67th Annual Meeting Abstracts
High Risk Prostate Cancer Biochemical Recurrence with Robotic Radical Prostatectomy
*Y. Mark Hong, William M Kao, Jon Rhee, Jason D Engel
George Washington University, Washington, DC
Prior studies have demonstrated feasibility of open radical prostatectomy in the high-risk setting. Management of high risk disease with robotic assisted laparoscopic radical prostatectomy (RALP) is controversial. We examined biochemical recurrence in a select cohort of high risk patients undergoing RALP.
From an IRB-approved, prospectively maintained database, men with high risk prostate cancer who underwent RALP by a single surgeon without adjuvant or neoadjuvant therapy were identified. High risk was defined by preoperative PSA>10 ng/dl, Gleason score ≥ 8 on final pathology or stage ≥ pT3. Postoperative PSA ≥ 0.2 defined biochemical recurrence. Two-tailed t-tests, Chi-squared and ANOVA tests analyzed cohort characteristics and biochemical survival.
We identified 71 high-risk men. There was no significant difference in surgical margin positivity (38% overall), prostate size or cancer volume on final pathology between recurrence and non-recurrence cohorts. Biochemical recurrence occurred significantly earlier than later (p=0.017) with most recurring by 3 to 6 months (Graph) at follow-up to 49 months (mean 15 months). Biochemical failure was significantly associated with higher preoperative PSA (mean PSA 13.7, p=0.039), pathological stage (p=0.037) and Gleason score (p=0.048).
Using a stringent definition of high risk prostate cancer, men undergoing RALP have similar short-term biochemical outcomes and associations to those previously reported for open prostatectomy. Our data suggests that RALP is feasible in a select cohort of high-risk prostate cancer patients.