Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute.

PURPOSE We performed a prospective oncological evaluation of laparoscopic radical prostatectomy in regard to local tumor control and biochemical recurrence. MATERIALS AND METHODS Between January 1998 and March 2002, 1,000 consecutive patients with a mean age +/- SD of 63 +/- 6.2 years and clinically localized prostate cancer underwent laparoscopic radical prostatectomy at 1 institution. Preoperative 1997 TNM clinical stage was T1a in 6 patients (0.6%), T1b in 3 (0.3%), T1c in 660 (66.5%), T2a in 304 (30.4%) and T2b in 27 (2.7%). Mean preoperative prostate specific antigen (PSA) +/- SD was 10 +/- 6.1 ng./ml. (range 1.5 to 55). Postoperatively, surgical specimens were assessed and positive surgical margins recorded. Factors that could influence the surgical margins status were evaluated. Irrespective of pathological stage or surgical margin status, no adjuvant treatment was proposed before an increasing PSA. PSA recurrence was defined as PSA greater than 0.1 ng./ml. and was confirmed by a second increase. Recurrence time was defined as the time of the first increase in PSA. RESULTS Postoperative pathological stage was pT2aN0/Nx in 203 patients (20.3%), pT2bN0/Nx in 572 (57.2%), pT3aN0/Nx in 142 (14.2%), pT3bN0/Nx in 77 (7.7%) and pT1-3 N1 in 6 (0.6%). Positive surgical margin rate was 6.9%, 18.6%, 30% and 34% for pathological stages pT2a, pT2b, pT3a and pT3b, respectively (p <0.001). The main predictors of a positive surgical margin were preoperative PSA (p <0.001), clinical stage (p = 0.001), pathological stage (p <0.001) and Gleason score (p = 0.003). The overall actuarial biochemical progression-free survival rate was 90.5% at 3 years. According to the pathological stage, the progression-free survival rate was 91.8% for pT2aN0/Nx, 88% for pT2bN0/Nx, 77% for pT3aN0/Nx, 44% for pT3bN0/Nx and 50% for pT1-3N1 (p <0.001). Of the patients 94% with negative surgical margins and 80% with positive margins had progression-free survival (p <0.001). Preservation of the neurovascular bundles in patients with localized tumors had no significant effect on the subsequent risk of positive surgical margins or progression-free survival. CONCLUSIONS Based on followup, our evaluation confirms that laparoscopic radical prostatectomy provides satisfactory results in regard to local tumor control and biochemical recurrence.

[1]  T. Stamey,et al.  Modified Extrafascial Radical Retropubic Prostatectomy Technique Decreases Frequency of Positive Surgical Margins in T2 Cancers <2 cm3 , 2000, European Urology.

[2]  Richard A. Szucs,et al.  TNM Classification of Malignant Tumors. 5th ed , 1998 .

[3]  D. Bostwick,et al.  Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4. , 2001, The Journal of urology.

[4]  D. Bostwick,et al.  Correlation of margin status and extraprostatic extension with progression of prostate carcinoma , 1999, Cancer.

[5]  W. Catalona,et al.  Cancer recurrence and survival rates after anatomic radical retropubic prostatectomy for prostate cancer: intermediate-term results. , 1998, The Journal of urology.

[6]  D. Carter.  TNM Classification of Malignant Tumors , 1998 .

[7]  F. Schröder,et al.  Positive margins after radical prostatectomy: correlation with local recurrence and distant progression. , 1993, British journal of urology.

[8]  A W Partin,et al.  Serum PSA after anatomic radical prostatectomy. The Johns Hopkins experience after 10 years. , 1993, The Urologic clinics of North America.

[9]  B. Guillonneau,et al.  Laparoscopic radical prostatectomy: the Montsouris technique. , 2000, The Journal of urology.

[10]  T. Stamey,et al.  Morphologic analysis of surgical margins with positive findings in prostatectomy for adenocarcinoma of the prostate , 1992, Cancer.

[11]  B. Guillonneau,et al.  Laparoscopic radical prostatectomy. , 2002, The Journal of urology.

[12]  D M Parkin,et al.  Cancer incidence and mortality in the European Union: cancer registry data and estimates of national incidence for 1990. , 1997, European journal of cancer.

[13]  N. Olson,et al.  Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy. , 1993, The Journal of urology.

[14]  T. Stamey,et al.  Positive surgical margins at radical prostatectomy: importance of the apical dissection. , 1990, The Journal of urology.

[15]  A. Partin,et al.  Prostate-specific antigen after anatomic radical retropubic prostatectomy. Patterns of recurrence and cancer control. , 1997, The Urologic clinics of North America.

[16]  M. Kattan,et al.  Prognostic significance of positive surgical margins in radical prostatectomy specimens. , 1995, The Journal of urology.

[17]  A. Partin,et al.  Extended followup of the influence of wide excision of the neurovascular bundle(s) on prognosis in men with clinically localized prostate cancer and extensive capsular perforation. , 1996, The Journal of urology.

[18]  A W Partin,et al.  Era specific biochemical recurrence-free survival following radical prostatectomy for clinically localized prostate cancer. , 2001, The Journal of urology.

[19]  B. Guillonneau,et al.  [Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions]. , 1998, Presse medicale.

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