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Laparoscopic Radical Prostatectomy in Men with High-Risk Prostate Cancer: A Mid-Term Follow-up

Ting Chun Yeh 1.2, Huai-Ching Tai1,2, Ming-Kuen Lai1,5, Chao-Yuan Huang1,2, Shuo-Meng Wang1,2, Kuo-How Huang1,2, Yeong-Shiau Pu1,2, Chung-Hsin Chen1,2, Shiu-Dong Chung1,2,3, Shih-Chieh Jeff Chueh2,4 and Hong-Jeng Yu1,2 1Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

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Laparoscopic Radical Prostatectomy in Men with High-Risk Prostate Cancer: A Mid-Term Follow-up

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  1. Ting Chun Yeh 1.2, Huai-Ching Tai1,2, Ming-Kuen Lai1,5, Chao-Yuan Huang1,2, Shuo-Meng Wang1,2, Kuo-How Huang1,2, Yeong-Shiau Pu1,2, Chung-Hsin Chen1,2, Shiu-Dong Chung1,2,3, Shih-Chieh Jeff Chueh2,4 and Hong-Jeng Yu1,2 1Department of Urology, National Taiwan University Hospital, Taipei, Taiwan 2Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan 4Glickman Urological & Kidney Institute, & Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, OH, USA Laparoscopic Radical Prostatectomy in Men with High-Risk Prostate Cancer: A Mid-Term Follow-up

  2. Introduction • Treatment for high risk prostate cancer remains controversial. Data regarding minimal invasive surgery is limited. • Aims of this study: • To present the oncological results of laparoscopic radical prostatectomy (LRP) monotherapy for men with D’Amico stratified high-risk, clinically localized prostate cancer • To find factors associated with good prognosis via surgery alone

  3. Methods • Between 2002 and 2009, 241 men underwent LRP at an Asian tertiary referral center. • Among them, we retrospectively identified 85 men (35.3%) who met the D’Amico’s high-risk criteria: PSA level > 20 ng/mL, Gleason score of 8-10, or clinical stage ≥ T2c. • All procedures were performed by two experienced surgeons. • Perioperative parameters were analyzed against biochemical recurrence (BCR)-free survival.

  4. Results • At a median follow-up of 54 months, 28 men (34.1%) developed BCR, with the actuarial BCR-free survival rate of 63.3% at 5 years.

  5. Results • Specifically, men (56 men, 65.9%) having only one risk factor had a better 5-year BCR-free survival rate of 76.9%, compared to 34.6% in patients (29 men) with ≥ 2 risk factors (log-rank, p< 0.001).

  6. Results • Pathologically, 37.6% of men had organ-confined (OC) disease. • Positive surgical margins (PSM) were identified in 49.4% of the patients. • Favorable pathological outcome, defined as OC(+)PSM(-), was observed in 24 patients and associated with a 5-year BCR-free survival rate of 87%

  7. Conclusions • LRP monotherapy seems a viable treatment option for men with high-risk prostate cancer, especially in a selective subgroup with only one D’Amico risk factor. • Men with ≥ 2 risk factors are more prone to develop BCR following surgery, and may need a second-line therapy or combined RT + ADT. • Primary LRP therapy might offer more adjuvant treatment options even the monotherapy itself fails to eradicate the cancer

  8. Thank You for Your Attention!

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