PD43-04 COMPARING THE 8-YEAR ONCOLOGIC OUTCOMES OF OPEN AND ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR HIGH RISK PROSTATE CANCER (2015)

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 2015PD43-04 COMPARING THE 8-YEAR ONCOLOGIC OUTCOMES OF OPEN AND ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR HIGH RISK PROSTATE CANCER Vidit Sharma, Marco Moschini, Fabio Zattoni, Matthew K. Tollefson, Stephen A. Boorjian, R. Houston Thompson, Igor Frank, Matthew T. Gettman, and R. Jeffrey Karnes Vidit SharmaVidit Sharma More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Matthew K. TollefsonMatthew K. Tollefson More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Igor FrankIgor Frank More articles by this author , Matthew T. GettmanMatthew T. Gettman More articles by this author , and R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2563AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the rapid dissemination of robot-assisted radical prostatectomy (RARP), its long-term efficacy relative to open radical prostatectomy (ORP) remains a subject of debate particularly in high-risk prostate cancer. Here we employ a large institutional series to compare long term oncologic outcomes between RARP and ORP for high risk prostate cancer. METHODS Men with high-risk prostate cancer (using D'Amico Classification) undergoing ORP and RARP as primary therapy between 2003 and 2012 were identified in a prospectively maintained institutional prostate cancer registry. Patients with prior prostate cancer therapy or metastases at the time of RP were excluded. Kaplan-Meier analyses were used to compare univariate 8-year rates of biochemical recurrence, systemic progression, cancer specific mortality, and overall mortality. Multivariate cox proportional hazard models were used to adjust for age, grade, pathologic stage, nodal stage, PSA, and margin status at the time of surgery. RESULTS There were 523 men identified, with a mean follow up of 4.1 years. There were 353 (67.5%) ORPs and 170 (32.5%) RARPs. Baseline characteristics of the two groups were the following: mean PSA (21.1 ORP vs 18.3 RARP, p=0.256), cT3 or higher (50.1% ORP vs 25.4%, p<0.001), Gleason Score of at least 8 (75.0% ORP vs 78.1% RARP, p=0.226). After surgery, ORP had significantly higher rates of pT3/4 (30.6% vs 9.4%, p<0.001) and pN+ (28.6% vs 18.2%, p=0.009) than RARP. Overall complication (31.0% vs 30.4%, p=0.880) and positive surgical margin rates (41.9% vs 37.6%, p=0.350) did not differ significantly between ORP and RARP. The 8-year rates of biochemical recurrence (59.9% vs 54.6%, p=0.884), systemic progression (23.3% vs 13.1%, p=0.636), prostate cancer mortality (10.2% vs 4.9%, p=0.812), and overall mortality (19.6% vs 16.1%, p=0.565) did not significantly differ between ORP vs RARP. After adjusting for patient age, tumor characteristics, and margin status, there were no significant differences between ORP and RARP for any of the above oncologic outcomes (Table 1). CONCLUSIONS Eight year oncologic outcomes did not significantly vary with open vs robotic approach during RP for high-risk prostate cancer. This implies that operative approach may not be as important in the long run as individual surgical skill. Multivariate Cox Proportional Hazard Analyses Comparing 8 Year Outcomes of RARP vs ORP Endpoint Hazard Ratio RARP vs ORP (95% CI) P-value Biochemical Recurrence 1.016 (0.743-1.389) P=0.921 Systemic Progression 1.294 (0.759-2.206) P=0.344 All Cause Mortality 1.663 (0.662-4.176) P=0.279 Prostate Cancer Mortality 1.069 (0.230-4.968) P=0.932 Any BCR, Systemic Progression or Mortality 1.071 (0.786-1.458) P=0.664 Hazard ratios adjust for age, grade, pathologic stage, nodal stage, PSA, and margin status © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e892 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Vidit Sharma More articles by this author Marco Moschini More articles by this author Fabio Zattoni More articles by this author Matthew K. Tollefson More articles by this author Stephen A. Boorjian More articles by this author R. Houston Thompson More articles by this author Igor Frank More articles by this author Matthew T. Gettman More articles by this author R. Jeffrey Karnes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...