Korean J Urol.  2009 Nov;50(11):1101-1107.

Outcome of Laparoscopic Radical Prostatectomy in High-Risk Prostate Cancer

• Lee HJ
• Kim SJ
• Cho HJ
• Ha US
• Hong SH
• Lee JY
• Kim JC
• Kim SW
• Hwang TK

Abstract

PURPOSE
Because of the lack of conclusive and well-conducted randomized studies, the optimal therapy for high-risk prostate cancer remains controversial. We investigated the results of patients with high-risk prostate cancer after laparoscopic radical prostatectomy (LRP).
MATERIALS AND METHODS
The records of 75 prostate cancer patients undergoing LRP between 2001 and 2008 with preoperative high-risk prostate cancer were reviewed. Patients who underwent radiation therapy for prostate cancer before LRP and patients with lymph node or distant metastases were excluded. High-risk prostate cancer was defined as a prostate-specific antigen (PSA) level of more than 20 ng/ml, a biopsy Gleason score of greater than 7, or a clinical stage greater than T2c. Biochemical recurrence (BCR)-free survival was plotted via the Kaplan-Meier method.
RESULTS
After a mean follow-up of 36.1 months, 24 (32%) patients experienced PSA progression with a median time of 17.6 months. Twenty patients received adjuvant hormonal or external beam radiation therapy or both before BCR. The BCR-free survival calculated by the Kaplan-Meier method at 3 and 5 years was 47.4% and 33.8%, respectively. A total of 44.0% of the patients had stage pT2 disease and 56.0% had stage pT3 disease. Surgical margins were positive in 35 patients (46.7%), of whom 11 (31.4%) had positive margins of more than 1. Preoperative PSA, postoperative pathologic Gleason score, and stage were correlated with BCR.
CONCLUSIONS
Our results suggest that LRP is a useful tool in the management of high-risk prostate cancer because it provides adequate local control of the prostate and pathological stage. Selection of patients with high-risk prostate cancer who require surgical treatment should be evaluated further in more studies.

Keyword

Laparoscopy; Prostatectomy; Prostate-specific antigen

MeSH Terms

Biopsy
Follow-Up Studies
Humans
Laparoscopy
Lymph Nodes
Neoplasm Grading
Neoplasm Metastasis
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Recurrence
Prostate-Specific Antigen

Figure

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  Fig. 1 Kaplan-Meier estimated BCR-free probability curves after LRP. (A) All patients, (B) Patients who did not receive adjuvant treatment or received adjuvant treatment after BCR. BCR: biochemical recurrence, LRP: laparoscopic radical prostatectomy.

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