title: Analysis of outcome following robotic assisted radical prostatectomy for patients with high risk prostate cancer as per D'Amico classification.
abstract: BACKGROUND
  Prognosis of prostate cancer depends on the risk stratification. D'Amico classification, the most commonly used risk stratification method is based on three factors, i.e., prostate specific antigen (PSA), Gleason grade and clinical stage. The impact of presence of multiple risk factors on prognosis after radical prostatectomy has not been studied in Indian patients. We analyzed the outcome of patients with high-risk disease undergoing robotic-assisted radical prostatectomy (RARP), as per D'Amico classification.
  
  
  METHODS
  Our study is a review of the data of all patients with high-risk prostate cancer who underwent RARP between July 2010 and January 2015. Preoperative, perioperative and outcome data were analyzed for patients with high-risk disease as per D'Amico classification.
  
  
  RESULTS
  Of 227 patients who underwent RARP, 90 (39.6%) were in the high-risk group. PSA > 20 ng/ml was the most common risk factor, present in 50 (55.6%) patients. All three risk factors were present in 3 patients, and single risk factor was present in 65 patients. Nine (10%) patients had lymphnode involvement, 18 (20%) had positive margin, and 38 (41.1%) had extraprostatic extension (EPE). Among these adverse outcomes, only EPE showed significant association with multiplicity of risk factors. At 12 months, 27.8% had biochemical recurrence (BCR). 92% of patients were continent at 12 months.
  
  
  CONCLUSIONS
  About 92% of patients with high-risk disease were continent at 12 months, whereas less than one-third of the patients had BCR. EPE was the only outcome associated with multiplicity of risk factors. Adjuvant treatment is not required in two-thirds of patients.
authors.affiliation: Department of Urology, Medanta Kidney and Urology Institute, Medanta, Gurgaon, Haryana, India.
authors.forename: Narmada Prasad
authors.initials: NP
authors.lastname: Gupta
authors.affiliation: Department of Urology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Anandan
authors.initials: A
authors.lastname: Murugesan
authors.affiliation: Department of Urology, Medanta Kidney and Urology Institute, Medanta, Gurgaon, Haryana, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Urology, Medanta Kidney and Urology Institute, Medanta, Gurgaon, Haryana, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Yadav
keywords: Carcinoma prostate; high risk; multiplicity of factors; outcome; robotic-assisted radical prostatectomy