title: Laparoscopic radical prostatectomy monotherapy, a more aggressive yet less invasive option, is oncologically effective in selected men with high-risk prostate cancer having only one D'Amico risk factor: experience from an Asian tertiary referral center.
abstract: OBJECTIVE
  To present oncologic results of laparoscopic radical prostatectomy (LRP) monotherapy for men with high-risk, localized prostate cancer, and to find factors associated with a good prognosis via surgery alone.
  
  
  METHODS
  Between 2002 and 2009, 241 men underwent LRP at an Asian tertiary referral center. Among them, we retrospectively identified 85 (35.3%) men who met the D'Amico's high-risk criteria: Prostate-specific antigen level >20 ng/mL, Gleason score of 8 to 10, or clinical stage ≥T2c. Perioperative parameters were analyzed against biochemical recurrence (BCR)-free survival.
  
  
  RESULTS
  At a median follow-up of 54 months, BCR developed in 28 (34.1%), with an actuarial BCR-free survival rate of 63.3% at 5 years. Pathologically, 37.6% of the men had organ-confined (OC) disease. Positive surgical margins (PSM) were identified in 49.4% of the patients. A favorable pathologic outcome, defined as OC(+)PSM(-), was observed in 24 patients and associated with a 5-year BCR-free survival rate of 87.0%, compared with 100%, 54.0%, and 46.4% in men with OC(+)PSM(+), OC(-)PSM(-) and OC(-)PSM(+) disease (log-rank, P=0.008). The overall positive lymph node rate was 14.1%. Men (65.9%) with only one D'Amico risk factor had a 5-year BCR-free survival rate of 76.9%, compared with 34.6% in men (34.1%) with ≥2 risk factors (log-rank, P<0.001).
  
  
  CONCLUSIONS
  Radical prostatectomy monotherapy performed laparoscopically or robotically appears to be an option for high-risk prostate cancer, especially in men with a single D'Amico risk factor. Men with ≥2 risk factors are more prone for BCR to develop after surgery and may need second-line therapy.
authors.affiliation: 1 Department of Urology, National Taiwan University Hospital , Taipei, Taiwan .
authors.forename: Huai-Ching
authors.initials: HC
authors.lastname: Tai
authors.forename: Ming-Kuen
authors.initials: MK
authors.lastname: Lai
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Shuo-Meng
authors.initials: SM
authors.lastname: Wang
authors.forename: Kuo-How
authors.initials: KH
authors.lastname: Huang
authors.forename: Chung-Hsin
authors.initials: CH
authors.lastname: Chen
authors.forename: Shiu-Dong
authors.initials: SD
authors.lastname: Chung
authors.forename: Shih-Chieh Jeff
authors.initials: SC
authors.lastname: Chueh
authors.forename: Hong-Jeng
authors.initials: HJ
authors.lastname: Yu
authors.forename: Yeong-Shiau
authors.initials: YS
authors.lastname: Pu
mesh_terms: D000368:Aged; D001208:Asia; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D062606:Tertiary Care Centers
chemical_list: D017430:Prostate-Specific Antigen