AUA 2013: Open, robotic RP outcomes similar regardless of risk

Robot-assisted laparoscopic prostatectomy in patients with intermediate- or high-risk cancers achieves outcomes similar to those attained by the open procedure, results of a large retrospective comparative study indicate.

“The robotic approach is an option in these patients and in my opinion, it is a preferred option. Some early observations held that robotic procedures should be restricted to favorable-risk patients. I think the robot may offer greater advantages to higher risk patients than to lower risk patients,” said senior author Joseph A. Smith, Jr., MD, of Vanderbilt Medical Center, Nashville, TN.

For the study, Dr. Smith and colleagues conducted a retrospective review of 1,286 intermediate- and high-risk patients drawn from among 3,781 men who underwent prostatectomies at Vanderbilt between 2003 and 2009. The patients were diagnosed with cT2b cancer or higher, Gleason sum ≥7, or preoperative PSA ≥10.0 ng/mL. Those who received neoadjuvant therapy, had less than 6 months follow-up, or had insufficient clinicopathologic data were excluded. Some 631 men met the study’s criteria.

The 209 men undergoing the open procedure tended to carry a somewhat heavier cancer burden than the 422 men undergoing the robot-assisted procedure. Median PSA was higher in the open group compared with patients undergoing robotic surgery (4.5 ng/mL vs. 3.7 ng/mL, respectively). Patients in the open group also showed a greater percentage of pathologic (Gleason sum 8-10) tumors (38% vs. 15%, respectively) as well as greater seminal vesicle involvement (25% vs. 15%, respectively).

Outcomes and positive surgical margin rates were similar between the groups. Some 176 of the men in the study (28%) presented with biochemical recurrence (open, 68 [32.5%]; robotic, 108 [25.6%]). There was no significant difference in biochemical recurrence-free survival between the groups. Multivariate analysis showed extracapsular extension, pathologic Gleason score, and positive surgical margin to be independent predictors of biochemical recurrence.