title: Oncologic outcome of robot-assisted laparoscopic prostatectomy in the high-risk setting.
abstract: OBJECTIVE
  Previous studies have demonstrated the feasibility of open radical prostatectomy in the high-risk setting. Management of high-risk disease with robot-assisted laparoscopic radical prostatectomy (RALP) is controversial. We examined biochemical recurrence in a selected cohort of high-risk patients who were undergoing RALP.
  
  
  METHODS
  Men with high-risk prostate cancer who underwent bilateral nerve-sparing, nonsalvage RALP by a single surgeon without adjuvant or neoadjuvant therapy of any kind were identified. High risk was defined by preoperative prostate-specific antigen (PSA) level >10 ng/dL, Gleason score ≥8 on final pathologic evaluation, or stage ≥pT(3). Postoperative PSA value ≥0.2 ng/dL defined biochemical recurrence.
  
  
  RESULTS
  A total of 73 men were identified. There was no significant difference in surgical margin positivity (38% overall) or prostate size between recurrence and nonrecurrence cohorts. Biochemical failure was significantly associated with higher pathologic Gleason score (P = 0.0085) but not pathologic stage (P = 0.22) or preoperative PSA level (P = 0.18). With follow-up to 85 months (mean 31.8 mos), biochemical recurrence-free survival was 77% with mean time to recurrence of 7.7 months. Recurrence occurred significantly earlier than later (P < 0.001).
  
  
  CONCLUSIONS
  Reasonable short- to intermediate-term biochemical outcomes can be achieved in a recurrence-prone group of high-risk men who are undergoing RALP. RALP is feasible in a selected cohort of high-risk men who are undergoing aggressive local therapy.
authors.affiliation: Department of Urology, George Washington University Hospital, Washington, District of Columbia 20006, USA. jengel@dcurology.net
authors.forename: Jason D
authors.initials: JD
authors.lastname: Engel
authors.forename: William W
authors.initials: WW
authors.lastname: Kao
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.forename: Y Mark
authors.initials: YM
authors.lastname: Hong
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D012307:Risk Factors; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome