TY - JOUR
T1 - Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients
AU - Busch, Jonas
AU - Magheli, Ahmed
AU - Leva, Natalia
AU - Hinz, Stefan
AU - Ferrari, Michelle
AU - Friedersdorff, Frank
AU - Fuller, Tom Florian
AU - Miller, Kurt
AU - Gonzalgo, Mark L.
N1 - Funding Information:
Acknowledgments We acknowledge the excellent work of Markus Loos on the Charité prostate cancer database. This study was funded by a Charles Huggins-Grant of the German Society of Urology.
Publisher Copyright:
© 2014, Springer-Verlag Berlin Heidelberg.
PY - 2014/11/19
Y1 - 2014/11/19
N2 - Purpose: 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.Materials and 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.
AB - Purpose: 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.Materials and 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.
KW - High risk
KW - Laparoscopy
KW - Oncologic outcome
KW - Propensity score matching
KW - Prostate cancer
KW - Prostatectomy
KW - Robotic surgery
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U2 - 10.1007/s00345-014-1270-0
DO - 10.1007/s00345-014-1270-0
M3 - Article
C2 - 24609219
AN - SCOPUS:84911999890
SN - 0724-4983
VL - 32
SP - 1411
EP - 1416
JO - World Journal of Urology
JF - World Journal of Urology
IS - 6
ER -