title: [Propensity score comparison of the various radical surgical techniques for high-risk prostate cancer].
abstract: BACKGROUND
  The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP). We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence.
  
  
  METHODS
  A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models.
  
  
  RESULTS
  Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7% for RARP, in 8.2, 36.4, 55.5% for LRP and in 0, 60.9 and 39.1% for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0% for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1% (p<0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100% respectively (statistically not significant).
  
  
  CONCLUSIONS
  RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.
authors.affiliation: Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin.
authors.forename: J
authors.initials: J
authors.lastname: Busch
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gonzalgo
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Leva
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin.
authors.forename: F
authors.initials: F
authors.lastname: Friedersdorff
authors.affiliation: Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin.
authors.forename: S
authors.initials: S
authors.lastname: Hinz
authors.affiliation: Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin.
authors.forename: C
authors.initials: C
authors.lastname: Kempkensteffen
authors.affiliation: Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin.
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.affiliation: Klinik für Urologie, Charité Universitätsmedizin Berlin, Berlin.
authors.forename: A
authors.initials: A
authors.lastname: Magheli
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000209:etiology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D057216:Propensity Score; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen