title: Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients.
abstract: OBJECTIVE
  Comparative data related to the use of open and minimally invasive surgical approaches for the treatment of high-risk prostate cancer (PCa) remain limited. We determined outcomes of open radical prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in matched cohorts of patients with high-risk prostate cancer.
  
  
  METHODS
  A total of 805 patients with high-risk PCa [prostate-specific antigen (PSA) >20 ng/mL, Gleason score ≥8, or clinical stage ≥cT2c] were identified. A total of 407 RRP cases were propensity score (PS) matched 1:1 to 398 LRP or RARP cases to yield 3 cohorts (RARP, LRP, and RRP) of 110 patients each for analysis. PS matching variables included the following: age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon experience, and nerve-sparing technique. Overall survival (OS) and recurrence-free survival (RFS) were compared with log-rank test. RFS predictor analysis was calculated within Cox regression models.
  
  
  RESULTS
  Pathological Gleason scores <7, =7, and >7 were found in 3.3, 50.9, and 45.8 % of patients. There were no statistically significant differences for pathological stage and positive surgical margins between surgical techniques. Mean 3-year RFS was 41.4, 77.9, and 54.1 %, for RARP, LRP, and RRP, respectively (p < 0.0001 for RARP vs. LRP). There were no significant differences for mean estimated 3-year OS for patients treated with RARP, LRP, or RRP (95.4, 98.1, and 100 %).
  
  
  CONCLUSIONS
  RARP demonstrated similar oncologic outcomes compared to RRP and LRP in a PS-matched cohort of patients with high-risk prostate cancer.
authors.affiliation: Department of Urology, Charité University Medicine Berlin, Berlin, Germany, jonas.busch@charite.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Busch
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magheli
authors.forename: Natalia
authors.initials: N
authors.lastname: Leva
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinz
authors.forename: Michelle
authors.initials: M
authors.lastname: Ferrari
authors.forename: Frank
authors.initials: F
authors.lastname: Friedersdorff
authors.forename: Tom Florian
authors.initials: TF
authors.lastname: Fuller
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gonzalgo
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D057216:Propensity Score; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen