Document Detail


Contemporaneous comparison of open vs minimally-invasive radical prostatectomy for high-risk prostate cancer.
MedLine Citation:
PMID:  23356390     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To analyze pathological and short-term oncological outcomes in men undergoing open and minimally-invasive radical prostatectomy (MIRP) for high-risk prostate cancer (HRPC; prostate-specific antigen level [PSA] >20 ng/mL, ≥ cT2c, Gleason score 8-10) in a contemporaneous series.
PATIENTS AND METHODS: In total, 913 patients with HRPC were identified in the Johns Hopkins Radical Prostatectomy Database subsequent to the inception of MIRP at this institution (2002-2011) Of these, 743 (81.4%) underwent open radical retropubic prostatectomy (ORRP), 105 (11.5%) underwent robot-assisted laparoscopic radical prostatectomy (RALRP) and 65 (7.1%) underwent laparoscopic radical prostatectomy (LRP) for HRPC. Appropriate comparative tests were used to evaluate patient and prostate cancer characteristics. Proportional hazards regression models were used to predict biochemical recurrence.
RESULTS: Age, race, body mass index, preoperative PSA level, clinical stage, number of positive cores and Gleason score at final pathology were similar between ORRP and MIRP. On average, men undergoing MIRP had smaller prostates and more organ-confined (pT2) disease (P = 0.02). The number of surgeons and surgeon experience were greatest for the ORRP cohort. Overall surgical margin rate was 29.4%, 34.3% and 27.7% (P = 0.52) and 1.9%, 2.9% and 6.2% (P = 0.39) for pT2 disease in men undergoing ORRP, RALRP and LRP, respectively. Biochemical recurrence-free survival among ORRP, RALRP and LRP was 56.3%, 67.8% and 41.1%, respectively, at 3 years (P = 0.6) and the approach employed did not predict biochemical recurrence in regression models.
CONCLUSIONS: At an experienced centre, MIRP is comparable to open radical prostatectomy for HRPC with respect to surgical margin status and biochemical recurrence.
Authors:
Phillip M Pierorazio; Jeffrey K Mullins; John B Eifler; Kipp Voth; Elias S Hyams; Misop Han; Christian P Pavlovich; Trinity J Bivalacqua; Alan W Partin; Mohamad E Allaf; Edward M Schaeffer
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-28
Journal Detail:
Title:  BJU international     Volume:  112     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-09-13     Completed Date:  2013-11-19     Revised Date:  2014-04-10    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  751-7     Citation Subset:  IM    
Copyright Information:
© 2013 BJU International.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Disease-Free Survival
Follow-Up Studies
Humans
Laparoscopy / methods*
Laparotomy / methods*
Male
Middle Aged
Neoplasm Grading*
Prostatectomy / methods*
Prostatic Neoplasms / diagnosis,  mortality,  surgery*
Retrospective Studies
Robotics / methods*
Survival Rate / trends
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
P30 CA006973/CA/NCI NIH HHS; P50CA58236/CA/NCI NIH HHS; T32DK007552/DK/NIDDK NIH HHS
Comments/Corrections
Comment In:
BJU Int. 2013 Oct;112(6):711-2   [PMID:  24028761 ]

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