsh Urology , 2011 .

[12]  S Duke Herrell,et al.  Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. , 2005, Urology.

[13]  A. Jemal,et al.  Cancer Statistics, 2008 , 2008, CA: a cancer journal for clinicians.

[14]  A. Partin,et al.  Anatomic radical retropubic prostatectomy , 2005 .

[15]  Stuart R. Lipsitz,et al.  Utilization and outcomes of minimally invasive radical prostatectomy. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  Mani Menon,et al.  Evolution of robotic radical prostatectomy , 2007, Cancer.

[17]  S. Herrell,et al.  A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. , 2007, The Journal of urology.

[18]  L R Kavoussi,et al.  Laparoscopic radical prostatectomy: initial short-term experience. , 1997, Urology.

[19]  Guy Vallancien,et al.  Laparoscopic Radical Prostatectomy: Technical and Early Oncological Assessment of 40 Operations , 1999, European Urology.

[20]  Michael W Kattan,et al.  Cancer control with radical prostatectomy alone in 1,000 consecutive patients. , 2002, The Journal of urology.

[21]  J. Parsons,et al.  Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. , 2008, Urology.

[22]  A. Partin,et al.  Time to prostate specific antigen recurrence after radical prostatectomy and risk of prostate cancer specific mortality. , 2006, The Journal of urology.

[23]  Stefano Cavalleri,et al.  Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. , 2007, European urology.

[24]  William J Catalona,et al.  Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. , 2004, The Journal of urology.

[25]  A. Partin,et al.  Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. , 2001, The Urologic clinics of North America.

[26]  M. Blute,et al.  Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot‐assisted techniques , 2009, BJU international.