Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer.
OBJECTIVE
To evaluate the oncologic outcomes of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa), we compared the surgical margin status and biochemical recurrence-free survival (BCRFS) rates between retropubic radical prostatectomy (RRP) and RARP.


METHODS
A comparative analysis was conducted of high-risk PCa patients who underwent RRP or RARP by a single surgeon from 2007 to 2013. High-risk PCa was defined as clinical stage≥T3a, biopsy Gleason score 8-10, or prostate-specific antigen>20 ng/mL. Propensity score matching was performed to minimize selection bias, and all possible preoperative and postoperative confounders were matched. A Kaplan-Meier analysis was performed to assess the 5-year BCRFS, and Cox regression models were used to evaluate the effect of the surgical approach on biochemical recurrence.


RESULTS
A total of 356 high-risk PCa patients (106 [29.8%] RRP and 250 [70.2%] RARP) were included in the final cohort analyzed. Before adjustment, the mean percentage of positive cores on biopsy and pathologic stage were poorer for RRP versus RARP (p=0.036 vs. p=0.054, respectively). The unadjusted 5-year BCRFS rates were better for RARP than for RRP (RRP vs. RARP: 48.1% vs. 64.4%, p=0.021). After adjustment for preoperative variables, the 5-year BCRFS rates were similar between RRP and RARP patients (48.5% vs. 59.6%, p=0.131). The surgical approach did not predict biochemical recurrence in multivariate analysis.


CONCLUSIONS
Five-year BCRFS rates of RARP are comparable to RRP in high-risk PCa. RARP is a feasible treatment option for high-risk PCa.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Donghyun
D
Lee
Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
Seung-Kwon
SK
Choi
Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
Jinsung
J
Park
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Myungsun
M
Shim
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Aram
A
Kim
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sangmi
S
Lee
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cheryn
C
Song
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hanjong
H
Ahn
D000368:Aged; D016208:Databases, Factual; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
Prostatectomy; Prostatic neoplasms; Treatment outcome