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01-12-2014 | Original Article

Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients

Authors: Jonas Busch, Ahmed Magheli, Natalia Leva, Stefan Hinz, Michelle Ferrari, Frank Friedersdorff, Tom Florian Fuller, Kurt Miller, Mark L. Gonzalgo

Published in: World Journal of Urology | Issue 6/2014

Abstract

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.

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Title: Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients
Authors: Jonas Busch
Ahmed Magheli
Natalia Leva
Stefan Hinz
Michelle Ferrari
Frank Friedersdorff
Tom Florian Fuller
Kurt Miller
Mark L. Gonzalgo
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 6/2014
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-014-1270-0

At a glance: The STEP trials

Springer Medicine

Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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