Oncologic outcomes of laparoscopic radical prostatectomy: Intermediate-term follow-up

Objectives: A paucity of literature discusses biochemical recurrence (BCR) after laparoscopic radical prostatectomy (LRP). We report the intermediate-term cancer control and variables associated with BCR based on the 8-yr experience of a single surgeon. Methods: Between January 1998 and March 2006, one surgeon performed LRP on 1071 patients at two institutions. Excluded from analysis are 20 patients who received neoadjuvant therapy, 27 lost to follow-up, and 23 without prostate-specific antigen (PSA) controls due to recent date of surgery. Kaplan-Meier curves were generated to estimate time to BCR, defined as a PSA of 0.2 ng/ml and rising or start of secondary therapy. The log-rank test was used to compare pathologic variables. Positive surgical margin (PSM) was defined as cancer cells at the inked margins. Cox regression analysis estimated variables associated with time to BCR. Results: Of the study population, 1%, 75%, 23%, and 1% had pT0, pT2, pT3, and pT4 disease, respectively; 41%, 1%, and 58% had no nodal involvement, lymph node metastases, and no lymph node dissection, respectively. The cumulative 5-yr BCR-free rate was 75% for the 1001 evaluable patients, with 95 patients fulfilling criteria for BCR. The mean follow-up was 22.3 mo (95%CI, 20,24.6). In multivariable Cox regression analysis, higher serum PSA (p < 0.001), palpable nodule (p = 0.009), presence of extracapsular extension (ECE; p = 0.038), seminal vesicle invasion (SVI; p < 0.001), pathologic Gleason 4 + 3 (p < 0.001), and pathologic Gleason 8-10 (p < 0.001) when compared to pathologic Gleason < 6 were significantly associated with shorter time to BCR. The concordance index for the model was 0.86. The overall PSM rate was 13%, 9% for capsule-confined disease (pT2) and 24% for extracapsular extension (pT3). Conclusion: LRP seems to offer comparable oncologic outcomes to open surgery; however, more extended follow-up of patients is needed to better assess the oncologic safety of the LRP. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.