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Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years.

Authors
 Kyo Chul Koo  ;  Dae Chul Jung  ;  Seung Hwan Lee  ;  Young Deuk Choi  ;  Byung Ha Chung  ;  Sung Joon Hong  ;  Koon Ho Rha 
Citation
 Prostate International, Vol.2(3) : 127-132, 2014 
Journal Title
 Prostate International 
ISSN
 2287-8882 
Issue Date
2014
Abstract
PURPOSE: Robot-assisted radical prostatectomy with pelvic lymph node dissection (RALP-PLND) is a feasible treatment option for high-risk prostate cancer (HPCa), but remains controversial for very high-risk prostate cancer (VHPCa). We aimed to assess the feasibility of RALP-PLND in men ≥70 years with VHPCa features by comparing outcomes to those of HPCa. METHODS: Among patients aged ≥70 years who underwent RALP-PLND between 2005 and 2012, 101 HPCa patients (31%) (PSA≥20 ng/mL or biopsy Gleason 8-10 or cT3a) and 53 VHPCa patients (16%) (≥cT3b or cN1) were identified. Perioperative, functional, and oncological outcomes were compared between groups. RESULTS: Perioperative outcomes including operative time (P=0.917), estimated blood loss (P=0.181), and complications (P=0.239) were comparable. Due to Gleason score downgrading, 19% of HPCa and 4% of VHPCa were actually of intermediate risk. VHPCa revealed higher LN involvements (P=0.002). Discrepancy between clinical and pathological nodal status was more frequent in VHPCa (36% vs. 7%, P<0.01). Nodal metastasis would have been missed in 23% patients without PLND, while 13% of cN1 patients were shown to be metastasis-free by PLND. Continence rates were lower for VHPCa (32% vs. 56%, P=0.013). Although biochemical recurrence-free survival rates were comparable (P=0.648), risk for later adjuvant treatments was higher for VHPCa patients (14% vs. 34%, P<0.01). CONCLUSIONS: RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. Patients who are unable to accept the risk of adjuvant therapy and its side effects or incontinence should be deterred from surgical treatment, and other options such as radiation therapy could be an alternative.
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DOI
10.12954/PI.14050
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
구교철(Koo, Kyo Chul) ORCID logo https://orcid.org/0000-0001-7303-6256
나군호(Rha, Koon Ho) ORCID logo https://orcid.org/0000-0001-8588-7584
이승환(Lee, Seung Hwan) ORCID logo https://orcid.org/0000-0001-7358-8544
정대철(Jung, Dae Chul) ORCID logo https://orcid.org/0000-0001-5769-5083
정병하(Chung, Byung Ha) ORCID logo https://orcid.org/0000-0001-9817-3660
최영득(Choi, Young Deuk) ORCID logo https://orcid.org/0000-0002-8545-5797
홍성준(Hong, Sung Joon) ORCID logo https://orcid.org/0000-0001-9869-065X
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100156
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